Prospective observational study of conjunctival scarring after phacoemulsification

PurposeTo examine whether anterior segment-optical coherence tomography (AS-OCT) can detect conjunctival scarring after transscleral phacoemulsification and whether temporal transscleral phacoemulsification causes scarring in the superior conjunctiva. MethodsTransscleral phacoemulsification was performed in the superior conjunctiva (superior incision group) or the temporal conjunctiva (temporal incision group). Anterior segment-optical coherence tomography (AS-OCT) images of the superior conjunctiva were obtained before and after surgery. We quantified the thickness of the conjunctiva and preservation rates of the borderlines among thesubconjunctival layers. The relationship between the AS-OCT images and histology was evaluated in rabbit eyes with phacoemulsification. ResultsEach group comprised 25 patients. At 1month after surgery, the superior conjunctiva was significantly thicker in the superior incision group than the temporal incision group (1day, 7days, and 1month after surgery; p<0.0001, p<0.0001, and p<0.001 respectively); however, there were no significant differences between the two groups at 2months. The borderline of the conjunctival stroma/Tenon's capsule and the borderline of the Tenon's capsule/sclera were preserved significantly better in the temporal incision group after surgery (p<0.0001). The cell densities in the conjunctiva of the rabbit temporal incision group were unchanged after surgery, whereas the rabbit superior incision group had significantly more neutrophils (p=0.0001) and myofibroblasts (p<0.0001) in the superior conjunctiva than the temporal incision group. ConclusionsAnterior segment-optical coherence tomography (AS-OCT) images can detect conjunctival scarring after transscleral phacoemulsification. The layer structures in the superior conjunctiva are unaffected by temporal transscleral incision.