Comparison of Phacodynamic Effects on Postoperative Corneal Edema Between 2.8 mm and 2.2 mm Microcoaxial Torsional Phacoemulsification

Ho Jeong Jin; Jin Lee Hye; Ho Lee Sun

doi:10.3341/jkos.2013.54.5.709

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Jin, Hye, and Sun: Comparison of Phacodynamic Effects on Postoperative Corneal Edema Between 2.8 mm and 2.2 mm Microcoaxial Torsional Phacoemulsification

Original Article

J Korean Ophthalmol Soc 2013;54(5):709-715.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.5.709

Comparison of Phacodynamic Effects on Postoperative Corneal Edema Between 2.8 mm and 2.2 mm Microcoaxial Torsional Phacoemulsification

Ho Jeong Jin, MD, PhD, Jin Lee Hye, MD, Ho Lee Sun, MD

¹Department of Ophthalmology, Jeju National University School of Medicine, Jeju, Korea

Address reprint requests to Jin Ho Jeong, MD, PhD Department of Ophthalmology, Jeju National University Hospital #15 Aran13-gil, Jeju 690-767, Korea Tel: 82-64-717-1362, Fax: 82-64-717-1102, E-mail: amario@naver.com

Received 8 September 201211 January 2013 Accepted 25 March 2013

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 the effects of phacodynamic parameters on postoperative corneal edema between 2.8 mm and 2.2 mm microincisional coaxial cataract surgery.

Methods

A prospective randomized study design was conducted and included 144 cases randomly divided into 2 coaxial cataract surgery groups based on incision size, a 2.8 mm incision (n = 72) or a 2.2 mm microincision (n = 72). The cataract was graded using the lens opacity classification system (LOCS III). The total ultrasound time (TUT), cumulative dispersed energy (CDE), average torsional amplitude (ATA), fluid amount, and case time were measured for each surgery. Central corneal thickness (CCT) was measured preoperatively, and 1 day and 1 month postoperatively. Intraoperative parameters were correlated with postoperative corneal edema.

Results

The average nuclear opacity, intraoperative parameters, and postoperative corneal edema did not differ sig-nificantly between the 2 surgical groups. Regression analysis showed corneal edema to be significant in ATA ( p = 0.028) in the standard (2.8-mm incision) coaxial group, whereas edema was significantly different with TUT ( p = 0.001), CDE ( p = 0.001), fluid amount ( p = 0.021), and case time ( p = 0.027) in the microcoaxial (2.2-mm microincision) group. CCT re-turned to baseline with an increase of 1.8% at 1 month.

Conclusions

In the microcoaxial group, sustained ultrasound exposure and prolonged case time caused moderate post-operative corneal edema, while ATA was a significant factor in the standard coaxial group. These data can be used to de-vise an effective surgical strategy for cataract treatment.

Keywords: Coaxial microincisional cataract surgery, Corneal edema, Phacodynamics

References

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7. Zeng M, Liu X, Liu Y, et al. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol. 2008; 92:1092–6.

8. Liu Y, Zeng M, Liu X, et al. Torsional mode versus conventional ultrasound mode phacoemulsification: randomized comparative clinical study. J Cataract Refract Surg. 2007; 33:287–92.

9. Lee KM, Kwon HG, Joo CK. Microcoaxial cataract surgery out-comes: comparison of 1.8 mm system and 2.2 mm system. J Cataract Refract Surg. 2009; 35:874–80.

10. Elkady B, Piñero D, Alió JL. Corneal incision quality: micro-incision cataract surgery versus microcoaxial phacoemulsification. J Cataract Refract Surg. 2009; 35:466–74.

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Figure 1.

Measurement of central corneal thickness using spectral domain optical coherence tomography (Cirrus; Carl Zeiss Meditec, Dublin, CA) with the anterior module.

Figure 2.

Comparison of preoperative and intraoperative parameters between the mild and moderate postoperative corneal edema subgroups. Mild corneal edema group means corneal edema at postoperative day 1 ≤ 64 μ m, Moderate corneal edema group means corneal edema at postoperative day 1 >64μ m. ^* Statistically significant by the Mann-Whitney test.

Table 1.

Demographic data and preoperative biometric data

	Standard coaxial	Micro-coaxial	p-value^*
Gender ratio (M:F)	34:38	43:29	0.139
Age (year)	70.67 ± 8.27	72.30 ± 10.85	0.365
Wound orientation (temporal:superior)	51:17	56:16	0.783
Nucleus opacity	3.30 ± 0.72	3.26 ± 0.73	0.627
Preoperative corneal thickness (μ m)	530.02 ± 32.61	534.86 ± 31.23	0.326

Values are presented by mean ± standard deviation.

Table 2.

