Corneal Epithelial Thickness Remodeling Following Phacoemulsification: A Comparative Analysis Of Superior And Temporal Incision Locations

To evaluate longitudinal changes in corneal epithelial thickness (CET) using anterior segment optical coherence tomography (AS-OCT) following uncomplicated phacoemulsification cataract surgery, and to determine the impact of the primary corneal insicion location on postoperative epithelial remodeling.

Eskişehir Osmangazi University, Eskişehir, Türkiye.

In this prospective study, 27 eyes undergoing cataract surgery by phacoemulsification were analyzed and categorized into superior and temporal incision groups. Corneal epithelial thickness maps were obtained using spectral-domain AS-OCT at baseline (preoperative), postoperative week 1, and postoperative month 1. In the CET map, one central (2 mm), eight paracentral (2–5 mm), and eight peripheral (5–6 mm) quadrants were evaluated separately. Longitudinal changes across visits were analyzed on a sector-by-sector basis using linear mixed-effects models.

In the overall analysis of 27 patients aged 40–82 years, epithelial thickness decreased across all quadrants at postoperative week 1 and returned to baseline or showed slight increases by month 1 (all p > 0.05). In the superior incision group (n=20), most sectors demonstrated week-1 thinning (p > 0.05), most pronounced in the superior 5-mm region (≈−1.13 µm), with values approaching baseline at month 1. In the temporal incision group (n=7), no uniform thinning was observed; temporal sectors showed mild thickening (≈+0.9 to +1.7 µm), whereas superior sectors localized thinning (≈−1.1 to −1.8 µm) at week 1 (all p > 0.05). By postoperative month 1, epithelial thickness had largely approached baseline values (p > 0.05).

Phacoemulsification was associated with transient corneal epithelial remodeling characterized by early thinning at postoperative week 1 and a return toward baseline by month 1, although changes were not statistically significant. Incision location demonstrated distinct spatial patterns, with more uniform superior thinning after superior incisions and a more heterogeneous sectoral response following temporal incisions.