Factors affecting stromal hydration of clear corneal incision architecture.

Factors affecting stromal hydration of clear corneal incision architecture We have some comments about the article by Calladine et al. thatwewould like to sharewith the authors. First, one factor thatmight cause the difference in architecture betweenhydrated clear corneal incisions (CCIs) and nonhydrated CCIs is the corneal stromal edema at the incision site induced by hydration. The authors might have to record the grade of edemaat theCCIs before hydration under the surgical microscope. This measurement could serve as the baseline status of the CCI edema before hydration. The difference in the baseline status between the 2 study groups might contribute to the architectural differences detected by anterior segment optical coherence tomography. Second, Calladine et al. might consider the cataract nucleus grading of the patients when interpreting the data. This is because the harder the lens nucleus, the more ultrasound energy would be used and the more damage to the corneal endothelium, leading to more corneal edema; even a phaco burn might occur at the CCIs. Third, the authors might have to adjust for factors other than stromal hydration that could influence the development of Descemet membrane detachment (DMD); ie, specifying every abnormal finding at the cornea before the surgeries, especially those at the CCI sites. In our clinical practice, we found that patients with arcus senilis were prone to developing DMD during phacoemulsification surgery. We also discovered that local DMDwas more common in phacoemulsification surgery done by junior surgeons than in those done by senior surgeons. This may be due to the junior surgeons having less skill in controlling the phaco handpiece, whichmight accidentally ‘‘shave off’’ a piece of Descemet membrane. Even senior surgeons may have different styles of controlling the phaco handpiece. Therefore, Calladine et al. might consider comparing the architectural features in 2 groups of patients whose surgeries were done by the same surgeon. A hard lens nucleus might be another factor causing more local DMD due to more manipulation to the CCIs by the handpiece. Patient compliance might also affect the occurrence of DMD. When the patients have poor compliance, the surgeonsmight have to control the eye and adjust the eye’s position using the handpiece and chopper from time to time, possibly leading to excessive manipulation of the CCIs. Six patients in the Calladine et al. study had surgery under topical anesthesia, and they were in the nohydration group. We are interested in knowing their compliance. If most of them had poor compliance during surgery, the actual difference in DMD might be more than the data provided in the article.