Changes in corneal thickness and corneal endothelial cell density after phacoemulsification cataract surgery
A double-blind randomized trial
Keywords:
Cataract, Phacoemulsification, Corneal endothelial cell density, Corneal thicknessAbstract
Background: Age-related cataract is a leading cause of visual impairment, considered a global health burden, it is responsible for over 47% of blindness worldwide. Surgical intervention is usually the treatment of choice and phacoemulsification cataract surgery with implantation of an intraocular lens is the most common procedure, which may have several complications. Objectives: To determine the effects of phacoemulsification surgery on corneal endothelial cell density and corneal thickness in patients undergoing cataract surgery. Methods: The present study was conducted on patients diagnosed with immature senile cataract requiring surgical intervention from November 2013 to 2014 in Khatam al Anbia Hospital (a tertiary ophthalmology center). Physical examination included best-corrected visual acuity using the Snellen chart, refraction, slit-lamp bio-microscopy for anterior chamber evaluation, keratometry, Goldman tonometry, gonioscopy, and dilated indirect ophthalmoscopy, pachymetry, specular microscopy and biometry. Surgery was performed by similar method and technique in all patients. The change in the corneal endothelial cell count or density and central corneal thickness (CCT) number were compared preoperatively and one day, one week, one month, and three months post–operatively. Results: A total of 92 eyes of 85 patients (43 females and 42 males with mean age of 62.1±12.2 years) were studied. Patients’ visual acuity improved (log MAR: 1±0.5 preoperatively to 0.45±0.34 post-operatively) (p=0.001). There was 11.4% endothelial cell loss (ECL) and significant decrease in ECC (from 2,791.15±99.86 to 2,472.87±472.14) (p=0.04). The central corneal thickness increased significantly (from 530.47±2.60 to 540.91±36.07). Diabetic patients (12.9%) had a statistically significant higher ECL rate after phacoemulsification (14.6% versus 8.7% respectively, p=0.002). Conclusion: Phacoemulsification resulted in significant corneal endothelial damage, which is particularly important in patients with a borderline reservoir of endothelial cell, such as diabetic patients, which highlights the necessity of refining the current surgical methods and instruments to minimize the endothelial damage. Trial registration: The trial was registered in the Thai clinical trial registry (http://www.clinicaltrials.in.th) with the ID: TCTR20171122001. Funding: The study was supported by a research grant of Mashhad University of Medical Sciences.
References
Clemons TE, Kurinij N, Sperduto RD. Associations of mortality with ocular disorders and an intervention
of high-dose antioxidants and zinc in the Age-Related Eye Disease Study: AREDS Report No. 13. Arch
Ophthalmol. 2004; 122(5): 716-26. doi: 10.1001/archopht.122.5.716. PMID: 15136320, PMCID:
PMC1473208.
Foong AW, Fong CW, Wong TY, Saw SM, Heng D, Foster PJ. Visual acuity and mortality in a chinese
population. The Tanjong Pagar Study. Ophthalmology. 2008; 115(5): 802-7. doi:
1016/j.ophtha.2007.04.066.
Knudtson MD, Klein BE, Klein R. Age-related eye disease, visual impairment, and survival: the Beaver
Dam Eye Study. Archives of ophthalmology. 2006; 124(2): 243-9. doi: 10.1001/archopht.124.2.243.
Jonas JB, Bourne RR, White RA, Flaxman SR, Keeffe J, Leasher J, et al. Visual impairment and blindness
due to macular diseases globally: a systematic review and meta-analysis. American journal of
ophthalmology. 2014; 158(4): 808-15. doi: 10.1016/j.ajo.2014.06.012.
Duerksen R, Limburg H, Carron JE, Foster A. Cataract blindness in Paraguay--results of a national survey.
Ophthalmic epidemiology. 2003; 10(5): 349-57. doi: 10.1076/opep.10.5.349.17326.
Zheng Y, Lavanya R, Wu R, Wong WL, Wang JJ, Mitchell P, et al. Prevalence and causes of visual
impairment and blindness in an urban Indian population: the Singapore Indian Eye Study. Ophthalmology.
; 118(9): 1798-804. doi: 10.1016/j.ophtha.2011.02.014.
Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, et al. Global data on visual
impairment in the year 2002. Bull World Health Organ. 2004; 82(11): 844-51. doi: /S0042- 96862004001100009. PMID: 15640920, PMCID: PMC2623053.
Ivers RQ, Cumming RG, Mitchell P, Simpson JM, Peduto AJ. Visual risk factors for hip fracture in older
people. Journal of the American Geriatrics Society. 2003; 51(3): 356-63. doi: 10.1046/j.1532- 5415.2003.51109.x.
