Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision.
OBJECTIVE
To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters.


METHODS
Fifty-eight patients had phacoemulsification through temporal, two-step clear corneal tunnel incisions. In Group A (n = 28), a one-piece, plate-haptic foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color-coded, computer-assisted specular microscopy was used for special cell analysis after 1 year.


RESULTS
Collective data showed an ECL of 7.9 +/- 4.1% (mean +/- standard deviation) at 2 to 5 days postoperatively, 6.7 +/- 2.9% after 6 months, and 7.3 +/- 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST < or = 11/2 minutes, 6.7% with UST > 11/2 to 21/2 min, and 9.6% with UST > 21/2 to 31/2 min; in Group B it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age-related cell parameters 1 year postoperatively.


CONCLUSIONS
Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.
Dick
H B
HB
Department of Ophthalmology, Justus-Liebig-University of Giessen, Germany.
Kohnen
T
T
Jacobi
F K
FK
Jacobi
K W
KW
D000368:Aged; D002452:Cell Count; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007910:Lenses, Intraocular; D008297:Male; D008768:Methylmethacrylates; D008853:Microscopy; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications / Q000473:pathology*; D011446:Prospective Studies; D011474:Prosthesis Design; D012828:Silicones; D014945:Wound Healing / Q000502:physiology*
D008768:Methylmethacrylates; D012828:Silicones