RESUMO
BACKGROUND: To assess minimum and maximum changes in anterior chamber dimensions following routine cataract surgery in non-glaucomatous eyes. METHODS: Forty-two eyes (42 participants) underwent routine cataract surgery with same surgeon and were assessed preoperatively, 1, 3, 6 and 12 months postoperatively. Primary outcome measure: Angle-to-angle diameter (AAD) (at 0-180o, 45-225o, 90-270o, 135-315o), Anterior-chamber-angle (ACA) (at 0o, 45o, 90o, 135o, 180o, 225o, 270o and 315o) and central anterior chamber depth (ACD) at all visits. Secondary outcome measures: relationship to axial length (AL). RESULTS: The mean AAD and ACA increased post-operatively in all meridians at all visits postoperatively. At 12 months, there was a maximum change in AAD in horizontal meridian (506.55 ± 468.71 µm) and least in vertical meridian (256.31 ± 1082.3 µm). The mean percentage increase in ACA postoperatively was least at 90o (5% increase compared to 29-35% elsewhere). Central ACD deepened at all postoperative visits and this did not change over 12 months. There was no correlation between AAD, ACA and ACD with AL at any visit. CONCLUSION: The AAD, ACA and ACD increases following cataract surgery in non-glaucomatous eyes, but at 12 months increase in AAD is least in vertical compared to horizontal meridian. Also, ACA was narrower (only 5% increase) superiorly compared to elsewhere (29-35% increase in ACA). This may have implications with regards to surgeries performed in the anterior chamber and corneal endothelial cell loss.
RESUMO
PURPOSE: To assess intraoperative and postoperative graft thickness (GT) after donor deturgescence for ultrathin Descemet stripping automated endothelial keratoplasty and to evaluate visual outcomes, endothelial cell density, and patient satisfaction at 1 year. METHODS: Prospective interventional case series of patients with Fuchs endothelial dystrophy, Fuchs endothelial dystrophy and cataract, and pseudophakic bullous keratopathy (n = 12 grafts). The donor cornea was allowed to thin out by simple evaporation on an artificial anterior chamber, to the required precut thickness, before a single microkeratome pass. GT after microkeratome cut, at 1 week, 1, 3, 6, and 12, months was measured. Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity, Pelli-Robson contrast sensitivity, endothelial cell density, and score on the visual function questionnaire (VFQ-25) were assessed. RESULTS: Mean intraoperative postmicrokeratome cut GT was 78.9 ± 33.3 µm. Mean GT at 1 week, 1, 3, 6, and 12 months was 70.7, 70.9, 62.8, 66.5, and 58.9 µm, respectively. Mean initial donor corneal thickness was 647 ± 67 µm, and mean precut thickness was 526 ± 4.5 µm (mean thinning time: 17 min). Best-corrected visual acuity at 1 week, 1, 3, 6, and 12 months was 68.8, 76.9, 76.3, 76.9, and 78.6 letters with 9-letter gain at 12 months (P = 0.02). Mean endothelial cell loss at 3, 6, and 12 months was 36.8% ± 6.75%, 37.2% ± 8%, and 37.9% ± 9.75% loss, respectively. At 1 year, 83.3% of patients achieved ≥20/40 (6/12) and 66.7% of patients achieved ≥20/32 (6/9.5). VFQ-25 testing showed an improvement in the visual function. CONCLUSIONS: This pilot study demonstrates a simple graft deturgescence technique that reproducibly creates ultrathin grafts without donor wastage.
