Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery

CONTEXTThe corneal endothelial cells are incapable of regeneration. When the endothelial cell density falls below 500 cells/mm 2 , corneal decompensation occurs resulting in corneal oedema. Manual Small Incision Cataract Surgery (SICS) and phacoemulsification are two common techniques of cataract surgery followed. AIMTo study the relationship between change in corneal endothelial cell density and the change in central corneal thickness before and after surgery in manual small incision cataract surgery versus phacoemulsification cataract surgery. SETTINGS AND DESIGNDepartment of Ophthalmology, Govt. Medical College, Kottayam. Longitudinal study. MATERIALS AND METHODSSubjects selected were patients admitted for cataract surgery (Manual small incision cataract surgery and phacoemulsification cataract surgery). The basic details of the patients and type of surgery going to be done were obtained. The endothelial cell count and central corneal thickness was measured (Using SP3000 P, TOPCON specular microscope with pachymeter on 3 occasions -1 day prior to surgery, one day after surgery and 4 weeks after surgery. The collected data was entered in excel and analysed using SPSS 16.0. The percentage decrease in endothelial cell count and increase in corneal thickness was calculated and compared among the two groups. Statistical analysis used, t test. RESULTSAverage CCT of SICS and phaco group was comparable on postoperative day 1 (SICS -555.1 µ phaco -564.71 µ), day 7 (SICS 535.08 µ, phaco -539.43 µ), day 28 (SICS-520.04 µ, phaco -523.49 µ). Percentage loss of endothelial cells -6.78% in SICS and 5.49% in phacoemulsification on postoperative day 28. CONCLUSIONSThere is no statistical significance in the decrease in endothelial cell count or increase in CCT between SICS and phacoemulsification.

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“…by Gogate P et al in 2010. 11 were much higher (SICS-15.52%, phaco-15.33%) than values obtained in this study.…”

Section: Endothelial Cell Countcontrasting

confidence: 79%

“…11 However, the result by Ganekal S et al in 2014. 14 a statistically significant difference between the endothelial cell density was found at week 1 and 6 postoperatively between the SICS and the phaco group.…”

Section: Endothelial Cell Countmentioning

confidence: 98%

Changes in Endothelial Cell Count and Central Corneal Thickness in Manual Small Incision Cataract Surgery Versus Phacoemulsification Cataract Surgery

Philip¹,

Kamalakshy²,

Narayaniyamma³

2016

jemds

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“…In this study, the mean ECD loss was approximately 80 cells/mm 2 (11.5%). Recent studies evaluating eyes with a normal preoperative ECD 7,20,28,29 report an endothelial cell loss of 1.8% to 15.0% after phacoemulsification. Previous studies 20,29 also found that the preoperative cell count was not predictive of corneal endothelial cell loss in eyes with a normal ECD.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of cataract surgery in eyes with a low corneal endothelial cell density

Yamazoe¹,

Yamaguchi²,

Hotta³

et al. 2011

Journal of Cataract and Refractive Surgery

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“…One month after surgery, the corneal endothelial loss was 24.3% in the phacoemulsification group versus only 11.2% in the Aqualase group. Previous studies on endothelial cell changes following cataract surgery demonstrated very low or no significant cell count changes at all between 1 and 4 weeks, and even between 3 and 6 months [27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Aqualase® Revisited: Endothelial Cell Loss Strongly Depends on Lens Density

Bergholz²,

Gonnermann³

et al. 2013

Ophthalmic Res

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Purpose: To analyze the dependence between corneal endothelial cell loss by Aqualase® cataract surgery and the nuclear opalescence grade of the lens. Patients and Methods: A total of 100 eyes of 92 patients were enrolled in this prospective, single-center study. Patients were randomly assigned to the Aqualase (50 eyes) or the phacoemulsification group (50 eyes). The nuclear density was classified with the Lens Opacities Classification System III. All procedures were performed by the same surgeon. Preoperatively and 1 week postoperatively, endothelial cell counts were obtained using a noncontact specular microscope (Konan, Japan). Results: (1) Aqualase group: the group of patients with a nuclear density of 1-2 (17 patients) showed no significant endothelial cell loss (4.1%, p = 0.163). The endothelial cell loss in grade 3 cataracts (28 eyes) was 13.9% (p = 0.004) and in grade 4 cataracts (5 eyes) 69.1% (p = 0.043), being statistically significant in both groups. (2) Phacoemulsification group: in nuclear density groups 1 and 2, endothelial cell loss was 6.3% (p = 0.41), in group 3 it was 17.6% (p = 0.001) and in group 4 it was 14.9% (p = 0.08). Only in nuclear opalescence grade 4 there was a significant difference between the Aqualase and the phacoemulsification procedure (p = 0.008). Conclusion: Endothelial cell loss by Aqualase technology depends strongly on the nuclear opalescence grade. In low- and medium-density cataracts, Aqualase does not seem to provoke significant endothelial cell loss. Due to very high endothelial loss in hard nuclei, Aqualase is unsuitable for these cataracts.

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Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery

Abstract: There were no clinically or statistically significant differences in ECC loss or visual acuity between phacoemulsification and SICS, although there was a small difference in the astigmatic shift.

Cited by 83 publications

References 19 publications

Changes in Endothelial Cell Count and Central Corneal Thickness in Manual Small Incision Cataract Surgery Versus Phacoemulsification Cataract Surgery

Changes in Endothelial Cell Count and Central Corneal Thickness in Manual Small Incision Cataract Surgery Versus Phacoemulsification Cataract Surgery

Outcomes of cataract surgery in eyes with a low corneal endothelial cell density

Aqualase® Revisited: Endothelial Cell Loss Strongly Depends on Lens Density

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