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Abtahi MA, Beheshtnejad AH, Latifi G, Akbari-Kamrani M, Ghafarian S, Masoomi A, Sonbolastan SA, Jahanbani-Ardakani H, Atighechian M, Banan L, Nouri H, Abtahi SH. Corneal Epithelial Thickness Mapping: A Major Review. J Ophthalmol 2024; 2024:6674747. [PMID: 38205099 PMCID: PMC10776199 DOI: 10.1155/2024/6674747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.
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Affiliation(s)
| | | | - Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sadegh Ghafarian
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoomi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Laleh Banan
- Sunshine Coast University Hospital, Brisbane, Queensland, Australia
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Real-time corneal thickness changes during phacoemulsification cataract surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:1609-1618. [PMID: 36662235 DOI: 10.1007/s00417-022-05971-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To observe the changes in corneal thickness during phacoemulsification cataract surgery and to analyze the influencing factors. METHODS One hundred two patients (102 eyes) with cataracts undergoing phacoemulsification cataract surgery at Shandong Eye Hospital between July and October 2021 were included. Intraoperative OCT was applied to capture real-time images preoperatively, before and after ultrasonic emulsification, at the end of irrigation aspiration and the end of surgery. Then, the corneal thickness at the above time points was measured using Photoshop software. RESULTS The corneal thickness of 102 cataract patients was 511.79 ± 31.46 μm before operation and 512.71 ± 31.51 μm at the beginning of phacoemulsification, which increased by 0.91 ± 1.48 μm (0.2%). At the end of ultrasonic emulsification, the corneal thickness was 521.58 ± 32.75 μm and 8.87 ± 8.71 μm (1.7%) thicker than that before the procedure. After irrigation aspiration, the corneal thickness reached 528.09 ± 33.87 μm, which increased by 6.52 ± 6.38 μm (1.3%) compared with that of the previous step. At the end of the operation, the corneal thickness was 539.19 ± 33.88 μm, 11.09 ± 10.92 μm, and 27.37 ± 13.64 μm thicker than that of the previous step and the preoperative thickness, respectively, with an overall increase of 5.3%. The differences were statistically significant at all time points (all P < 0.001). Correlation analysis showed that postoperative corneal thickness changes were correlated with age, cataract lens nuclear grade, actual phacoemulsification time (APT), effective phacoemulsification time (EPT), average phacoemulsification energy (APE), total surgery time (TST), cell density (CD), maximum cell area (MAX), and cell area standard deviation (SD) (all P < 0.05), while the changes in thickness were not correlated with gender, cell area coefficient of variation (CV), percentage of hexagonal cells (6A), average cell area (AVE), or minimum cell area (MIN) (all P > 0.05). CONCLUSIONS During phacoemulsification cataract surgery, corneal thickness gradually increases in real time with the increase of perfusion pressure and intraocular manipulation time. The real-time magnitude of intraoperative corneal thickness change is closely related to lens nucleus hardness, corneal endothelial cell density, ultrasound energy, and time for emulsification.
