Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes

Abstract

Purpose:To compare Endothelial cell(EC) loss following Phacoemulsification (PKE) in pupils of different sizes.Methods:A prospective double masked observational study in which a total of 150 eyes of 150 patients between 50 & 70 years of age with senile cataract of nuclear sclerosis grade II were enrolled. Patients were allocated into three groups of 50 eyes each in Group A (pupil size <5 mm), Group B (pupil size 5–7 mm) and Group C (pupil size >7 mm). Pupillary size was measured by determining the height of slit on slit-lamp biomicroscope examination. PKE was done by the same expert surgeon using vertical chop technique and a foldable intraocular lens was implanted in the capsular bag. Corneal EC count and pachymetry were performed twice and average of 2 readings was taken for the purpose of this study. Measurements were taken preoperatively and postoperatively on day 1, day 7 and day 30.Results:The mean EC count loss on postoperative day 1 in Group A was 19.45%, Group B 14.89%, Group C 10.19% with statistical significant difference between Group A and Group B, as also Group A and Group C. The difference was not significant between Group B and Group C, though there was a fall in EC count in Group C as well. Increase in corneal thickness on postoperative day 1 in group A was 5.43%, Group B 3.55%, Group C 2.14% with statistical significant difference between Group A and Group B, as also Group A and Group C with no difference in Group B and Group C.Conclusion:PKE done in eyes with maximal pupillary dilatation of <5 mm causes a greater EC loss and results in thicker corneas postoperatively as compared to eyes with pupillary dilatation of >5 mm at the end of one month.

Intraocular lens implantation in the absence of capsular support: scleral-fixated vs retropupillary iris-claw intraocular lenses

“…During cataract surgery, endothelial cell loss may be caused by ultrasound vibration, air bubbles, turbulent flow of irrigating solution, direct contact with surgical instruments, or the IOL during the surgical procedure. 8,104…”

“…During cataract surgery, endothelial cell loss may be caused by ultrasound vibration, air bubbles, turbulent flow of irrigating solution, direct contact with surgical instruments, or the IOL during the surgical procedure. 8,104 Several studies of SF IOL implantation (both sutured and sutureless) have reported an average 2.1% to 6% endothelial cell loss postoperatively. 23,27,41,42,51,63 In addition, there are reports of endothelial cell loss of up to 14.1% after 3 months, 17.5% after 7 months, and 27% after 1 year of SF IOL implantation.…”

In vitro analysis of clinically relevant aspects of a polymer-coated phacoemulsification tip vs a traditional tip

“…22 Corneal endothelial cell density is reduced by ∼0.5% per year with normal aging, and additional endothelial cell loss can occur after cataract surgery. [28][29][30] Previous in vitro studies demonstrated the formation of cavitation bubbles at the probe tip that was dependent on the ultrasound power. 15,22,31 An in vitro phacoemulsification study that simulated cataract surgery reported the formation of free radicals, generated as a result of acoustic cavitation.…”

Safety and efficacy of cataract surgery performed with a low-energy femtosecond laser compared with conventional phacoemulsification in Chinese patients: a randomized clinical trial

“…Cataract surgery is the most commonly performed ophthalmic procedure worldwide. Although phacoemulsification is effective in providing good visual acuity, the dissipation of ultrasonic energy during phacoemulsification causes mechanical and thermal damage to the corneal endothelium [ 1 ]. Corneal endothelial cells play a pivotal role in maintaining corneal transparency; therefore, damage to corneal endothelium function may lead to corneal edema and, in advanced stages, corneal decompensation/bullous keratopathy [ 2 ].…”