| Objective To investigate the effect of anterior chamber(AC)irrigation on AC stability during phacoemulsification and possible ocular complications resulting from intraoperative AC instability.Methods The prospective clinical study enrolled 242(280 eyes)age-related cataract patients who underwent phaco combined with intraocular lens implantation between at the Ophthalmology Center of Affiliated Hospital of Nantong University from May 2020 to May 2021.The patients were categorized into the irrigation and non-irrigation groups,respectively,depending on the use of a self-made anterior chamber maintainer(ACM)during phaco.AC stability was evaluated using the microscope-integrated intraoperative optical coherence tomography(i OCT).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 at1 week,1 month,and 3 months postoperatively.The chi-square test was used to analyze PVD grade.The Mann–Whitney U test was used to compare AC flare and cell values between groups.The level of agreement between operating microscopy and i OCT was analyzed using the Kappa test.Results In total,121(86.4%)and 127(90.7%)eyes completed the3-month follow-up in the irrigation and non-irrigation groups.There was good consistency in AC stability evaluation between operating microscopy and i OCT.The incidence of AC instability was significantly different between groups after the phaco and irrigation/aspiration(I/A)tips were withdrawn from the AC(P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%),14(28.6%)eyes and 22(40.7%),37(68.5%)eyes in the irrigation and non-irrigation groups,respectively(P=0.006,P<0.001).CFT was significantly higher in the non-irrigation group at 1 and 3 months postoperatively(P=0.018,P=0.010).Conclusions Both operating microscopy and i OCT are efficient for AC stability evaluation.When the phaco and I/A tips were withdrawn from the AC there was frequent instability.Intraoperative AC instability can increase surgery-induced inflammation and lead to postoperative complications such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 and macular edema.The self-made ACM can effectively reduce the incidence of intraoperative AC instability and these complications. |
