Early corneal pachymetry maps after cataract surgery and influence of 3D digital visualization system in minimizing corneal oedema

Abstract

Purpose: To describe the early topography of corneal swelling occurring after cataract surgery and to evaluate the impact of the three-dimensional (3D) digital visualization system in minimizing corneal oedema. Methods: Prospective observational, single-centre, consecutive case series of 134 patients undergoing cataract surgery performed by the same surgeon, with either 3D or conventional visualization systems. Eyes were assigned to two groups based on their anterior chamber depth (group ACD ≤3 mm and group ACD >3 mm). Optical coherence tomography was performed to evaluate postoperative corneal swelling. Results: Three corneal swelling profiles were identified on the first postoperative day type 1, limited corneal oedema near peripheral corneal incisions; type 2, domeshaped corneal swelling spreading from the principal corneal incision and reaching the paracentral cornea; type 3, continuous oedema spreading from the principal incision to central cornea, with a generalized oedema predominating in the upper part of the cornea.On the first day after surgery, in group ACD ≤3 mm, visual acuity was significantly better in patients undergoing surgery with 3D visualization (0.023 vs 0.072 logMar, p = 0.014) with reduced central corneal thickening 17.3 µm (AE3.2) in comparison with conventional visualization 44.0 µm (AE9.3) (p = 0.0082). In group ACD >3 mm, no significant association was found between the use of the 3D system and pachymetry changes and early visual rehabilitation. On day 21 after surgery, no significant differences in corneal pachymetry values were observed between the two surgical approaches in both groups. Conclusions: We describe early postoperative corneal map profiles providing insight into the pathogenesis of postoperative corneal swelling and possible prevention strategies. By improving visualization of the narrow surgical space in patients with shallow anterior chambers, the 3D system could help to minimize postoperative corneal oedema.

Comparison of Three-Dimensional Surgical System Versus Binocular Microscope for Clear Corneal Incision in Cataract Surgery

“…In this study, we observed no intergroup difference in endothelial cell loss; this finding coincides with that reported in another randomized clinical trial [ 17 ]. In terms of corneal edema, a recently published articled noted that the 3D system could reduce corneal edema in eyes with narrow ACD (≤ 3 mm); however, no difference was found in eyes with deeper ACD (> 3 mm) [ 21 ]. The average ACD values in our study were 3.19 ± 0.38 mm (3D group) and 3.23 ± 0.47 mm (BM group), which might explain why we did not observe the difference in postoperative corneal edema.…”

Three-Dimensional Heads-up Display in Cataract Surgery: A Review

“…In addition, the surgeon’s peripheral visual field is extended to a width not possible for the OSM 4. This improved depth of field and peripheral visualization allows for a larger perceived operating field 3,16…”

Use of Black-and-White Digital Filters to Optimize Visualization in Cataract Surgery

“…The 3D system extends the depth of field, thereby improving visualization of the anterior chamber at high magnification. This makes intraocular interventions safer and helps to minimize postoperative corneal edema in eyes with a shallow anterior chamber [ 5 ]. The ocular-free design of the 3D system not only improves ergonomic conditions for the surgeon, but also makes it possible to perform surgery in unusual and challenging positions, by rotating the microscope for cataract surgery in patients who are unable to remain supine, or through extending the peripheral retinal view in retinal surgery [ 6 , 7 ].…”