title: Prospective observational study of conjunctival scarring after phacoemulsification.
abstract: OBJECTIVE
  To examine whether anterior segment-optical coherence tomography (AS-OCT) can detect conjunctival scarring after transscleral phacoemulsification and whether temporal transscleral phacoemulsification causes scarring in the superior conjunctiva.
  
  
  METHODS
  Transscleral phacoemulsification was performed in the superior conjunctiva (superior incision group) or the temporal conjunctiva (temporal incision group). Anterior segment-optical coherence tomography (AS-OCT) images of the superior conjunctiva were obtained before and after surgery. We quantified the thickness of the conjunctiva and preservation rates of the borderlines among the subconjunctival layers. The relationship between the AS-OCT images and histology was evaluated in rabbit eyes with phacoemulsification.
  
  
  RESULTS
  Each group comprised 25 patients. At ≤1 month after surgery, the superior conjunctiva was significantly thicker in the superior incision group than the temporal incision group (1 day, 7 days, and 1 month after surgery; p < 0.0001, p < 0.0001, and p < 0.001 respectively); however, there were no significant differences between the two groups at ≥2 months. The borderline of the conjunctival stroma/Tenon's capsule and the borderline of the Tenon's capsule/sclera were preserved significantly better in the temporal incision group after surgery (p < 0.0001). The cell densities in the conjunctiva of the rabbit temporal incision group were unchanged after surgery, whereas the rabbit superior incision group had significantly more neutrophils (p = 0.0001) and myofibroblasts (p < 0.0001) in the superior conjunctiva than the temporal incision group.
  
  
  CONCLUSIONS
  Anterior segment-optical coherence tomography (AS-OCT) images can detect conjunctival scarring after transscleral phacoemulsification. The layer structures in the superior conjunctiva are unaffected by temporal transscleral incision.
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Gozawa
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takamura
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Miyake
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Satoshi
authors.identifier: http://orcid.org/0000-0002-3727-7279
authors.initials: S
authors.lastname: Yokota
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Sakashita
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Arimura
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takihara
authors.affiliation: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan. inatani@u-fukui.ac.jp.
authors.forename: Masaru
authors.initials: M
authors.lastname: Inatani
mesh_terms: D000199:Actins / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging; D002452:Cell Count; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology*; D003229:Conjunctival Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D018918:Phacoemulsification / Q000009:adverse effects*; D011446:Prospective Studies; D011817:Rabbits; D012590:Sclera / Q000000981:diagnostic imaging / Q000601:surgery; D041623:Tomography, Optical Coherence
chemical_list: C541116:ACTA2 protein, human; D000199:Actins
keywords: conjunctiva; phacoemulsification; scarring; trabeculectomy