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Artuç T, Batur M. Comparison of central corneal thickness in corneal edema by ultrasound pachymetry, specular microscopy, and anterior segment optical coherence tomography. Saudi J Ophthalmol 2023; 37:1-5. [PMID: 36968778 PMCID: PMC10032283 DOI: 10.4103/sjopt.sjopt_63_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/01/2022] [Accepted: 11/08/2022] [Indexed: 03/11/2023] Open
Abstract
PURPOSE The purpose of this study was to compare ultrasound pachymetry Ultrasound pachymetry (UP), specular microscopy (SM), and anterior segment optical coherence tomography (ASOCT) in the measurement of central corneal thickness (CCT) in cases of corneal edema before and after uncomplicated phacoemulsification. METHODS Preoperative pachymetric measurements were performed in all patients before cataract surgery. Sixty -seven patients who developed corneal edema after routine faoemulsification surgery were included in the study. CCT measurements were made the day before surgery and on the 1st, 7th, and 14th days after surgery. Correlation and agreement between the devices were quantified with the intraclass correlation coefficient (ICC), limits of agreement, and Bland-Altman plots. RESULTS The mean age of the patients was 70.99 ± 9.56 (36-92) years. While CCT could be measured in all eyes with ASOCT after surgery, the number of eyes measured with UP and SM were 24 (11.7%) and 27 (16.1%), 55 (82.1%) and 52 (77.6%), and 46 (88.8%) and 45 (86.9%) on postoperative days 1, 7, and 14, respectively. ICC values between UP and SM, UP and ASOCT, and SM and ASOCT, respectively, were: preoperative 0.91, 0.94, and 0.92; 1st postoperative day 0.93, 0.86, and 0.93; 7th postoperative day 0.94, 0.85, and 0.96; and 14th postoperative day 0.95, 0.92, and 0.96. CONCLUSION In all eyes with corneal edema, CCT measurements can be taken with ASOCT; however, in some cases, CCT measurements with SM and UP cannot be taken. However, there is a good correlation between measurements taken with these devices.
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Jing D, Jiang X, Ren X, Su J, Wei S, Hao R, Chou Y, Li X. Change Patterns in Corneal Intrinsic Aberrations and Nerve Density after Cataract Surgery in Patients with Dry Eye Disease. J Clin Med 2022; 11:jcm11195697. [PMID: 36233565 PMCID: PMC9572385 DOI: 10.3390/jcm11195697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the change patterns in corneal intrinsic aberrations and nerve density after cataract surgery in dry eye disease. The preoperative, 1- and 3-month postoperative dry eye-related parameters were obtained by the Oculus keratograph and the ocular surface disease index questionnaire. The corneal intrinsic aberrations were measured using the Pentacam HR system. In vivo confocal microscopy was performed to observe the vortical and peripheral corneal nerves. An artificial intelligence technique run by the deep learning model generated the corneal nerve parameters. Corneal aberrations on the anterior and total corneal surfaces were significantly increased at 1 month compared with the baseline (p < 0.05) but gradually returned to the baseline by 3 months (p > 0.05). However, the change in posterior corneal aberration lasted up to 3 months (p < 0.05). There was a significant decrease in the corneal vortical nerve maximum length and average density after the operation (p < 0.05), and this damage lasted approximately 3 months. The corneal vortical nerve maximum length and average density were negatively correlated with the anterior corneal surface aberrations before and 1 month after the operation (correlation coefficients, CC = −0.26, −0.25, −0.28; all p < 0.05). Corneal vortex provided a unique site to observe long-term corneal nerve injury related to eye dryness. The continuous damage to the corneal vortical nerve may be due to the continuous dry eye state.
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Affiliation(s)
- Dalan Jing
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China
| | - Xiaodan Jiang
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China
| | - Xiaotong Ren
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China
| | - Jie Su
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China
| | - Shanshan Wei
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100069, China
| | - Ran Hao
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100069, China
| | - Yilin Chou
- Department of Ophthalmology, BenQ Medical Centre, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210017, China
- Correspondence: (Y.C.); (X.L.); Tel.: +86-18600862321 (Y.C.); +86-13911254862 (X.L.)
| | - Xuemin Li
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing 100191, China
- Correspondence: (Y.C.); (X.L.); Tel.: +86-18600862321 (Y.C.); +86-13911254862 (X.L.)
