Influences on Astigmatism and Corneal Endothelium Using Two Different Incision Sizes and Mode of Phacoemulsification

Kyung Sup Shin; Jong Eun Lee; Si Hwan Choi

doi:10.3341/jkos.2013.54.2.237

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Shin, Lee, and Choi: Influences on Astigmatism and Corneal Endothelium Using Two Different Incision Sizes and Mode of Phacoemulsification

Original Article

J Korean Ophthalmol Soc 2007;54(2):237-244.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.237

Influences on Astigmatism and Corneal Endothelium Using Two Different Incision Sizes and Mode of Phacoemulsification

Kyung Sup Shin, MD¹, Jong Eun Lee, MD¹, Si Hwan Choi, MD^1,²

¹Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea

²Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea

Address reprint requests to Si Hwan Choi, MD, Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea Tel: 82-42-280-7609, Fax: 82-42-255-3745, E-mail: shchoi@cnu.ac.kr

Received 27 July 201231 August 2012 Accepted 20 December 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare surgically induced astigmatism and influences on the corneal endothelium in phacoemulsification by Ozil^® and Hyperpulse mode of Infiniti^® using 2 different corneal incision lengths of 2.2 mm and 2.8 mm.

Methods

The patients were grouped by the mode of phacoemulsification and incision size as follows: Ozil^® mode with 2.2 mm incision group (n = 29), and 2.8 mm incision group (n = 30); Hyperpulse mode with 2.2 mm incision group (n = 29), and 2.8 mm incision group (n = 30). The surgically induced astigmatism, central corneal thickness and endothelial cell density were measured up to 2 months after surgery and the efficiency of 2 modes compared by measuring average phacoemulsification times.

Results

There was no significant difference in the surgically induced astigmatism, central corneal thickness, endothelial cell density, best corrected visual acuity and average phaco power among 4 groups. The cumulated dissipated energy (CDE) using Ozil^® mode was lower than Hyperpulse mode in the group of nuclear sclerosis grade 1 and 2.

Conclusions

Two different modes of phacoemulsification using Ozil^® and Hyperpulse mode, and different incision sizes of 2.2 mm and 2.8 mm in Infiniti^® showed no significant difference in the endothelial cell density or the surgically induced astigmatism up to 2 months after surgery. Phacoemulsification using Ozil^® mode is considered more efficient in low grade nuclear sclerosis cataract.

Keywords: Corneal endothelium, Hyperpulse, Incision, Ozil^®, Surgically induced astigmatism

References

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Table 1.

Demographics of the patients

	Ozil^® mode		Hyperpulse mode		p-value^∗
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗
Number of eyes	29	30	29	30
Average patient age (years)	65.2 ± 9.7	67.9 ± 11.0	67.8 ± 9.5	66.7 ± 11.4	0.527
Male/Female	14/15	14/16	14/15	14/16
Mean nucleus density	2.07 ± 0.92	2.03 ± 0.89	2.07 ± 0.88	2.07 ± 0.83	0.890

Values are presented as mean ± SD.

^∗One way ANOVA, p < 0.05.

Table 2.

Comparison of preoperative conditions

	Ozil^® mode		Hyperpulse mode		p-value^∗
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗
BCVA	0.48 ± 0.26	0.45 ± 0.34	0.40 ± 0.28	0.44 ± 0.30	0.268
Corneal curvature (D)	43.5 ± 1.2	43.5 ± 1.3	43.7 ± 1.3	43.3 ± 1.2	0.844
Corneal thickness (μm)	538.6 ± 30.0	533.7 ± 33.3	540.7 ± 35.1	545.0 ± 30.7	0.587
Endothelial cell count (cells/mm²)	2544.6 ± 306.4	2505.1 ± 275.8	2470.3 ± 330.6	2541.0 ± 384.6	0.504
Hexagonality (%)	62.0 ± 9.2	57.2 ± 10.4	61.5 ± 10.6	59.5 ± 13.7	0.866
Coefficient of variation	0.30 ± 0.06	0.35 ± 0.07	0.32 ± 0.08	0.33 ± 0.09	0.531

Values are presented as mean ± SD.

BCVA = best corrected visual acuity (log MAR).

^∗One way ANOVA, p < 0.05.

Table 3.

Comparison of surgically induced astigmatism (Holladay-Cravy-Koch)

	Ozil^® mode		Hyperpulse mode		p-value^∗	p-value^†
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗	p-value^†
POD 1 day	1.2 ± 0.5	1.5 ± 0.5	1.4 ± 0.6	1.3 ± 0.7	0.219	0.135/0.845
POD 1 week	1.2 ± 0.5	1.4 ± 0.3	1.4 ± 0.5	1.0 ± 0.5	0.985	0.552/0.888
POD 2 weeks	0.2 ± 0.4	0.3 ± 0.3	0.1 ± 0.4	0.1 ± 0.3	0.738	0.399/0.536
POD 1 month	0.2 ± 0.2	0.2 ± 0.3	0.2 ± 0.3	0.1 ± 0.2	0.645	0.602/0.373
POD 2 months	0.2 ± 0.2	0.1 ± 0.2	0.2 ± 0.3	0.2 ± 0.2	0.791	0.290/0.849

Values are presented as mean diopter ± SD.

POD = post operation day.

^∗One way ANOVA, p < 0.05; ^†Independent t-test, Ozil 2.2 versus Ozil 2.8 / Hyperpulse 2.2 versus Hyperpulse 2.8, p < 0.05.

Table 4.