Comparison of the intraoperative phacodynamics parameters and the corneal edema at postoperative day 1 between 2.8 mm and 2.2 mm microincisional coaxial cataract surgical groups. Data were stratified by nuclear sclerosis as graded by the lens opacifi-cation classification system III

NO	Group	N	Total Ultrasound Time (second)	Cumulative Dispersed Energy (unit)	Average Torsional Amplitude (unit)	Fluid (ml)	Case time (second)	Increase of corneal thickness at post-op 1 day (um)	Increase of corneal thickness at post-op 1 month (um)
2	2.8 mm	4	22.63 ± 15.01	1.80 ± 1.23	21.60 ± 4.80	37.33 ± 3.21	462.00 ± 88.28	12.00 ± 1.73	4.73 ± 2.34
	2.2 mm	7	35.39 ± 14.61	3.30 ± 1.90	22.70 ± 8.18	51.33 ± 11.02	469.89 ± 58.34	43.08 ± 41.03	5.35 ± 5.28
	p-value		0.309	0.229	0.782	0.078	0.782	0.052	0.659
3	2.8 mm	46	38.82 ± 18.30	5.48 ± 3.32	34.10 ± 8.94	58.35 ± 14.43	474.85 ± 68.28	63.61 ± 29.40	8.09 ± 6.14
	2.2 mm	39	42.21 ± 21.29	6.14 ± 3.41	36.87 ± 9.01	61.26 ± 21.51	485.25 ± 68.29	56.67 ± 41.51	9.18 ± 6.45
	p-value		0.430	0.358	0.151	0.470	0.476	0.145	0.278
4	2.8 mm	18	60.77 ± 23.27	9.11 ± 3.82	37.73 ± 10.22	76.45 ± 24.55	513.45 ± 66.77	72.73 ± 66.11	12.09 ± 9.91
	2.2 mm	22	48.47 ± 15.51	7.70 ± 3.09	38.52 ± 7.03	69.50 ± 21.45	519.36 ± 72.25	79.64 ± 55.34	11.72 ± 10.34
	p-value		0.299	0.418	0.749	0.693	0.895	0.560	0.704
5	2.8 mm	4	83.20 ± 4.83	16.79 ± 2.42	51.97 ± 11.18	110.67 ± 48.81	595.00 ± 17.94	81.33 ± 54.27	14.12 ± 12.89
	2.2 mm	4	84.27 ± 26.10	15.59 ± 4.88	46.30 ± 2.45	101.33 ± 15.31	628.00 ± 84.87	112.00 ± 27.62	17.09 ± 16.93
	p-value		0.513	0.827	0.513	0.827	0.513	0.369	0.473
Tota	al 2.8 mm	72	43.62 ± 22.22	6.40 ± 4.27	34.93 ± 10.12	62.66 ± 22.23	490.81 ± 70.31	63.94 ± 39.23	9.24 ± 8.34
	2.2 mm	72	44.98 ± 20.87	6.65 ± 3.90	36.01 ± 9.68	64.16 ± 22.13	498.25 ± 81.32	65.63 ± 48.01	10.02 ± 8.91
	p-value		0.795	0.799	0.580	0.759	0.496	0.819	0.798

Values are presented by mean ± standard deviation.

Table 3.

Linear regression analysis of intraoperative phacodynamics parameters against corneal edema at post-operative day 1

Group		Total Ultrasound Time (second)	Cumulative Dispersed Energy (unit)	Average Torsional Amplitude (unit)	Fluid (ml)	Case time (second)
Corneal 2.8 mm	Cor^† (sig.)	0.114 (0.355)	0.216 (0.076)	0.344 (0.004)^*	0.148 (0.228)	0.065 (0.599)
edema (μ m)2.2 mm	Cor^† (sig.)	0.392 (0.001)^*	0.382 (0.001)^*	0.123 (0.298)	0.269 (0.021)^*	0.257 (0.027)^*

^* Statistically significant ( p < 0.05)

^† Pearson correlation.

Table 4.

Comparison of intraoperative and postoperative parameters between the mild and moderate corneal edema subgroups in 2.8 mm standard coaxial cataract surgery group. Cases were divided into 2 subgroups with a cut-off value of 64 μm at postoperative day 1 for corneal edema

	Corneal thickness < 64 μ m (n = 48)	Corneal thickness ≥ 64 μ m (n = 24)	p-value
Total ultrasound time (second)	43.05 ± 23.59	44.19 ± 21.10	0.835
Average torsional amplitude (unit)	32.24 ± 9.83	37.62 ± 9.82	0.028^*
Cumulative dispersed energy (unit)	5.95 ± 4.45	6.86 ± 4.11	0.383
Fluid used (ml)	62.56 ± 22.73	62.75 ± 22.05	0.970
Case time (second)	497.15 ± 99.07	499.35 ± 65.42	0.930
Corneal edema at 1 day (μ m)	35.76 ± 17.30	110.79 ± 47.35	0.000^*

Values are presented by mean ± standard deviation.

^* Statistically significant ( p < 0.05).

Table 5.

Comparison of intraoperative and postoperative parameters between the mild and moderate corneal edema subgroups in 2.2 mm micro-coaxial cataract surgery group. Cases were divided into 2 subgroups with a cut-off value of 64 μ m at postoperative day 1 for corneal edema

	Corneal thickness < 64 μ m (n = 45)	Corneal thickness ≥ 64 μ m (n = 27)	p-value
Total ultrasound time (second)	39.16 ± 19.08	52.06 ± 21.63	0.010^*
Average torsional amplitude (unit)	35.37 ± 10.90	36.52 ± 7.88	0.602
Cumulative dispersed energy (unit)	5.66 ± 3.24	7.85 ± 4.45	0.024^*
Fluid used (ml)	58.98 ± 20.78	70.52 ± 22.66	0.029^*
Case time (second)	471.51 ± 68.17	514.26 ± 67.88	0.010^*
Corneal edema at 1 day (μ m)	32.09 ± 14.42	115.28 ± 35.59	0.000^*

Values are presented by mean ± standard deviation.

^* Statistically significant ( p < 0.05).

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