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Density and distribution of dendritiform cells in the peripheral cornea of healthy subjects using in vivo confocal microscopy. Ocul Surf 2022; 26:157-165. [PMID: 35998820 DOI: 10.1016/j.jtos.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To establish dendritiform cell (DC) density and morphological parameters in the central and peripheral cornea in a large healthy cohort, using in vivo confocal microscopy (IVCM). METHODS A prospective, cross-sectional, observational study was conducted in 85 healthy volunteers (n = 85 eyes). IVCM images of corneal center and four peripheral zones were analyzed for DC density and morphology to compare means and assess correlations (p < 0.05 being statistically significant). RESULTS Central cornea had lower DC density (40.83 ± 5.14 cells/mm2; mean ± SEM) as compared to peripheral cornea (75.42 ± 2.67 cells/mm2, p < 0.0001). Inferior and superior zones demonstrated higher DC density (105.01 ± 7.12 and 90.62 ± 4.62 cells/mm2) compared to the nasal and temporal zones (59.93 ± 3.42 and 51.77 ± 2.98 cells/mm2, p < 0.0001). Similarly, lower DC size, field and number of dendrites were observed in the central as compared to the average peripheral cornea (p < 0.0001), with highest values in the inferior zone (p < 0.001 for all, except p < 0.05 for number of dendrites in superior zone). DC parameters did not correlate with age or gender. Inter-observer reliability was 0.987 for DC density and 0.771-0.922 for morphology. CONCLUSION In healthy individuals, the peripheral cornea demonstrates higher DC density and larger morphology compared to the center, with highest values in the inferior zone. We provide the largest normative cohort for sub-stratified DC density and morphology, which can be used in future clinical trials to compare differential changes in diseased states. Furthermore, as DC parameters in the peripheral zones are dissimilar, random sampling of peripheral cornea may be inaccurate.
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Jacobsen MF, Holm LM, Erichsen JH, Konge L, Siersma V, Cour M, Thomsen ASS. Defining the surgical footprint in cataract surgery: patient-related outcomes dependent on the experience of the surgeon. Acta Ophthalmol 2021; 99:e999-e1005. [PMID: 33377606 DOI: 10.1111/aos.14733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate which patient-related outcomes are dependent on the experience of the cataract surgeon. METHODS The study was designed as a prospective observational study. Novice (<150 surgeries performed) and experienced (>1000 surgeries performed) cataract surgeons from the Department of Ophthalmology, Rigshospitalet - Glostrup and Nordsjaellands Hospital - Hillerød were included in the study. Patients operated by the included surgeons were examined preoperatively, 1 day, 3 days, and 3 weeks after standard, noncomplicated cataract surgery. Primary outcomes were change in central corneal thickness and endothelial cell loss. Secondary outcomes were best-corrected visual acuity, intraocular pressure, aqueous flare, central macular thickness, and surgical complications. RESULTS Surgery performed by novice surgeons resulted in significantly lower visual acuity (mean -3.6 letters (Early Treatment Diabetic Retinopathy Study (ETDRS)); 95% CI: -7.3; -0.4, p = 0.03) and greater corneal thickness (mean 26.7 µm; 95% CI: 6.8; 46.6, p = 0.01) on the first day postoperative than surgery performed by experienced surgeons. CONCLUSION The experience of the cataract surgeon affected visual acuity and central corneal thickness in the immediate postoperative period. In the future, these patient-related outcomes may be used to assess the technical proficiency of surgical trainees and investigate the effect of different training programs.
