In vivo architectural analysis of clear corneal incisions using anterior segment optical coherence tomography

Purpose

To use anterior segment optical coherence tomography (AS-OCT) to analyze the in vivo architecture of clear corneal incisions after phacoemulsification using different techniques.

Setting

Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, Paris, France.

Methods

This prospective observational study analyzed clear corneal incisions used in phacoemulsification. All wounds were evaluated 1 day and 8 days postoperatively by AS-OCT (Visante). Incision architecture and pachymetry at the wound level were analyzed.

Results

Thirty-five clear corneal incisions were analyzed. Six eyes had 2.75 mm coaxial phacoemulsification, 19 had 2.20 mm microincision coaxial phacoemulsification, and 10 had 1.30 mm bimanual microincision phacoemulsification. The 1.30 mm incision had a straight-line configuration. The 2.20 mm and 2.75 mm incisions had an arcuate configuration. The angles of incidence of 1.30 mm incisions were greater than those of 2.20 mm incisions (P<.001). All incisions had slight corneal edema limited to the incision area. The edema was slightly greater around 1.30 mm incisions (mean pachymetry 1143 μm ± 140 [SD]) than around 2.20 mm incisions (mean 1012 ± 101 μm) (P = .001). Bimanual procedures had satisfactory endothelial apposition in the enlarged areas, where stromal edema was less than that surrounding the unenlarged 1.30 mm incisions.

Conclusions

The 3 phacoemulsification techniques induced gaping of the endothelial edge, minor inadequate endothelial apposition, and mild stromal edema in the area of the clear corneal incisions. Bimanual microincision sleeveless phacoemulsification may alter the wound slightly more than coaxial 2.75 mm and microcoaxial 2.20 mm sleeved-tip phacoemulsification.