Healing changes in clear corneal cataract incisions evaluated using Fourier-domain optical coherence tomography

Wang, Li; Dixit, Lena; Weikert, Mitchell P.; Jenkins, Richard B.; Koch, Douglas D.

doi:10.1016/j.jcrs.2011.10.030

Cited by 44 publications

(32 citation statements)

References 13 publications

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“…Posterior wound retraction was defined as a step-off or recession of the limbal edge of the posterior wound surface. 9 Statistical analysis was done using SPSS software version 15.0 (SPSS, Inc., Chicago, IL, USA) and Po0.05 was considered significant.…”

Section: Surgical Techniquementioning

confidence: 99%

Comparison of new motorized injector vs manual injector for implantation of foldable intraocular lenses on wound integrity: an ASOCT study

Khokhar¹,

Sharma²,

Patil³

et al. 2014

Eye

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Purpose To compare intraocular lens implantation using a motorized injector vs standard manual injector through a 2.2-mm clear corneal incision. Methods Patients underwent standard phacoemulsification using a 2.2-mm clear corneal incision. Hydrophobic acrylic aspheric intraocular lens (Acrysof SN60WF intraocular lens (IOL)) was inserted using D cartridge with manual monarch injector or autosert motorized injector. IOL safety, final incision size and wound integrity in terms of anterior and posterior wound gape, and descemet's membrane detachment were compared between the two groups at post-operative day 1 and at 1 month using Anterior Segment Optical Coherence Tomography. Results The study recruited 32 patients in the group I (manual injector) and 30 patients in group II (motorized injector). In group I, the final incision after IOL insertion increased by 0.12 mm (95% CI: 0.134-0.106) (Po0.0001), which was seen in 100% of the patients. In group II, the incision enlarged by 0.01 (95% CI: 0.021-0.0.001) (P ¼ 0.07) and was seen in only 6.67% of the cases. IOL nicks were seen in 9.37% of the cases in group I only. Although the incidence of descemet's membrane detachment and anterior wound gape was similar for both groups, posterior wound gape was seen more often with the manual injector in the immediate postoperative period. (P ¼ 0.018) Conclusion The motorized insertion system was gentle and safe for the IOLs with lesser incidence of IOL nicks. Regarding wound safety, it caused significantly less incision enlargement and better posterior wound integrity.

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Section: Surgical Techniquementioning

confidence: 99%

Comparison of new motorized injector vs manual injector for implantation of foldable intraocular lenses on wound integrity: an ASOCT study

Khokhar¹,

Sharma²,

Patil³

et al. 2014

Eye

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“…Epithelial gaping counteracts the suction and barrier mechanisms, and creates a risk of endophthalmitis (16). The incisions in our study were sclerocorneal, which is the reason our results could not be compared with those of the reviewed reports, for the reason they were evaluating clear corneal incisions (CCIs) (7, [17][18][19][20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 96%

Assessment of sclerocorneal incision architecture after phacoemulsification using AS-OCT

Šímová

Radeva

Grupchev

et al. 2018

SSM

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INTRODUCTION: The construction of the main incision is crucial for the outcome of cataract surgery. There are many considerations including: wound preparation and stability, surgically induced astigmatism, stability of anterior chamber, and wound closure stability with rising intraocular pressure (IOP). Irrespective of modality, the main goal is to achieve stable watertight self-sealing wound in order to avoid possible intra-and postoperative complications. Therefore, evaluating the architecture and healing of the surgical wound would be of benefit, as the integrity of incisions may decrease the risk of endophthalmitis or other problems. Anterior segment OCT (AS-OCT) provides the opportunity to visualize anterior chamber structures and cornea in particular. In the interest of the current study this was used to examine the anatomy of the main incision in vivo and evaluate its changes over time. AIM: The aim of this article is to examine the architecture of the main incision in vivo and evaluate its changes over time, using anterior segment optical coherence tomography (AS-OCT). MATERIALS AND METHODS: Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction, under local anesthesia, was used. Patients with previous ocular surgery or trauma, and other ocular pathology, as well as cases with complications were not included in the study. Wound anatomy was visualized using AS-OCT (Topcon 3D SD OCT 2000) at three postoperative visits: day 1, day 7, and day 30. The following features were examined and analyzed: external gaping, endothelial (internal) alignment and gaping, localized DMD, loss of coaptation, wound retraction, and other changes on the external or the internal side of the wound. RESULTS: Sixty eyes of 51 patients were examined, of whom 23 were men and 28 women, aged between 53 and 87 years (mean 72 years). The scleral tunnel incisions had a three-plane architecture and all of them were watertight with no leakage at any time. Several architectural features were assessed, including epithelial gaping, endothelial gaping and misalignment, local Descemet's membrane detachment (DMD). CONCLUSION: AS-OCT is a risk-free, quick, high-informative method for visualization of the morphological characteristics of cataract surgical incisions and their evolution over time. Hence, this technology is indispensable in evaluating the integrity of the wound, and the information obtained could be used to develop a consistent technique to create self-sealing incisions and decrease the risk of endophthalmitis.

