Abstract
PurposeThickness changes of corneal sub-layers after phacoemulsification were investigated by spectral domain ultra-high resolution optical coherence tomography (UHR-OCT). MethodsThe corneas (n = 26) of 26 age-related cataract surgery patients were studied. UHR-OCT was used to evaluate the thickness of Descemet’s Endothelium Complex (DEC), stroma, Bowman’s layer, epithelium, and full cornea at the center (CCT) before, one day after, and one week after surgery. Non-contact specular microscopy measured CCT, endothelial cell density, and morphology.ResultsThe DEC, stroma, Bowman’s layer, and epithelium were visualized by UHR-OCT. Before surgery, the DEC in all cases appeared as a translucent space between two smooth opaque lines. One day after surgery, the posterior corneal surfaces in half of the eyes were wavy and irregular. Compared to the baseline, one day after surgery the thickness increases of the DEC, stroma, and CCT were 4.3 ± 2.6 µm, 25.5 ± 24.9 µm, and 32.1 ± 26.6 µm, respectively (P < 0.001). The morphology of the DEC and the CCT recovered to baseline one week after surgery (P > 0.05), but endothelial cell density was 8.7% less than at baseline. There were no significant changes in Bowman’s layer and epithelium after the operation. The pre-operative DEC thickness was positively correlated with the decreased endothelial cell density at 1 day after surgery (r = 0.55, P = 0.003).ConclusionsThe DEC showed edematous thickening and different degrees of morphological changes after phacoemulsification. The DEC deformation and corneal edema recovered by one week after surgery, which indicated recovery of endothelial function. UHR-OCT is a useful tool to evaluate function of the DEC after phacoemulsification. Pre-operative DEC thickness may indicate the integrity of the endothelium and could be used for predicting endothelial cell loss after phacoemulsification.
Highlights
The evolution of phacoemulsification surgery has resulted in a trend towards improved visual acuity with optimal safety and minimum invasiveness [1]
The corneal laminae were outlined semiautomatically in the exported images (Figure 1) as we described in a previous study [15]
Pre-operatively, the Descemet’s Endothelium Complex (DEC), stroma, Bowman’s layer, and epithelium were visualized in ultra-high resolution optical coherence tomography (OCT) (UHR-OCT) images as bands separated by smooth opaque lines (Figure 1)
Summary
The evolution of phacoemulsification surgery has resulted in a trend towards improved visual acuity with optimal safety and minimum invasiveness [1]. Several methods have been used to assess endothelial function post-operatively: specular microscopy and in vivo confocal microscopy for endothelial morphology, fluorophotometric measurement of corneal barrier functions, and pachymetry for central corneal thickness (CCT) [6,7,8,9]. Some of these techniques require contact with the eye and none of them is able to document the thickness of the endothelium. The aim of this study was to determine thickness changes in the central DEC and other corneal sub-layers after phacoemulsification
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