Corneal Wound Architecture and Corneal Wound Architecture and Integrity after OZil and Mixed Integrity after OZil and Mixed

Phacoemulsification: Evaluation of Phacoemulsification: Evaluation of Standard and Microincisional Standard and Microincisional

Coaxial TechniquesCoaxial Techniques

Bokkwan Jun MD, John P Berdahl MD, Anthony NBokkwan Jun MD, John P Berdahl MD, Anthony N Kuo MD, Kuo MD, Thomas J Cummings MD, Terry Kim MDThomas J Cummings MD, Terry Kim MD

Duke University Eye CenterDuke University Eye CenterDurham, North CarolinaDurham, North Carolina

Commercial Relationships

PurposePurpose

To compare corneal wound architecture To compare corneal wound architecture and integrity after OZil torsional and and integrity after OZil torsional and mixed ultrasound modalities with various mixed ultrasound modalities with various phacoemulsification (PE) power levels phacoemulsification (PE) power levels

Two different size of incisionsTwo different size of incisions Standard (2.75mm) Standard (2.75mm) Microincisional (2.2mm)Microincisional (2.2mm)

MethodsMethods Prospective studyProspective study

Twenty human cadaver eyes, Four groups of 5 eyes/group Twenty human cadaver eyes, Four groups of 5 eyes/group Group 1Group 1 : 2.75mm, only 100% OZil: 2.75mm, only 100% OZil Group 2Group 2 : 2.2mm, only 70% OZil: 2.2mm, only 70% OZil Group 3Group 3 : 2.2mm, only 100% OZil: 2.2mm, only 100% OZil Group 4Group 4 : 2.2mm, mixed ultrasound modality : 2.2mm, mixed ultrasound modality

(ultrasound 50% for 10ms; OZil 100% for 60ms, 30ms off) (ultrasound 50% for 10ms; OZil 100% for 60ms, 30ms off)

Phacoemulsification (PE) settingsPhacoemulsification (PE) settings Vacuum: 300mmHg, Aspiration: 12cc/min, Bottle height : 100cmVacuum: 300mmHg, Aspiration: 12cc/min, Bottle height : 100cm Phacoemulsification time: ~ 45 seconds with full power and simulated Phacoemulsification time: ~ 45 seconds with full power and simulated

5~10 seconds5~10 seconds On/Off occlusion and instrument manipulationOn/Off occlusion and instrument manipulation Tip: Mini-Flared 30° Kelman tipTip: Mini-Flared 30° Kelman tip Sleeve: MicroSleeve for 2.75mm, UltraSleeve for 2.2mmSleeve: MicroSleeve for 2.75mm, UltraSleeve for 2.2mm

India inkIndia ink : 2 eyes/group, IOP was varied from 0~125mmHg: 2 eyes/group, IOP was varied from 0~125mmHg

Entry of India ink into the wound or aqueous leakage from the Entry of India ink into the wound or aqueous leakage from the wound was recordedwound was recorded

Histopathologic examination of India ink Histopathologic examination of India ink : 2 eyes/group: 2 eyes/group

Optical coherence tomography (OCT)Optical coherence tomography (OCT) : 3 eyes/group : 3 eyes/group before and after the phacoemulsificationbefore and after the phacoemulsification

Scanning electron microscopy (SEM)Scanning electron microscopy (SEM) : 3 eyes/group : 3 eyes/group

MethodsMethods

Results Results (Gross observation)(Gross observation) Spontaneous wound leakage (No ingress of India ink)Spontaneous wound leakage (No ingress of India ink)

Group 1Group 1 : 1/5 eyes : 1/5 eyes

Group 3Group 3 : 0/5 eyes : 0/5 eyes

Group 2Group 2 : 0/5 eyes : 0/5 eyes

Group 4Group 4 : 0/5 eyes : 0/5 eyes

India ink demonstration India ink demonstration after PE and IOP variationafter PE and IOP variation

Group 3Group 3 Group 4Group 4

Group 2Group 2Group 1Group 1

2.75mm100% OZil

2.2mm100% OZil

2.2mm70% OZil

2.2mmMixed U/S

No India ink penetrated into the inner wound tract in any of the No India ink penetrated into the inner wound tract in any of the study eyesstudy eyes

Results Results (Histopathology)(Histopathology)

Group 3Group 3 Group 4Group 4

Group 2Group 2Group 1Group 1

2.75mm100% OZil

2.2mmMixed U/S

2.2mm70% OZil

2.2mm100% OZil

Results Results (OCT)(OCT) Wound architecture and apposition remained intact in Wound architecture and apposition remained intact in

each group after simulated PE without stromal hydrationeach group after simulated PE without stromal hydration

Group 1Group 1

Group 3Group 3

Group 2Group 2

Group 4Group 4

2.75mm100% OZil

2.2mm70% OZil

2.2mmMixed U/S

2.2mm100% OZil

Results Results (SEM, endothelial view)(SEM, endothelial view) SEM demonstrated comparable gaping of the internal SEM demonstrated comparable gaping of the internal

wound and minimal trauma to DM and corneal endotheliumwound and minimal trauma to DM and corneal endothelium

Group 1Group 1 Group 2Group 2

Group 3Group 3 Group 4Group 4

2.75mm100% OZil

2.2mm70% OZil

2.2mmMixed U/S

2.2mm100% OZil

ConclusionsConclusions

No gross differences in corneal wound architecture No gross differences in corneal wound architecture and integrity was observed among the four and integrity was observed among the four treatment groups as confirmed by gross, treatment groups as confirmed by gross, histopathologic, OCT, and SEM examination. histopathologic, OCT, and SEM examination.

Torsional and mixed ultrasound settings do not Torsional and mixed ultrasound settings do not appear to induce any adverse effects on incision appear to induce any adverse effects on incision integrity in standard and microincisional coaxial integrity in standard and microincisional coaxial OZil and longitudinal ultrasound applications.OZil and longitudinal ultrasound applications.