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“…37 It is a focus of our research group as well. Depth of penetration remains a vexing issue for all OCT systems because optical scattering and absorption limit the return of coherent photomicrographs to the imaging system.…”

Section: Discussionmentioning

confidence: 99%

Real-Time Subglottic Stenosis Imaging Using Optical Coherence Tomography in the Rabbit

Lin

Yau²,

Boyd³

et al. 2013

JAMA Otolaryngol Head Neck Surg

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Importance Subglottic stenosis (SGS) is a severe, acquired, potentially life-threatening disease that can be caused by endotracheal tube intubation. Newborns and neonates are particularly susceptible to SGS owing to the small caliber of their airway. Objective To demonstrate optical coherence tomography (OCT) capabilities in detecting injury and scar formation using a rabbit model. Optical coherence tomography may provide a noninvasive, bedside or intensive care unit modality for the identification of early airway trauma with the intention of preventing progression to SGS and can image the upper airway through an existing endotracheal tube coupled with a small fiber-optic probe. Design Rabbits underwent suspension laryngoscopy with induction of of SGS via epithelial injury. This model was used to test and develop our advanced, high-speed, high-resolution OCT imaging system using a 3-dimensional microelectromechanical systems-based scanning device integrated with a fiber-optic probe to acquire high-resolution anatomic images of the subglottic epithelium and lamina propria. Setting All experiments were performed at the Beckman Laser Institute animal operating room. Intervention or Exposure Optical coherence tomography and endoscopy was performed with suspension laryngoscopy at 6 different time intervals and compared with conventional digital endoscopic images and histologic sections. Fifteen rabbits were killed at 3, 7, 14, 21, and 42 days after the induction of SGS. The laryngotracheal complexes were serially sectioned for histologic analysis. Main Outcome and Measure Histologic sections, endoscopic images, and OCT images were compared with one another to determine if OCT could accurately delineate the degree of SGS achieved. Results The rabbit model was able to reliably and reproducibly achieve grade I SGS. The real-time OCT imaging system was able to (1) identify multiple structures in the airway; (2) delineate different tissue planes, such as the epithelium, basement membrane, lamina propria, and cartilage; and (3) detect changes in each tissue plane produced by trauma. Optical coherence tomography was also able demonstrate a clear picture of airway injury that correlated with the endoscopic and histologic images. With subjective review, 3 patients had high correlation between OCT and histologic images, 10 demonstrated some correlation with histologic images, and 2 showed little to no correlation with histologic images. Conclusions and Relevance Optical coherence tomography, coupled with a fiber-optic probe, identifies subglottic scarring and can detect tissue changes in the rabbit airway to a depth of 1 mm. This technology brings us 1 step closer to minimally invasive subglottic airway monitoring in the intubated neonate, with the ultimate goal of preventing SGS and better managing the airway.

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Healing changes in clear corneal cataract incisions evaluated using Fourier-domain optical coherence tomography

Abstract: Descemet membrane detachment and posterior wound gape appeared in the early postoperative period and persisted for up to 3 months, whereas posterior wound retraction developed later and was present in more than 90% of eyes after 3 years, indicating long-term wound remodeling.

Cited by 44 publications

References 13 publications

Comparison of new motorized injector vs manual injector for implantation of foldable intraocular lenses on wound integrity: an ASOCT study

Comparison of new motorized injector vs manual injector for implantation of foldable intraocular lenses on wound integrity: an ASOCT study

Assessment of sclerocorneal incision architecture after phacoemulsification using AS-OCT

Real-Time Subglottic Stenosis Imaging Using Optical Coherence Tomography in the Rabbit

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