Near-term analysis of corneal epithelial thickness after cataract surgery and its correlation with epithelial cell changes and visual acuity

PURPOSE: To quantify corneal central epithelial thickness and cell changes 2 weeks after cataract surgery and correlate it with corrected distance visual acuity (CDVA). SETTING: Eye and ENT Hospital of Fudan University, Shanghai, China. DESIGN: Prospective observational study. METHODS: Patients having cataract surgery were assessed preoperatively and 1, 2, 3, 5, 7, and 14 days postoperatively. Anterior segment spectral-domain optical coherence tomography and corneal confocal laser scanning microscopy were used to measure central epithelial thickness, central corneal thickness (CCT), corneal basal epithelial cell density, and Langerhans cell density. RESULTS: The CCT and central epithelial thickness were significantly increased on 1 day postoperatively. From 1 day to 14 days, the CCT gradually decreased but was greater than the baseline value, whereas the central epithelial thickness declined to near baseline values at 3 days, became thinner at 5 and 7 days, and then returned to baseline at 14 days. The corneal basal epithelial cell density increased significantly postoperatively. Significant Langerhans cell infiltration was seen at 3 days and 5 days. Significant correlations were found between CDVA and the central epithelial thickness and CCT. The maximum increase in central epithelial thickness and CCT correlated with the lowest achieved values of CDVA postoperatively. Patients with significant edema at 1 day had worse CDVA at 14 days. CONCLUSIONS: Near-term epithelial remodeling occurred, initially appearing as a thickening that might be attributed to edema. This was followed by thinning, possibly caused by inflammation, and finally reaching baseline levels. Edema of the corneal epithelium was related to visual recovery after cataract surgery.