Effect of Reformation of the Anterior Chamber by Air or by a Balanced Salt Solution (BSS) on Corneal Endothelium after Phacoemulsification: A Comparative Study

Abstract

Aim To study the effect of reformation of the anterior chamber by air or by a balanced salt solution, after smooth phacoemulsification on the corneal endothelial count and morphology. Methods A prospective interventional nonrandomized comparative study included 500 eyes of 500 patients with age range between 50 and 60 years, prepared for cataract surgery and presented to the Ophthalmology department of Sohag University Hospital in the period from October 2016 to May 2017. Corneal endothelial morphology and count were examined, and the results were recorded for all cases before the surgery. Patients were divided into two groups, and both groups were diagnosed with grade 2 cataract and underwent uncomplicated phacoemulsification performed by well-trained surgeons. At the end of the surgery, group 1 was subjected to a reformation of the anterior chamber via a balanced salt solution (BSS) injection while group 2 was subjected to a reformation of the anterior chamber via air injection. Corneal endothelial morphology and count were evaluated in the first and 3rd month postoperatively. Results The study included 500 patients (250 in each group), 220 males (44%) and 280 females (56%) with no significant statistical age differences. Both preoperative and postoperative (3 months after the operation) recorded parameters of the corneal endothelium did not show any significant statistical differences. The cumulative dissipated energy was recorded, for all cases of both groups, during phacoemulsification with no significant statistical differences (P = 0.7). Conclusion There is no difference between the effect of reformation of the anterior chamber after phacoemulsification, using air or using a BSS injection, on the corneal endothelial count and morphology.

Effect of Reformation of the Anterior Chamber by Air or by Ringer’s lactate solution on Corneal Endothelial count and morphology after Phacoemulsification

“…The result goes with Alsmman A et al study 29 , which included 500 eyes of 500 patients with age range between 50 and 60 years, the authors compared the effect of air and BSS injected into the anterior chamber post smooth phacoemulsification surgery on corneal endothelial loss. They reported the reformation of the anterior chamber by air injection has no toxic effect on the corneal endothelium.…”

Intracameral air bubble tamponade in routine cataract surgery

“…However, in over 1000 cases of phacoemulsi cation cataract surgery with IABT that had been reported, including 201 cases in this study, no endophthalmitis was noted. 19,24,25 In our secondary analysis, postoperative CCT was more thickened in the non-IABT group. (11.2µm vs. 5µm; P = 0.034) Subclinical corneal edema caused by stromal hydration, which could not be observed by slit lamp biomicroscope, can be detected under specular microscope.…”

“…This nding was consistent with that of Alsmman et al, who have conducted a prospective non-randomized study allocating 500 cataract surgeries of 500 patients into IABT and non-IABT groups. 24 However, another prospective non-randomized study with 100 cases reported by Mataftsi et al showed a completely opposite result, that the ECD loss was signi cantly higher in the IABT group. 25 This difference may be caused by the selection bias, that these two studies and ours were all non-randomized.…”

“…22,23 However, in recent publications that cataract surgeries were performed with an advanced phacoemulsi cation and CCI technique, no pupillary block was noted in over 1000 cases with IABT, including cases in this study. 19,24,25 This huge difference may be explained the presence of capsule acting as a barrier in current cataract surgeries. In ICCE patients with IABT, the air can easily ow into vitreous cavity without lens capsule, which can lead to the danger of pupillary block.…”

The Effect of Air Bubble on Corneal Endothelium after Phacoemulsification

“…The endothelial cell density of the two groups was found to be similar preoperatively and at 3 months postoperatively [18]. Likewise, Alsmman et al [19] studied air bubble versus balanced salt solution for anterior chamber reformation at the end of phacoemulsi cation and found similar endothelial cell count-morphology in both groups at 1 and 3-month follow-up visits. In contrast, Mataftsi et al [20] compared intrastromal wound hydration with anterior chamber air tamponade to ensure waterproof closure of corneal incisions at the end of the phacoemulsi cation surgery and reported that air has a detrimental effect on endothelial cell count compared to balanced salt solution.…”