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Affiliation(s)
- Mads F. Jacobsen
- Department of Ophthalmology Copenhagen University Hospital Copenhagen Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR & EducationCopenhagen Denmark
| | - Lars M. Holm
- Department of Ophthalmology Copenhagen University Hospital Copenhagen Denmark
| | - Jesper H. Erichsen
- Department of Ophthalmology Copenhagen University Hospital Copenhagen Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation Centre for HR & EducationCopenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Morten Cour
- Department of Ophthalmology Copenhagen University Hospital Copenhagen Denmark
| | - Ann Sofia S. Thomsen
- Department of Ophthalmology Copenhagen University Hospital Copenhagen Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR & EducationCopenhagen Denmark
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Femtosecond laser-assisted cataract surgery in eyes with shallow anterior chamber depth: comparison with conventional phacoemulsification. J Cataract Refract Surg 2021; 46:1604-1610. [PMID: 32932370 DOI: 10.1097/j.jcrs.0000000000000341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the postoperative outcomes between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with shallow anterior chamber depth (ACD). SETTING Eye Clinic, NEUROFARBA Department, University of Florence, Italy. DESIGN Prospective case series. METHODS Forty eyes of 40 patients with senile cataract and true ACD less than 2.00 mm underwent FLACS (femto group, n = 20) or manual phacoemulsification (phacoemulsification group, n = 20). Preoperatively and 1 week and 1 month and 6 months postoperatively, central corneal thickness (CCT) and endothelial cell density were evaluated; basal epithelial cell (BEC) and Langerhans dendritic cell (LDC) densities and keratocyte activation were assessed using in vivo corneal confocal microscopy. Intraoperative parameters such as cumulative dissipated energy (CDE) and ultrasound (US) power were recorded. RESULTS Endothelial cell loss (ECL) was significantly lower in the femto group at all timepoints (P ≤ .001). In the phacoemulsification group, the CCT was significantly higher 1 week (P < .001) and 1 month (P < .001) postoperatively than preoperatively; conversely, in the femto group, it was higher only after 1 week (P < .001). BECs and LDCs significantly increased at 1 postoperative week (P < .001), returning to preoperative values after 1 month in both groups. Keratocyte activation remained significantly higher at 1 postoperative month only in the phacoemulsification group (P = .005). CDE and US power were lower in the femto group (P = .017 and P = .001, respectively); they were correlated with ECL (r = 0.662, P = .000; r = 0.389, P = .013). CONCLUSIONS In eyes with shallow ACD, FLACS was a safe and an effective technique, significantly reducing the postoperative ECL and corneal inflammation compared with conventional phacoemulsification.
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Evaluation of Safety Following Optic Exchange of a Modular Intraocular Lens. J Cataract Refract Surg 2021; 47:1273-1278. [PMID: 33769763 DOI: 10.1097/j.jcrs.0000000000000628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize safety of optic exchange using a modular lens. SETTING 3 study sites (New Zealand, Philippines). DESIGN Prospective clinical study. METHODS Harmoni modular intraocular lens (HMIOL) with separate base and optic components was implanted in the study eye (monovision target -1.5 D). Contralateral eyes received standard monofocal lenses. Subjects could elect optic exchange 3 months after primary implantation. Adverse events (AEs) and endothelial cell loss (ECL) were assessed through 12-months follow-up. RESULTS 114 subjects successfully received HMIOL and 114 received control lens in contralateral eye. At month 3, 65 HMIOL eyes had optic exchange due to unsatisfactory visual outcome from high monovision (Exchange cohort); 49 eyes received no exchange (No Exchange cohort). Exchange, No Exchange, and Control cohorts reported ocular AEs in 10 (15%), 6 (12%), and 14 (12%) eyes. No posterior capsular rupture occurred during optic exchange procedures. Short-term (12-month) posterior capsule opacification (PCO) evaluation showed all eyes had PCO grade ≤1 at month 12; no YAG capsulotomy was performed in the Exchange cohort. No Exchange and Exchange cohorts had similar ECL at 3 months versus preoperative baseline (-4.5%, n=48 and -4.0%, n=65). In the Exchange cohort, additional 2.7% ECL occurred 3 months after optic exchange compared with pre-exchange baseline; ECL was significantly below the 14% threshold (P<0.001) and was 5.8% at 12 months. CONCLUSIONS HMIOL safety outcomes were comparable with standard monofocal lenses; HMIOL may provide an effective method for correcting postoperative refractive errors.
