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Central corneal thickness following cataract surgery: return to baseline and relationship with surgical experience

Poster Details

First Author: C.Quigley IRELAND

Co Author(s):    S. Tizi   V. Ferguson           

Abstract Details

Purpose:

This study investigated the return to baseline of central corneal thickness (CCT) following cataract surgery and examined its relationship with level of experience of the surgeon. Cataract surgery causes stress to the cornea through numerous mechanisms. The cumulative effects of these stresses cause loss of endothelial cells and swelling of the cornea. Measurement of CCT is commonplace in clinics and could be a useful in skills assessment during cataract surgery training if found to be associated with surgical experience. Skills assessment is particularly important in training programmes where there is competitive progression to surgical specialisation, such as in Ireland.

Setting:

Imperial College Healthcare NHS Trust, Western Eye Hospital, London

Methods:

The prospective study evaluated 34 eyes of 17 patients undergoing routine phacoemulsification cataract surgery. Surgical experience, CCT, and other covariates including Alcon Infiniti phaco power employed, operative complications, type of anaesthetic, and postoperative visual outcome of surgery were measured. CCT was measured using ultrasonic pachymetry prior to cataract surgery and on two postoperative visits at two and three weeks.

Results:

Prior to surgery median CCT was 564µm (n=17), which increased postoperatively at two weeks to median 601µm (n=16), and at 3 weeks was 585µm (n=11). Surgeon experience was not found to be associated with postoperative CCT, but was associated with use of higher phaco power during surgery, with the highest phaco powers being employed only by consultants. There was a trend for higher phaco power to be associated with raised CCT, at an increase of 10.7µm per phaco level (95% CI -5.1µm- 26.4µm, p=0.2).

Conclusions:

CCT may be limited in its potential for use as a trainee assessment tool due to the confounding effects of higher phaco power to lead to increased corneal swelling. Higher power settings are required in removal of more mature cataracts, and higher phaco power trends toward an association with increased CCT postoperatively. More extensive characterization of the changes in CCT, their associations, and their time course is required. If the hardness of the cataract can be controlled for CCT could be further investigated as a trainee assessment tool. FINANCIAL DISCLOUSRE: NONE

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