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Kim, Lee, and Kim: Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(11): 1215-1224.

Published online: 15 November 2017

DOI: https://doi.org/10.3341/jkos.2017.58.11.1215

Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision

Bong Jun Kim, MD, Jong-Hyuck Lee, MD, PhD, Sun Woong Kim, MD, PhD

Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea.

Address reprint requests to Sun Woong Kim, MD, PhD. Department of Ophthalmology, Wonju Severance Christian Hospital, #20 Ilsan-ro, Wonju 26426, Korea. Tel: 82-33-741-1346, Fax: 82-33-741-0460, eyedockim@yonsei.ac.kr

Received 25 May 2017       Revised 7 September 2017       Accepted 17 October 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

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 preoperative and postoperative thickness and to investigate the difference in the thickness change of corneal epithelium and stroma after cataract surgery through scleral tunnel incision.

Methods

Forty eyes of forty patients who were 40 years old or older and underwent small-incision superior scleral tunnel cataract surgery with phacoemulsification were included. Using the RTVue instrument (Optovue Inc., Fremont, CA, USA), corneal epithelial (ET) and stromal thicknesses (ST) of all subjects were measured preoperatively and at 3 days, 1 week, and 1 month postoperatively. Thicknesses were classified into 3 zones according to the distance from the vertex: central zone (within 2 mm), paracentral zone (2-5 mm diameter) and midperipheral zone (5-6 mm diameter).

Results

Mean central ST was 486.68 ± 25.15 µm, 535.16 ± 48.13 µm, 515.98 ± 44.07 µm, and 502.28 ± 34.87 µm preoperatively, and at 3 days, 1 week, and 1 month postoperatively, respectively (p < 0.001 for all). ST showed significant thickening in all three zones from 3 days to 1 month postoperatively (p < 0.001 for all). Mean central, paracentral, and midperipheral ET was 52.13 ± 3.41 µm, 50.42 ± 2.97 µm, 49.12 ± 3.05 µm at preoperatively and 51.03 ± 3.63 µm, 48.96 ± 3.62 µm, 47.67 ± 3.81 µm at 1 month postoperatively, respectively (p = 0.061, 0.006, 0.001, respectively), while there were no signficant changes in all three zones at 3 and 7 days postoperatively. Changes in ET and ST were prominent at the superotemporal incision site.

Conclusions

After scleral tunnel cataract surgery, corneal edema was observed in the stroma immediately after surgery. There was no significant change at early times after surgery in the epithelium, and there was a decrease in the peripheral cornea at 1 month postoperatively. The change in ET was considered a compensatory change due to stromal edema and appeared between 1 week to 1 month postoperatively.

Keywords: Cataract surgery, Corneal epithelium, Corneal remodeling, Corneal stroma, Corneal thickness

Figures and Tables

Figure 1

Schematic diagram of the cornea showing position of surgeon and analyzed area by RTVue. This diagram shows position of surgeon, incision site and analyzed areas on the cornea.

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Figure 2

Preoperative corneal thickness. The preoperative epithelial thickness was thinner in the superior than inferior, but stromal thickness was thicker in the superior than inferior. S = superior; N = nasal; T = temporal; I = inferior.

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Figure 3

Postoperative changes of corneal thickness. (A) 3 days postoperative. (B) 1 week postoperative. (C) 1 month postoperative. *p < 0.05; **p < 0.01 in repeated measure analysis of variance (ANOVA) with post-hoc comparison compared to preoperative thickness. S = superior; N = nasal; T = temporal; I = inferior.

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Figure 4

Epithelial thickness changes among nuclear grade groups. (A) Central. (B) Paracentral. (C) Midperiphery. (D) Topographic variability. Pre-op = preoperative.

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Figure 5

Stromal thickness changes among nuclear grade groups. (A) Central. (B) Paracentral. (C) Midperiphery. (D) Topographic variability. Pre-op = preoperative.

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Table 1

Demographic characteristics

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Values are presented as mean ± SD unless otherwise indicated.

Table 2

Preoperative and postoperative corneal epithelial and stromal thickness in the patients underwent cataract surgery

jkos-58-1215-i002

Values are presented as mean ± SD unless otherwise indicated.

*Repeated measure analysis of variance (ANOVA) with post-hoc comparison compared to preoperative thickness.

Table 3

Partial correlation coefficient between epithelium and stromal thickness change

jkos-58-1215-i003

Partial correlation test controlled with age and sex.

Cen = central; Para = paracetral; Mid = midperiphery; Epi = epithelium; St = stroma.

*p < 0.05; †p < 0.001.

Notes

This study was presented as a narration at the 117th Annual Meeting of the Korean Ophthalmological Society 2017.

Conflicts of Interest The authors have no conflicts to disclose.

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