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Triphasic polymeric corneal coating gel versus a balanced salt solution irrigation during cataract surgery: A postoperative anterior segment optical coherence tomography analysis and confocal microscopy evaluation. J Cataract Refract Surg 2020; 45:1148-1155. [PMID: 31371007 DOI: 10.1016/j.jcrs.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate the safety and efficacy of the intraoperative use of a triphasic polymeric gel as corneal coating during cataract surgery and its effect on postoperative ocular comfort. SETTING Eye Clinic, University of Florence, Italy. DESIGN Longitudinal observational retrospective study. METHODS Data on patients who received an application of a polysaccharide blend of hydroxypropyl methylcellulose, xanthan gum, and carrageenan (EyeDRO) on the corneal surface and data on patients who received a balanced salt solution during phacoemulsification surgery were analyzed. The central corneal thickness (CCT) and epithelial thickness were examined using anterior segment optical coherence tomography, and the corneal basal epithelial cell (BEC) and Langerhans cell densities by in vivo confocal microscopy. The ocular surface disease index (OSDI) score, tear breakup time (TBUT), and Schirmer test I values were evaluated. RESULTS The study comprised data on 28 patients in the coating gel group and 26 patients in the balanced salt solution group. In the coating gel group, the CCT and epithelial thickness values returned to the baseline value within 5 and 15 postoperative days, respectively; the BEC and Langerhans cell densities returned to baseline levels within 15 and 30 postoperative days. In the balanced salt solution group, the mean BEC and Langerhans cell densities were significantly different from the preoperative values at all follow-up assessments. The TBUT returned to the preoperative level at day 5 in the coating gel group. The OSDI scores returned to the preoperative values after 15 days in the coating gel group and 30 days in the balanced salt solution group. CONCLUSIONS The use of a tripolymeric gel as a corneal coating during cataract surgery played a protective role on the corneal surface and reduced postoperative discomfort symptoms.
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Long-Term Visual Quality after Microincision Cataract Surgery. J Ophthalmol 2020; 2020:9318436. [PMID: 33014445 PMCID: PMC7512104 DOI: 10.1155/2020/9318436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/17/2020] [Accepted: 09/04/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose Few studies have focused on long-term postoperative visual quality. This study aimed to evaluate the long-term visual quality after microincision cataract surgery (MICS). Methods 96 patients (144 eyes) diagnosed with age-related cataracts were enrolled in this one-year study. The patients underwent MICS and received aspheric monofocal intraocular lens implants. Uncorrected distance visual acuity (UDVA) was evaluated together with best-corrected distance visual acuity (BCDVA), best-corrected near visual acuity (BCNVA), contrast sensitivity, and surgically induced astigmatism (SIA). Results Compared to preoperative measurements, UDVA, BCDVA, and BCNVA were significantly better after surgery (P < 0.001), and they remained stable throughout follow-up. Contrast sensitivity was also significantly better after surgery (P < 0.001). Mean SIA during follow-up was 0.57 ± 0.33 D at 1 week, 0.36 ± 0.25 D at 3 months, and 0.18 ± 0.16 D at 1 year. SIA decreased significantly during the postoperative period (P < 0.001). The 1-year postoperative absolute residual diopter value was 0.32 ± 0.28 D. Conclusion MICS can provide excellent visual quality as soon as on postoperative day 1, which persists during the follow-up period of 1 year. In contrast to previous studies, SIA decreases over time and may not completely stabilize for as long as 1 year postoperatively.
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Elmekawey H, Abdelaziz M, El Baradey M, Kotb M. Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study. Clin Ophthalmol 2020; 14:2515-2523. [PMID: 32921979 PMCID: PMC7457868 DOI: 10.2147/opth.s266464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To compare the effect of phacoemulsification on corneal epithelial thickness in diabetic and nondiabetic cataract patients. Methods Fifty eyes with cataracts were enrolled in a prospective comparative interventional study. They were divided into two groups: group A (diabetics) and group B (nondiabetics) and underwent uneventful phacoemulsification. Epithelial thickness was assessed in the central, paracentral, and peripheral cornea on the first day and at 1 week, 1 month, and 3 months postoperatively using spectral-domain ocular coherence tomography. Results A significant increase in the first-day postoperative central epithelial thickness was noticed in both groups (57.16±3.5 µm and 55.96±2.81 µm in groups A and B, respectively), with increased baseline epithelial thickness of 3.8±2.1 µm and 3.4±2.14 µm in groups A and B, respectively (P<0.001). A significant decrease in epithelial thickness was noticed in both groups after 1 week (−2.40±3.1 µm and −2.76±2.71 µm in group A and B, respectively). No further significant change was noticed in the nondiabetic group at 1 month; however, significant reductions in for central epithelial thickness were found in the diabetic group up to the first month (−0.80±1.9 µm, P=0.05). Central corneal thickness followed the same pattern of change as the epithelium. A nonsignificant delay in visual acuity improvement was noticed in diabetic patients. Conclusion Phacoemulsification induces a temporary increase in corneal and epithelial thickness that should resolve by the first week postoperatively. However, diabetic patients had slower epithelial recovery that took up to 1 month, which could be reflected in delayed visual recovery with no effect on the final visual outcome.
