Phacoemulsification Induced Transient Swelling of Corneal Descemet’s Endothelium Complex Imaged with Ultra-High Resolution Optical Coherence Tomography

Purpose Thickness changes of corneal sub-layers after phacoemulsification were investigated by spectral domain ultra-high resolution optical coherence tomography (UHR-OCT). Methods The 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. Results The 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). Conclusions The 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.

[1]  Kostadinka Bizheva,et al.  In vivo volumetric imaging of the human corneo-scleral limbus with spectral domain OCT , 2011, Biomedical optics express.

[2]  Sander R. Dubovy,et al.  Ultra-high resolution optical coherence tomography for differentiation of ocular surface squamous neoplasia and pterygia. , 2011, Ophthalmology.

[3]  E. P. Kay,et al.  Extracellular matrix components in retrocorneal fibrous membrane in comparison to corneal endothelium and Descemet's membrane. , 2000, Molecular vision.

[4]  J. Emery,et al.  Phacoemulsification and aspiration of cataracts: Surgical techniques, complications, and results , 1979 .

[5]  Shuliang Jiao,et al.  Use of ultra-high-resolution optical coherence tomography to detect in vivo characteristics of Descemet's membrane in Fuchs' dystrophy. , 2010, Ophthalmology.

[6]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[7]  M. Coroneo,et al.  In vivo confocal microscopy of the human cornea , 2003, The British journal of ophthalmology.

[8]  M. Jonsson,et al.  Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery. , 2005, American journal of ophthalmology.

[9]  Sander R. Dubovy,et al.  Topographic thickness of Bowman's layer determined by ultra-high resolution spectral domain-optical coherence tomography. , 2011, Investigative ophthalmology & visual science.

[10]  M. Lanza,et al.  Corneal thickness and endothelial cell characteristics in patients with myotonic dystrophy. , 2010, Ophthalmology.

[11]  M. Bullimore,et al.  Factors Affecting Corneal Endothelial Morphology , 2007, Cornea.

[12]  H. Grossniklaus,et al.  Biomechanical and wound healing characteristics of corneas after excimer laser keratorefractive surgery: is there a difference between advanced surface ablation and sub-Bowman's keratomileusis? , 2008, Journal of refractive surgery.

[13]  M J Doughty,et al.  Assessment of the Reliability of Human Corneal Endothelial Cell-Density Estimates Using a Noncontact Specular Microscope , 2000, Cornea.

[14]  Meixiao Shen,et al.  Vertical and Horizontal Corneal Epithelial Thickness Profiles Determined by Ultrahigh Resolution Optical Coherence Tomography , 2012, Cornea.

[15]  K. Miyata,et al.  Corneal endothelial cell protection during phacoemulsification: Low‐ versus high‐molecular‐weight sodium hyaluronate , 2002, Journal of cataract and refractive surgery.

[16]  R. Bourne,et al.  Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery. , 2004, Ophthalmology.

[17]  M. Fakhry,et al.  Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract , 2011, Clinical ophthalmology.

[18]  S. Mishima,et al.  The permeability of the corneal epithelium and endothelium to water. , 1967, Experimental eye research.

[19]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[20]  Kostadinka Bizheva,et al.  Swelling of the human cornea revealed by high-speed, ultrahigh-resolution optical coherence tomography. , 2010, Investigative ophthalmology & visual science.

[21]  A. Steele.  Phacoemulsification and Aspiration of Cataracts , 1980 .

[22]  S. Mishima,et al.  Clinical investigations on the corneal endothelium-XXXVIII Edward Jackson Memorial Lecture. , 1982, American journal of ophthalmology.

[23]  Wolfgang Drexler,et al.  Local corneal thickness changes after small‐incision cataract surgery , 2006, Journal of cataract and refractive surgery.

[24]  A. Behndig,et al.  Transient corneal edema after phacoemulsification: comparison of 3 viscoelastic regimens , 2002, Journal of cataract and refractive surgery.

[25]  Jianhua Wang,et al.  Vertical and horizontal thickness profiles of the corneal epithelium and Bowman's layer after orthokeratology. , 2013, Investigative ophthalmology & visual science.

[26]  Dexi Zhu,et al.  Ultra-high resolution optical coherence tomography for imaging the anterior segment of the eye. , 2011, Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye.

[27]  J. Izatt,et al.  Group index of the human cornea at 1.3-microm wavelength obtained in vitro by optical coherence domain reflectometry. , 2004, Optics letters.

[28]  A. C. Ventura,et al.  Corneal thickness and endothelial density before and after cataract surgery , 2001, The British journal of ophthalmology.

[29]  Ronald H Silverman,et al.  Stromal thickness in the normal cornea: three-dimensional display with artemis very high-frequency digital ultrasound. , 2009, Journal of refractive surgery.

[30]  Fan Lu,et al.  Automatic Segmentation of the Central Epithelium Imaged With Three Optical Coherence Tomography Devices , 2012, Eye & contact lens.

[31]  Mats Lundström,et al.  The Swedish National Cataract Register: A 9-year review. , 2002, Acta ophthalmologica Scandinavica.

[32]  W. Fledelius,et al.  Three-year changes in epithelial and stromal thickness after PRK or LASIK for high myopia. , 2009, Investigative ophthalmology & visual science.

[33]  A. Hafez,et al.  Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery , 2012, Clinical ophthalmology.