Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography

PURPOSE: To investigate clear corneal incision (CCI) architecture in the immediate postoperative period using optical coherence tomography (OCT). SETTING: Prince Charles Eye Unit, King Edward VII Hospital, Windsor, United Kingdom. METHODS: Thirty-four CCIs in 34 adult eyes were examined prospectively using the Carl Zeiss Visante anterior segment OCT imaging system within 1 hour of uneventful phacoemulsification cataract surgery. The CCIs were created using 4 widths of stainless steel blades (2.20 mm, 2.50 mm, 2.75 mm, and 3.20 mm). Immediately afterward, a Seidel test, an inverse Seidel test, and intraocular pressure (IOP) measurements were performed independently. The OCT images were randomized and masked before evaluation. Approval was obtained from appropriate research and ethics committees. RESULTS: The mean CCI length was 1.61 mm +/- 0.26 (SD) (range 1.10 to 2.25 mm). The mean incision angle was 40.7 +/- 9.43 degrees (range 24 to 56 degrees). Five CCI architectural features were noted with the following frequencies: epithelial gaping (12%), endothelial gaping (41%), endothelial misalignment (65%), local detachment of Descemet's membrane (62%), and loss of coaptation (9%). A reduction in wound apposition up to 20% was caused by endothelial gaping and up to 25%, by loss of coaptation, in a bidimensional image. The mean postoperative IOP was 16.1 +/- 9.02 mm Hg (range 3 to 46 mm Hg). The IOP was lower with local detachment of Descemet's membrane (P<.l). Other CCI architectural features varied predicatively with IOP, but not with blade width. CONCLUSIONS: Optical coherence tomography architectural features of enclothelial gaping and loss of coaptation theoretically reduce CCI structural integrity in the immediate postoperative period. These features appeared to be more common at low IOP and could represent significant risk factors for endophthalmitis.