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Affiliation(s)
- Hany Elmekawey
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magda Abdelaziz
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Baradey
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Kotb
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Avetisov KS, Yusef NY, Surnina ZV, Avetisov SE, Ndary M. [Changes in corneal nerve fibers after microinvasive cataract surgery (a preliminary report)]. Vestn Oftalmol 2020; 136:6-12. [PMID: 32366063 DOI: 10.17116/oftalma20201360216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Potential changes in corneal nerve fibers (CNF) induced by cataract phacoemulsification remain insufficiently studied. The need for research in this direction is dictated by a number of circumstances: introduction of corneal confocal microscopy into clinical practice, the need for phaco surgery in the presence of corneal changes of various genesis, the possible negative impact of laser radiation during hybrid (femtosecond laser-assisted) phacoemulsification. PURPOSE To assess the changes in CNF after various methods of microinvasive cataract surgery. MATERIAL AND METHODS The studies were conducted in patients aged 50 to 60 years who underwent standard ultrasound and hybrid phacoemulsification; the patients were respectively divided into two groups (30 surgeries each). The algorithm for assessing the state of CNF involved laser confocal microscopy using original software. To quantify the state of the nerves, two coefficients were used: CNF orientation anisotropy (KΔL) and CNF orientation symmetry (Ksym). RESULTS Regardless of the surgery technique, tendencies were noted for the orientation anisotropy coefficient to decrease and the orientation symmetry coefficient to increase, which are conditionally comparable with previously identified age-related changes in CNF. After hybrid phacoemulsification, a decrease in the orientation anisotropy coefficient 2-2.5 months after the intervention turned out to be statistically less significant compared to the standard ultrasound technique. CONCLUSION Further research should be aimed at analyzing the long-term results of both microinvasive phacosurgery techniques and the «classical» extracapsular cataract extraction, which remains the method of choice in a number of clinical situations.
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Affiliation(s)
- K S Avetisov
- Research Institute of Eye Disease, Moscow, Russia
| | - N Yu Yusef
- Research Institute of Eye Disease, Moscow, Russia
| | - Z V Surnina
- Research Institute of Eye Disease, Moscow, Russia
| | - S E Avetisov
- Research Institute of Eye Disease, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M Ndary
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Utility of regional epithelial thickness measurements in corneal evaluations. Surv Ophthalmol 2020; 65:187-204. [DOI: 10.1016/j.survophthal.2019.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
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Avetisov SE, Surnina ZV, Avetisov KS, Ndary M. [Phacosurgery effects on the condition of corneal nerve fibers]. Vestn Oftalmol 2020; 136:283-288. [PMID: 33063978 DOI: 10.17116/oftalma2020136052283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The question of potential changes in the nerve fibers of the cornea induced by phacosurgery remains poorly investigated. This is a review of results of many individual studies aimed at assessing the condition of corneal nerve fibers following different techniques of cataract removal. The authors substantiate the necessity for structural analysis of fiber changes based on in vivo confocal microscopy of the cornea. Functional assessment of corneal sensitivity (esthesiometry) does not allow objective conclusions, for several reasons. Further studies on corneal nerve changes after phacosurgery could be directed at improving software products for objective quantitative assessment of corneal nerve fibers and analyzing long-term results of various phacosurgery techniques.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Z V Surnina
- Research Institute of Eye Diseases, Moscow, Russia
| | - K S Avetisov
- Research Institute of Eye Diseases, Moscow, Russia
| | - M Ndary
