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Session Title: Corneal Incisions and preloaded IOLs
Session Date/Time: Sunday 06/10/2013 | 08:00-09:30
Paper Time: 08:06
Venue: Elicium 2 (First Floor)
First Author: : P.Sharma INDIA
Co Author(s): : I. Lohmror S. Kalia
The purpose of this study was to assess and compare the wound integrity after modified stromal pocket hydration (MASH) with anterior stromal pocket hydration (ASPH) and conventional hydration (CH) after temporal clear corneal (CCI) 2.2 mm uniplanar phacoemulsification surgery with foldable intraocular lens (IOL) implantation. It was also attempted to study the surgically induced astigmatism (SIA) and any complications of each technique.
This study was conducted at the Department of Ophthalmology, SMS Medical College & Hospital, Jaipur, INDIA. The design was a hospital based age and sex matched prospective comparative case series conducted for a period of 6 months on 90 eyes that underwent routine phacoemulsification with, in the bag implantation, of foldable acrylic single piece IOL for senile, uncomplicated cataracts under topical anaesthesia.
After applying appropriate inclusion and exclusion criteria, eyes were randomly assigned to one of the 3 equal groups of 30 eyes each. Group A : Conventional hydration; Group B : Anterior stromal pocket hydration; Group C : Modified stromal pocket hydration. Under topical anaesthesia, a temporal 2.2 mm CCI was constructed. ASPH was done as described by Mifflin. In MASH, the triangular pocket was placed at the upper edge of the CCI with apex pointing downward and reaching upto the upper edge of CCI. At the end of the surgery, wound integrity was assessed with predefined protocol by observing BSS leakage intraoperatively, by pressing on posterior lip of CCI. In case of persistent leak in pocket hydration, conventional hydration was supplemented. Any complications were noted. Eyes with persistent leaks were patched and Seidel test was done postoperatively. Anterior Segment Optical Coherence Tomography (ASOCT) was done to assess wound and note complications like descemets detachment. Complete ocular exam was done at day 1, day 4 and 4 weeks inclusing keratometry and refraction to calculate SIA. . Results were compiled and studied. ANOVA, t- Test & Chi Square tests were used for statistical analysis as & when required.
All three groups were age and sex matched. Post hydration leakage rate on firm pressure on posterior lip of wound was seen in 63.3% in CH, 6.7% in ASPH and 6.7% in MASH (p<0.01 both between CH vs ASPH and CH vs MASH). There was no difference between ASPH and MASH groups. However, 4 eyes with ASPH had to be supplemented with CH due to inadequate localization of pocket at the end of surgery. Thus supplemental hydration rate of ASPH group was significantly higher in ASPH (13.3%) as compared to MASH (0%) (p<0.05). Minimal descemets detachment (DMD) was noted in 3 eyes in CH group which was confirmed with post operative ASOCT. Pocket hydration groups did not show DMD in any eye. Mean SIA was 0.17(SD=0.14) in CH; 0.17(SD=0.12) in ASPH; and 0.22 (SD=0.17) in MASH at the end of 4 weeks (p>0.1 between groups). None of the eyes showed leakage at day 1 in any of the groups confirmed by Seidel test. Mean post operative Log MAR BCVA was comparable in all 3 groups. There was no significant epithelial complication in any of the eyes. No eye developed endophthalmitis in any group.
Stromal pocket hydration technique is significantly better in terms of wound integrity in CCI uniplanar 2.2 mm phacoemulsification surgery as previously reported by Mifflin. Here we describe a variant of ASPH by modifying the location of the pocket (MASH). This did not, in any way, compromise the wound integrity as leakage rates were similar in the two types of pocket hydration. Both types of pocket hydrations were significantly better than conventional hydration. However, there was a significant supplementation rate of ASPH by conventional hydration due to poor localization of the pocket at the end of surgery since this pocket was directly over the roof of CCI. The modified pocket was superiorly located with the apex touching the superior edge of CCI. Effective hydration was successful in all such modified pockets. CH was associated with risk of DMD which was not clinically significant as it did not affect ultimate visual outcome. The SIA was comparable in all the three groups and pocket hydration was not associated with epithelial erosions or patient discomfort. Thus pocket hydration is an effective method of wound closure after CCI phacoemulsification surgery and modifying the location of the pocket may help keep the pocket identifiable at the completion of the surgery.
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