Abstract
Purpose
To evaluate the self-sealing on curved single-plane clear corneal incisions (CCIs) after cataract surgery. The collapse of the anterior chamber was made by aspirating the aqueous humor in order to make curved single-plane CCI.
Methods
A retrospective study was conducted at Asai Hospital in Japan. There were 189 eyes of 132 patients scheduled from February to April 2017 for single-plane CCI. There were 175 eyes of 128 patients from February to April 2018 for curved single-plane CCI. Curved single-plane CCIs were made with aqueous humor aspiration via aqueous humor pipette, and single-plane CCIs were made without the aspiration. In case of leakage of aqueous humor from the CCI at the end of surgery, sutures were used. The main outcome measure was the proportion of sutures for CCI. Secondary outcomes included CCI length and surgically induced astigmatism (SIA) magnitude.
Results
The proportions of suture in single-plane CCI and in curved single-plane CCIs were 25.4% (48/189) and 0% (0/175), respectively (p < 0.001). The length of curved single-plane CCI (2.06 ± 0.18 mm) was significantly greater than that of single-plane CCI (1.66 ± 0.12 mm; p < 0.001). The median postoperative SIAs of single-plane and curved single-plane CCIs were 0.64 D (n = 89) and 0.73 D (n = 85) for nasal incision, and 0.46 D (n = 100) and 0.47 D (n = 90) for temporal incision at examination 3 months after surgery, respectively, without significant change (p = 0.12 for nasal incision and p = 0.37 for temporal incision).
Conclusion
The curved single-plane CCI achieved by only aqueous humor aspiration showed significant effectiveness in self-sealing.
Trial registration
UMIN clinical trials registry UMIN000032480, retrospectively registered on 6 May 2018.
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Acknowledgements
The authors acknowledge Masako Watarai, Hiromu Osada, and Syunsuke Yagi, the staff involved in the study, for their assistance.
Funding
The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
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Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and data analysis were performed by Masahiro Zako, Masahiko Gosho, and Kyoichi Mizumoto. The first draft of the manuscript was written by Masahiro Zako, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The attached images and videos are entirely unidentifiable, and there are no details of individuals reported within the manuscript.
Ethical approval
All procedures in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the internal review board of our institution (ASAI20181001). The UMIN clinical trials registry number is UMIN000032480, and the date of registration was May 6, 2018.
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Informed consent was obtained from all individual participants included in the study.
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Movie 1 The 2.4-mm curved single-plane clear corneal incision (CCI) was made after aqueous humor aspiration via a commercially available disposable aqueous humor pipette. The 1.0-mm side-port CCI was made after the anterior chamber was artificially filled with viscoelastic materials. (MP4 14338 kb)
Movie 2 For a moderate extent of aspiration by pipette, it may be useful to estimate flattening bubbles in anterior chamber. The CCI tunnel could be safely achieved by directing the slit knife toward the flattened bubbles. (MP4 7331 kb)
Movie 3 It may be useful to observe flattening bubbles in anterior chamber for a moderate extent of aspiration. The CCI tunnel could be safely achieved by directing the slit knife toward the flattened bubbles. In this left eye case, we bent the needle of the aqueous humor pipette at an appropriate angle of about 30 degrees for easier manipulation before use. (MP4 10316 kb)
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Zako, M., Gosho, M. & Mizumoto, K. Curved single-plane clear corneal incision made under anterior chamber collapse by aqueous humor aspiration prevents leakage after cataract surgery. Int Ophthalmol 40, 1723–1730 (2020). https://doi.org/10.1007/s10792-020-01340-5
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DOI: https://doi.org/10.1007/s10792-020-01340-5