Corneal Changes After Cataract Surgery : Short Term Results of an in vivo Confocal Microscopy Study

Purpose:To investigate corneal changes after cataract surgery by means of confocal microscopy. Methods:In a prospective study 30 patients (age 74 ± 7 years) undergoing uncomplicated cataract (N2 AREDS classification) surgery were analyzed before and after phacoemulsification through lateral 2,5 mm clear cornea incision and foldable in the bag IOL implant. Viscoelastics were routinely used. All patients were operated on by the same surgeon (S.D.). A complete eye examination, including in vivo laser scanning confocal microscopy (Heidelberg Retina Tomograph 2- Rostock Cornea Module, HRT2-RCM) was performed at baseline and 1 and 3 months after surgery. At follow-up visits, the following corneal parameters were investigated: number, reflectivity, beading, changes in morphology of nerve fibers, presence of dendritic cells, endothelial cells number. The difference between baseline and follow-up visit was analyzed using paired t-test. Results:After cataract surgery, 71% of the patients showed a significant reduction of the number of the sub-basal nerve plexus fibers, 66% a significant decrease of reflectivity, 83% a significant increase of the beading; all patients had a statistically significant higher number of dendritic cells and a lower number of endothelial cells compared to baseline. In 60% patients, the nerve plexus morphology changed from regular to irregular (reticular-like aspect ) after surgery. Conclusions:Our results suggest that even an uneventful cataract surgery, when inspected by means of confocal microscopy, may lead to relevant corneal modifications, particularly in the sub-basal nerve plexus. Studies with larger sample size and longer follow-up are advisable to better clarify this clinically important though relatively unexplored issue.