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Corneal, epithelial layer thicknesses return to baseline values after cataract surgery
Anterior segment imaging with spectral-domain OCT was used before and after routine cataract surgery.
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Corneal and epithelial layer thicknesses returned to baseline values by 3 months after cataract surgery, according to a study using anterior segment optical coherence tomography for three-dimensional measurements.
“Having side-by-side qualitative and quantitative maps of the epithelium can help interpret traditional corneal topography and keratometry better and avoid IOL miscalculation mistakes,” A. John Kanellopoulos, MD, said in an interview with Ocular Surgery News. “A mistake of 1 D in the keratometry measurements may end up with an IOL miscalculation of about 1 refractive diopter, so it carries a very significant weight in everyday clinical practice.”
Kanellopoulos said he and colleagues have routinely used anterior segment imaging with spectral-domain OCT to evaluate longitudinal near-term changes in corneal and epithelial thickness after cataract surgery over the last 2 years in Europe.
The ability of the OCT system to incorporate anterior segment imaging with epithelial data makes it “extremely attractive” for monitoring cataract and refractive surgery patients, opening up a new horizon for evaluating the anterior segment and cornea, Kanellopoulos, an OSN Europe Edition Board Member, said.
A. John
Kanellopoulos
The study was published in the Journal of Refractive Surgery.
Patients and methods
The observational, prospective longitudinal study included 116 eyes of 79 patients who had unoperated, normal eyes with no history of ocular pathology other than cataract.
The LenSx femtosecond laser cataract surgery device (Alcon) and the Constellation Vision System (Alcon) were used for femto pretreatment and limited phacoemulsification for cataract removal, and the RTVue-100 OCT system (Optovue) was used to collect total corneal and epithelial thickness data covering a 6-mm diameter area.
“We used the Optovue device, which has helped us tremendously in understanding refraction and the quality of vision,” Kanellopoulos said. “It has helped us take care of our cataract surgery patients, both in the IOL calculation stage and in the postoperative care stage.”
Imaging was performed 1 day before surgery and 1 day, 1 week, 1 month and 3 months after surgery.
“We’ve done extensive work in evaluating all of our cataract patients with anterior segment OCT in order to evaluate corneal healing, specifically the epithelial remodeling after cataract surgery,” Kanellopoulos said. “It’s quite interesting that it takes about 3 months for the epithelial to calm down. We feel that refractive instability and visual complaints during that period correlate closely with the epithelial remodeling documented.”
Postoperative results
Mean increase in central corneal thickness was 60.89 µm at 1 day (P < .001) and 21.41 at 1 week (P < .001). The increases at 1 month and 3 months were not statistically significant.
Mean increase in center, mean and periphery epithelial thickness at day 1 was 2.84 µm (P < .001), 2.35 µm (P < .001) and 2.25 µm (P = .0014), respectively; at 1 week, the decrease was 1.91 µm (P < .001), 2.62 µm (P < .001) and 2.76 µm (P < .001), respectively. The decreases at 1 month and 3 months were not statistically significant.
“I think that epithelial mapping is here to stay,” Kanellopoulos said. “Anterior segment OCT devices appear to have become a ‘household’ entity. As clinicians become more familiar with it, I think they are going to open up to a new dimension of how the epithelium can interfere with vision, refraction, keratometry and traditional corneal topography and how to appreciate these changes to benefit the everyday management of our patients.” – by Nhu Te
- Reference:
- Kanellopoulos AJ, et al. J Refract Surg. 2014;doi:10.3928/1081597X-20140416-04.
- For more information:
- A. John Kanellopoulos, MD, can be reached 115 E. 61st St., Suite 1B, New York, NY 10021; 917-770-0589; email: ajk@brilliantvision.com.
Disclosure: Kanellopoulos is a consultant for Alcon/WaveLight, Avedro and i-Optics.
Perspective
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Karolinne Maia Rocha, MD, PhD
In this study, Kanellopoulos and Asimellis reported the changes in the total corneal thickness and epithelial thickness profiles after cataract surgery using a spectral-domain OCT. The corneal epithelium is highly reactive to underlying stromal asymmetries. The authors observed statistically significant increases in both corneal and epithelial thickness distribution the day after phacoemulsification and IOL implantation, and the measurements returned to baseline at 1 month postoperatively and remained stable at 3 months. Delayed return to baseline levels was observed in the 75 years or older group. The short-term changes in both the corneal and epithelial thickness profiles may indicate early postoperative corneal edema.
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