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. 2022 Feb 23:2022:2848565.
doi: 10.1155/2022/2848565. eCollection 2022.

Effect of Anterior Chamber Instability during Phacoemulsification Combined with Intraocular Lens Implantation

Wenjing Geng  1 , Wenli Lin  1 , Pei Song  1 , Min Zhang  1 , Jian Wu  1 , Shu Su  1 , Yurong Yuan  1 , Min Ji  1 , Huaijin Guan  1
Affiliations

Effect of Anterior Chamber Instability during Phacoemulsification Combined with Intraocular Lens Implantation

Wenjing Geng et al. J Ophthalmol. .

Abstract

Purpose: To determine the incidence of anterior chamber (AC) instability during phacoemulsification (phaco) combined with intraocular lens implantation and investigate its effect on intraocular tissues.

Methods: Among the 248 enrolled eyes, 121 and 127 eyes were categorized into the irrigation and nonirrigation groups, respectively, depending on the use of a self-made anterior chamber maintainer (ACM) during phaco. AC stability was evaluated using operating microscopy and intraoperative optical coherence tomography (iOCT). Slit-lamp examination of AC flare and cells was performed 1 day postoperatively. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), central corneal thickness (CCT), posterior vitreous detachment (PVD), and central foveal thickness (CFT) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively.

Results: There was good consistency in AC stability evaluation between operating microscopy and iOCT. The incidence of AC instability was significantly different between groups after the phaco and irrigation/aspiration tips were withdrawn from the AC (P < 0.001). At 1 day postoperatively, after excluding eyes in which the AC could not be visualized, AC cell grades were significantly lower in the irrigation group (P = 0.014). There was no significant difference in CDVA, IOP, ECD, and CCT between groups during the 3-month follow-up (P > 0.05). At 1 month and 3 months postoperatively, PVD occurred in 8 (16.3%) and 14 (28.6%) eyes and in 22 (40.7%) and 37 (68.5%) eyes in the irrigation and nonirrigation groups, respectively (P = 0.006 and P < 0.001). CFT was significantly higher in the nonirrigation group at 1 and 3 months postoperatively (P = 0.018 and P = 0.010).

Conclusions: Both operating microscopy and iOCT are efficient for AC stability evaluation. When the phaco and I/A tips were withdrawn from the AC, there was frequent instability. Intraoperative AC instability can increase surgery-induced inflammation and lead to postoperative complications such as PVD, retinal detachment, and macular edema. The self-made ACM can effectively reduce the incidence of intraoperative AC instability and these complications.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
The self-made anterior chamber maintainer irrigation tip (yellow arrows).
Figure 2
Figure 2
Posterior vitreous detachment (PVD) grading based on B-scan ultrasonography (US) and optical coherence tomography (OCT). (a) No PVD, B-scan US showing the absence of a hyperechoic membrane over the retinal pigment epithelium (RPE) layer. (b) Complete PVD, presence of a hyperechoic membrane (red arrows) in addition to the posterior RPE layer and completely detached from the RPE layer. (c) Stage 0, no PVD. (d) Stage 1, focal perifoveal PVD involving one to three quadrants. (e) Stage 2, perifoveal PVD across all quadrants, with persistent attachment to the fovea. (f) Stage 3, detachment of the posterior vitreous face from the fovea, with persistent attachment to the optic disc. (g) Stage 4, complete detachment of the posterior vitreous cortex (PVC) from the retina and optic disc, the PVC is not observed. White arrows denote the detached PVC.
Figure 3
Figure 3
Anterior chamber (AC) stability was evaluated by operating microscopy and intraoperative OCT (iOCT). (a) No forward movement of the posterior capsule (PC) was observed by operating microscopy. (b) A concave arcuate shape of the PC (white arrow) was observed by iOCT. (c) Forward movement of the PC was observed by operating microscopy. (d) Forward movement of the PC (white arrow) was observed by iOCT. (e) The disappearance of the AC was observed by operating microscopy. (f) The PC (white arrow) contact with the corneal endothelium was observed by iOCT. The yellow arrow denotes the self-made AC irrigation tip.
Figure 4
Figure 4
Percentage of eyes with posterior vitreous detachment preoperatively and at 1 week, 1 month, and 3 months postoperatively (∗P = 0.015). PVD: posterior vitreous detachment. ∗A significant P value.
Figure 5
Figure 5
The graph represents the means and the standard errors of the central foveal thickness (μm). The reported P values are significant comparisons between the two groups at each time point.
Figure 6
Figure 6
Schematic conceptual drawing of the anterior chamber collapse leading to vitreous anterior displacement.
See this image and copyright information in PMC

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