Cataract surgery in eyes with low corneal endothelial cell density
To compare corneal endothelial damage after cataract surgery in eyes with low endothelial cell density (ECD) and eyes with normal ECD.
Hayashi Eye Hospital, Fukuoka, Japan.
Cataract surgery was performed in eyes with a low ECD (500 to 1000 cells/mm(2)) (low-density group) and control eyes with a normal ECD. The ECD and central corneal thickness (CCT) were measured preoperatively and 1 and 3 months postoperatively, and the percentage cell loss and increase in CCT were compared.
The low-density group and control group each comprised 50 eyes. In the low-density group, 39 eyes had nonprogressive endothelial pathology and 11 had Fuchs dystrophy. The mean ECD was significantly less and the CCT significantly greater in the low-density group than in the control group throughout the follow-up (P ≤.0066). However, no significant difference in the percentage of cell loss was found between groups at 1 or 3 months (5.1%, low-density group; 4.2%, control group) (P ≥.1477). The percentage increase in CCT was significantly greater in the low-density group than in the control group at 1 month (P<.0001), although there was no significant difference at 3 months (0.4% and -0.4%, respectively) (P=.2172).
Corneal endothelial damage after cataract surgery in eyes with low ECD was slight and comparable to that in healthy eyes, which suggests that cataract surgery alone (without corneal transplantation) should be performed first.
Available from: Mário Santos
- "Currently, the phacoemulsification is the most used procedure to extract cataract and recover visual acuity. However, the use of an inadequate phacoemulsification energy can disrupt the posterior lens capsule, and among other complications, cause a significant loss of the corneal endothelial cells  . Thus, optimal phacoemulsification energy is demanded for safety cataract removal. "
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ABSTRACT: Cataract affects more than 20 million people worldwide and is the leading cause of vision loss. Currently, the phacoemulsification is the most used procedure to extract cataract and recover visual acuity. Optimal phacoemulsification energy is demanded for safety cataract removal. It is well established that the energy value is determined by the cataract hardness. In this study twenty porcine eyes were used as experimental samples. Cataract was induced by an ethanol:2-propanol:formalin solution. A 25 MHz focused transducer has been used to estimate the ultrasound velocity and attenuation. Statistical analysis was performed to compare the different used methodologies and to correlate the different ultrasound parameters with different stages of cataract formation (lens hardness).
Available from: Mohamed Abdel-Monem Soliman Mahdy
- "This naturally occurring process is exacerbated when there is additional cell loss resulting from intraocular surgery, caused by both the heat generated and the turbulence of fluids within the anterior chamber that occur during phaco surgery. Despite the fact that cases with low endothelial cell density (ECD) could be at greater risk of developing corneal decompensation, no significant correlation was found between the preoperative ECD and the percentage of postoperative endothelial cell loss.10 "
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ABSTRACT: To assess the relationship between postoperative endothelial cell loss and microcoaxial phaco parameters using Ozil IP (Alcon Laboratories, Inc, Fort Worth, TX) in noncomplicated cataract surgery.
In this prospective observational study, 120 consecutive cases of cataract patients with different grades of nuclear hardness underwent microcoaxial phacoemulsification through a 2.2-mm clear corneal incision. An Alcon Infinity Vision System with Ozil IP (Alcon Laboratories) was used with an Ozil torsional handpiece and a Kelman-style 45° phacoemulsification tip. Patients underwent preoperative and postoperative central endothelial cell counts.
The study included 120 cases of age-related cataract whose mean age (standard deviation [SD]) was 59.68 years (9.47). There was a highly statistically significant endothelial cell loss (P < 0.001). The endothelial cell loss ranged 11-1149 cells/mm(2) with a median (interquartile range) of 386 cells/mm(2) (184.5-686 cells/mm(2)). The percentage of postoperative ECLoss% ranged from 0.48% to 47.8% with a median (interquartile range) of 15.4% (7.2% to 26.8%). A significant positive correlation was found between the ECLoss% and different phaco parameters. The Spearman's rank-order correlation coefficient values, rho, (ρ) were as follows: CDE (ρ = 0.425), aspiration time (ρ = 0.176), and volume (ρ = 0.278). Also, ECLoss% was significantly correlated with the grade of nuclear opalescence (Kendall's tau τ = 0.42).
Microcoaxial phacoemulsification was efficient in removing noncomplicated cataracts; however a statistically significant endothelial cell loss was noted, especially with increased nuclear hardness. This endothelial cell loss was mostly related to the increased cumulative dissipated energy (CDE), aspiration time, and volume of balanced salt solution used.
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ABSTRACT: Corneal endothelial cell loss remains a well known, undesirable side-effect of cataract surgery that may, in severe cases, negatively impact patients' postoperative visual outcomes. This article reviews the current literature and describes in detail how the degree of corneal endothelial cell loss is influenced by specific patient risk factors, as well as the arrival of newer surgical techniques and technologies.
Recent studies have demonstrated a reduction in corneal endothelial cell loss after phacoemulsification with the use of viscoelastic materials and modifications in phacoemulsification technology. Some patient characteristics may predispose patients to increased endothelial cell loss during cataract surgery.
Advances in surgical technique, the implementation of newer surgical technologies such as torsional ultrasound and viscoelastic devices, and aspects of patients' preexisting medical history may lead to varying degrees of endothelial cell loss after cataract surgery. Appropriately addressing these issues during the perioperative period may improve the rate of endothelial cell loss, and thus further enhance the visual outcome of patients undergoing cataract surgery.
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