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

Corneal Wound Architecture and Integrity after OZil and Mixed Phacoemulsification: Evaluation of Standard and Microincisional Coaxial Techniques. Bokkwan Jun MD, John P Berdahl MD, Anthony N Kuo MD, Thomas J Cummings MD, Terry Kim MD Duke University Eye Center Durham, North Carolina.

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

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  1. Corneal Wound Architecture and Integrity after OZil and Mixed Phacoemulsification: Evaluation of Standard and Microincisional Coaxial Techniques Bokkwan Jun MD, John P Berdahl MD, Anthony NKuo MD, Thomas J Cummings MD, Terry Kim MD Duke University Eye Center Durham, North Carolina Commercial Relationships

  2. Purpose • To compare corneal wound architecture and integrity after OZiltorsional and mixed ultrasound modalities with various phacoemulsification (PE) power levels • Two different size of incisions • Standard (2.75mm) • Microincisional (2.2mm)

  3. Methods • Prospective study • Twenty human cadaver eyes, Four groups of 5 eyes/group • Group 1: 2.75mm, only 100% OZil • Group 2: 2.2mm, only 70% OZil • Group 3: 2.2mm, only 100% OZil • Group 4: 2.2mm, mixed ultrasound modality (ultrasound 50% for 10ms; OZil 100% for 60ms, 30ms off) • Phacoemulsification (PE) settings • Vacuum: 300mmHg, Aspiration: 12cc/min, Bottle height : 100cm • Phacoemulsification time: ~ 45 seconds with full power and simulated 5~10 secondsOn/Off occlusion and instrument manipulation • Tip: Mini-Flared 30° Kelman tip • Sleeve: MicroSleeve for 2.75mm, UltraSleeve for 2.2mm

  4. Methods • India ink : 2 eyes/group, IOP was varied from 0~125mmHg • Entry of India ink into the wound or aqueous leakage from the wound was recorded • Histopathologic examination of India ink : 2 eyes/group • Optical coherence tomography (OCT) : 3 eyes/group • before and after the phacoemulsification • Scanning electron microscopy (SEM) : 3 eyes/group

  5. Results (Gross observation) • Spontaneous wound leakage (No ingress of India ink) • Group 1 : 1/5 eyes • Group 3 : 0/5 eyes • Group 2 : 0/5 eyes • Group 4 : 0/5 eyes • India ink demonstration after PE and IOP variation Group 1 Group 2 2.2mm 70% OZil 2.75mm 100% OZil Group 3 Group 4 2.2mm 100% OZil 2.2mm Mixed U/S

  6. Results (Histopathology) • No India ink penetrated into the inner wound tract in any of the study eyes Group 1 Group 2 2.75mm 100% OZil 2.2mm 70% OZil Group 3 Group 4 2.2mm 100% OZil 2.2mm Mixed U/S

  7. Results (OCT) • Wound architecture and apposition remained intact in each group after simulated PE without stromal hydration Group 1 Group 2 2.2mm 70% OZil 2.75mm 100% OZil Group 3 Group 4 2.2mm 100% OZil 2.2mm Mixed U/S

  8. Results (SEM, endothelial view) • SEM demonstrated comparable gaping of the internal wound and minimal trauma to DM and corneal endothelium Group 1 Group 2 2.2mm 70% OZil 2.75mm 100% OZil Group 3 Group 4 2.2mm 100% OZil 2.2mm Mixed U/S

  9. Conclusions • No gross differences in corneal wound architecture and integrity was observed among the four treatment groups as confirmed by gross, histopathologic, OCT, and SEM examination. • Torsional and mixed ultrasound settings do not appear to induce any adverse effects on incision integrity in standard and microincisional coaxial OZil and longitudinal ultrasound applications.

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