Journal List > J Korean Ophthalmol Soc > v.54(5) > 1009668

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

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.

References

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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.
jkos-54-709f1.tif
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.
jkos-54-709f2.tif
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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