A comparative study on endothelial cell loss in nanophthalmic eyes undergoing cataract surgery by phacoemulsification

Abstract

Purpose: The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series. Methods: We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy. Results: The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0–23.5), 7.4 (IQR 1.0–-22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7–14.1) and 6.4 (IQR 2.6–-12.1) in age controlled normal eyes ( P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group ( P = 0.001). Nanophthalmic eyes with ACD <2.5 mm had a significantly greater reduction in ECD at 3 months postcataract surgery compared to baseline ( P = 0.039). Visual outcomes and IOP reduction in the study group with ACD >2.5 mm were significantly better postcataract surgery ( P = 0.02 and P = 0.002, respectively). Conclusion: The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth <2.5 mm, the percentage cell loss was significantly higher warranting the need for extensive intraoperative care. Increasing age was found to be the only significant risk factor influencing the ECD in short eyes.

Cataract surgery in adult eyes with short axial length

“…Jung and colleagues reported higher rates of endothelial cell loss in nanophthalmos (14.2%) compared to normal controls (7.6%), however, the difference was not statistically significant (P ¼ 0.54) [7]. A recent study by Rajendrababu and colleagues found that nanophthalmic eyes with AC depth <2.5 mm have a significantly greater reduction in endothelial cell density as compared to agematched controls (P ¼ 0.03) [48].…”

“…Eyes with short AL have an increased likelihood of experiencing complications at or after cataract surgery with studies reporting rates from 5.3 to 27.9% [47][48][49]. Day and colleagues reported a complication rate of 15.5% (16/103 eyes) including zonular dehiscence, aqueous misdirection, severe uveitis, IOL-related complications, and choroidal effusion.…”

“…Nanophthalmic eyes with AC depth <2.5 mm are at a significantly higher risk for endothelial cell loss from surgery [38 ▪▪ ]. Arshinoff's soft shell techniques are therefore recommended with the use of dispersive OVD to protect the endothelium and cohesive OVD to increase the depth of the AC [39,40].…”

Application of the Active-Fluidics System in Phacoemulsification: A Review

“…Eyes with short axial length (AL) are characterized by a shallow AC, narrow angle and thick lens. PKE in patients with short AL is very challenging because of their compacted anterior segment and limited space for maneuvers [ 62 , 63 , 64 ]. Maintaining a stable AC is crucial there, as a fluctuating IOP, especially a low IOP, greatly increases the risk of choroidal detachment, hemorrhage and PC rupture [ 15 ].…”

Medical Therapy and Scleral Windows for Uveal Effusion Syndrome: A Case Series and Literature Review

“…Additional precautions are required when treating nanophthalmic eyes with concomitant ocular conditions. Cataract surgery in these patients is challenging, and may result in poor visual outcomes and complications such as uveal effusion, retinal detachment, and corneal decompensation [ 47 ]. In one study of 114 nanophthalmic eyes undergoing cataract surgery, 29 eyes had complications, of which uveal effusion accounted for half [ 48 ].…”