Changes of central corneal thickness (postop - preop)

	Ozil^® mode		Hyperpulse mode		p-value^∗	p-value^†
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗	p-value^†
POD 1 day	30.9 ± 17.7	31.9 ± 26.0	34.3 ± 29.5	46.1 ± 21.2	0.074	0.399/0.893
POD 1 week	36.7 ± 21.4	29.9 ± 23.6	33.4 ± 34.3	27.8 ± 26.1	0.162	0.275/0.190
POD 2 weeks	29.3 ± 25.3	34.4 ± 32.2	27.7 ± 28.6	20.8 ± 26.4	0.709	0.522/0.061
POD 1 month	16.2 ± 19.3	17.0 ± 29.0	13.8 ± 23.3	14.1 ± 17.6	0.760	0.870/0.373
POD 2 months	6.4 ± 50.3	5.1 ± 43.8	8.0 ± 25.0	6.8 ± 23.3	0.389	0.135/0.592

Values are presented as mean μm ± SD.

POD = post operation day.

^∗One way ANOVA, p < 0.05; ^†Independent t-test, Ozil 2.2 versus Hyperpulse 2.2 / Ozil 2.8 versus Hyperpulse 2.8, p < 0.05.

Table 5.

Changes of endothelial cell count (preop - postop)

	Ozil^® mode		Hyperpulse mode		p-value^∗	p-value^†
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗	p-value^†
POD 1 day	126.5 ± 228.4	182.0 ± 282.0	130.1 ± 305.5	175.0 ± 207.4	0.922	0.511/0.767
POD 1 week	143.9 ± 275.6	149.8 ± 287.1	119.5 ± 243.4	198.5 ± 216.1	0.325	0.473/0.154
POD 2 weeks	161.1 ± 265.1	199.3 ± 279.3	120.7 ± 219.7	160.0 ± 218.8	0.906	0.145/0.071
POD 1 month	129.6 ± 215.4	155.5 ± 241.7	207.5 ± 211.6	155.0 ± 223.6	0.587	0.297/0.052
POD 2 months	125.3 ± 223.2	132.7 ± 327.4	145.2 ± 292.6	155.0 ± 123.6	0.710	0.722/0.063

Values are presented as mean cells/mm² ± SD.

POD = post operation day.

^∗One way ANOVA, p < 0.05; ^†Independent t-test, Ozil 2.2 versus Hyperpulse 2.2 / Ozil 2.8 versus Hyperpulse 2.8, p < 0.05.

Table 6.

Changes of BCVA (preop - postop)

	Ozil^® mode		Hyperpulse mode		p-value^∗
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗
POD 1 day	0.5 ± 0.5	0.4 ± 0.3	0.4 ± 0.2	0.4 ± 0.4	0.352
POD 1 week	0.4 ± 0.3	0.4 ± 0.3	0.4 ± 0.2	0.3 ± 0.3	0.383
POD 2 weeks	0.5 ± 0.3	0.3 ± 0.4	0.4 ± 0.3	0.4 ± 0.3	0.530
POD 1 month	0.4 ± 0.2	0.4 ± 0.3	0.3 ± 0.3	0.3 ± 0.3	0.366
POD 2 months	0.5 ± 0.3	0.4 ± 0.4	0.3 ± 0.3	0.4 ± 0.3	0.291

Values are presented as mean log MAR ± SD.

POD = post operation day.

^∗One way ANOVA, p < 0.05.

Table 7.

Comparison of CDE and average phaco power according to the grades of nuclear sclerosis

	Ozil^® mode		Hyperpulse mode		p-value^∗
	2.2 mm	2.8 mm	2.2 mm	2.8 mm	p-value^∗
CDE (sec)	NSG 1	6.5 ± 1.9	8.1 ± 4.1	14.2 ± 6.5	16.7 ± 6.6	0.008^∗
	NSG 2	11.5 ± 3.6	12.3 ± 5.7	23.3 ± 5.5	21.3 ± 4.9	0.003
	NSG 3	31.6 ± 2.5	30.5 ± 10.8	37.2 ± 17.2	35.0 ± 6.8	0.209
	NSG 4	33.8 ± 4.2	38.1 ± 3.4	39.8 ± 3.7	42.9 ± 5.4	0.232
Average phaco power (%)	NSG 1	26.5 ± 8.1	30.9 ± 9.2	32.7 ± 6.5	31.4 ± 8.6	0.385
	NSG 2	40.6 ± 8.1	37.6 ± 9.2	37.5 ± 3.3	36.9 ± 4.7	0.506
	NSG 3	40.7 ± 7.5	44.0 ± 10.5	45.2 ± 4.2	39.1 ± 9.2	0.771
	NSG 4	39.8 ± 4.1	41.3 ± 7.2	44.4 ± 5.0	38.3 ± 6.3	0.340

Values are presented as mean ± SD.

CDE = cumulative dissipated energy; NSG = nuclear sclerosis grade.

^∗One way ANOVA, p < 0.05.

Table 8.

Comparison of CDE according to phacoemulsification mode and incision at NSG 1 and 2

Phacoemulsification mode and incision size	p-value^∗
Phacoemulsification mode and incision size	NSG1	NSG2
2.2 mm Ozil – 2.8 mm Ozil	0.858	0.919
2.2 mm Ozil – 2.2 mm Hyperpulse	0.008^∗	0.000^∗
2.2 mm Ozil – 2.8 mm Hyperpulse	0.001^∗	0.001^∗
2.8 mm Ozil – 2.2 mm Hyperpulse	0.043^∗	0.000^∗
2.8 mm Ozil – 2.8 mm Hyperpulse	0.005^∗	0.000^∗
2.2 mm Hyperpulse – 2.8 mm Hyperpulse	0.823	0.585

CDE = cumulative dissipated energy; NSG = nuclear sclerosis grade.

^∗Post Hoc test by Turkey HSD, p < 0.05.

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