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Central corneal epithelial thickness changes after half-moon supracapsular nucleofractis phacoemulsification technique. Int Ophthalmol 2017; 39:311-315. [PMID: 29256165 DOI: 10.1007/s10792-017-0814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To find out the effect of half-moon supracapsular nucleofractis technique on central corneal epithelial thickness (CET) measured by spectral domain anterior segment optical coherence tomography (AS-OCT). MATERIALS AND METHODS Patients who underwent uneventful cataract surgery by the same surgeon with the same technique were recruited in this study. The effective phaco time (EPT) was recorded in each surgery. Central CET was measured by AS-OCT 1 day before and 1, 3, 7 days after surgery. CET was measured without precorneal tear film layer, and non-epithelial central corneal thickness was also calculated manually. Preoperative and postoperative values were compared by statistical analysis. RESULTS Thirty-one eyes of 31 patients were included in this study. The mean age of patients was 65.03 ± 11.47 years. On the first day of surgery, increase in mean CET was statistically significant, but on the 3rd and 7th day after surgery, this increase was declined (p = 0.001, p = 0.367, p = 1, respectively). A statistically significant positive correlation was found between mean EPT and mean CET on the first postoperative day (p = 0.013, r = 0.470). On the 3rd and 7th day, this correlation was not statistically significant (p = 0.055, p = 0.454, respectively). CONCLUSION Mean central CET was statistically thicker and positive correlated with EPT on the first postoperative day. But on the 7th day, it declined to preoperative values.
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Carracedo G, Serramito-Blanco M, Martin-Gil A, Wang Z, Rodriguez-Pomar C, Pintor J. Post-lens tear turbidity and visual quality after scleral lens wear. Clin Exp Optom 2017; 100:577-582. [PMID: 28125853 DOI: 10.1111/cxo.12512] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/31/2016] [Accepted: 09/20/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The aim was to evaluate the turbidity and thickness of the post-lens tear layer and its effect on visual quality in patients with keratoconus after the beginning of lens wear and before lens removal at the end of eight hours. METHODS Twenty-six patients with keratoconus (aged 36.95 ± 8.95 years) participated voluntarily in the study. The sample was divided into two groups: patients with intrastromal corneal ring (ICRS group) and patients without ICRS (KC group). Distance visual acuity (VA), contrast sensitivity, pachymetry, post-lens tear layer height and post-lens tear layer turbidity (percentage area occupied and number of particles per mm2 ) were evaluated with optical coherence tomography before and after wearing a scleral lens. RESULTS A significant increase of turbidity was found in all groups assessed (p < 0.05). The number of particles per square millimetre was eight times higher after scleral lens wear than at the beginning of wearing the lens for all groups. VA decreases in all groups after scleral lens wear (p < 0.001). All patients showed a statistical diminishing of contrast sensitivity after scleral lens wear (p < 0.05). A significant correlation was found for both turbidity parameters with distance VA but no correlation between turbidity and post-lens tear layer thickness at the beginning was found (p > 0.05). A strong correlation in all groups between the post-lens tear layer at the beginning and differences of tear layer thickness between two measures was also found (p < 0.05). CONCLUSION The VA decrease during the scleral lens wearing, filled with preserved saline solution, was due to the increasing post-lens tear layer turbidity.
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Affiliation(s)
- Gonzalo Carracedo
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.,Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Serramito-Blanco
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Alba Martin-Gil
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Zicheng Wang
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Candela Rodriguez-Pomar
- Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Pintor
- Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
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Kim BJ, Lee JH, Kim SW. Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.11.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bong Jun Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hyuck Lee
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
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