Taylor HR, Pezzullo ML, Keeffe JE. The economic impact and cost of visual impairment in Australia. Br J
Ophthalmol. 2006; 90(3): 272-5. doi: 10.1136/bjo.2005.080986. PMID: 16488942, PMCID: PMC1856946.
Allen D. Cataract. BMJ Clin Evid. 2011; 2011. PMID: 21718561, PMCID: PMC3275311.
Dandona R, Dandona L. Refractive error blindness. Bulletin of the World Health Organization. 2001;
(3): 237-43. PMID: 11285669, PMCID: PMC2566380.
Trivedi R, Werner L, Apple D, Pandey S, Izak A. Post cataract-intraocular lens (IOL) surgery
opacification. Eye. 2002; 16(3): 217-41. doi: 10.1038/sj.eye.6700066.
Trinh L, Denoyer A, Auclin F, Baudouin C. Femtosecond laser-assisted cataract surgery. J Fr Ophtalmol.
; 38(7): 646-55. doi: 10.1016/j.jfo.2015.05.002. PMID: 26206508.
de Silva SR, Riaz Y, Evans JR. Phacoemulsification with posterior chamber intraocular lens versus
extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract.
Cochrane Database Syst Rev. 2014; 1: Cd008812. doi: 10.1002/14651858.CD008812.pub2. PMID:
Bourne WM, Waller RR, Liesegang TJ, Brubaker RF. Corneal trauma in intracapsular and extracapsular
cataract extraction with lens implantation. Archives of ophthalmology. 1981; 99(8): 1375-6. doi:
1001/archopht.1981.03930020249006.
Thakur SK, Dan A, Singh M, Banerjee A, Ghosh A, Bhaduri G. Endothelial cell loss after small incision
cataract surgery. Nepalese journal of ophthalmology. 2011; 3(2): 177-80. doi: 10.3126/nepjoph.v3i2.5273.
Bourne RR, Minassian DC, Dart JK, Rosen P, Kaushal S, Wingate N. Effect of cataract surgery on the
corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery.
Ophthalmology. 2004; 111(4): 679-85. doi: 10.1016/j.ophtha.2003.07.015.
Rosado-Adames N, Afshari NA. The changing fate of the corneal endothelium in cataract surgery. Current
opinion in ophthalmology. 2012; 23(1): 3-6. doi: 10.1097/ICU.0b013e32834e4b5f.
Rajavi Z, Katibeh M, Ziaei H, Fardesmaeilpour N, Sehat M, Ahmadieh H, et al. Rapid assessment of
avoidable blindness in Iran. Ophthalmology. 2011; 118(9): 1812-8. doi: 10.1016/j.ophtha.2011.01.049.
Wang D, Amoozgar B, Porco T, Wang Z, Lin SC. Ethnic differences in lens parameters measured by
ocular biometry in a cataract surgery population. PloS one. 2017; 12(6): e0179836. doi:
1371/journal.pone.0179836.
Shahbazi S, Studnicki J, Warner-Hillard CW. A cross-sectional retrospective analysis of the racial and
geographic variations in cataract surgery. PloS one. 2015; 10(11): e0142459. doi:
1371/journal.pone.0142459.
Mohammadpour M, Jafannasab M, Javadi M. Outcomes of acute postoperative inflammation after cataract
surgery. European journal of ophthalmology. 2007; 17(1): 20-8. doi: 10.1177/112067210701700104.
PMID: 17294379.
Hashemi H, Alipour F, Mehravaran S, Rezvan F, Fotouhi A, Alaedini F. Five year cataract surgical rate in
Iran. Optometry and vision science: official publication of the American Academy of Optometry. 2009;
(7): 890-4. doi: 10.1097/OPX.0b013e3181ae1cc6.
O'Brien PD, Fitzpatrick P, Kilmartin DJ, Beatty S. Risk factors for endothelial cell loss after
phacoemulsification surgery by a junior resident. Journal of cataract and refractive surgery. 2004; 30(4):
-43. doi: 10.1016/s0886-3350(03)00648-5.
Faramarzi A, Javadi MA, Karimian F, Jafarinasab MR, Baradaran-Rafii A, Jafari F, et al. Corneal
endothelial cell loss during phacoemulsification: bevel-up versus bevel-down phaco tip. Journal of cataract
and refractive surgery. 2011; 37(11): 1971-6. doi: 10.1016/j.jcrs.2011.05.034.
Yamazoe K, Yamaguchi T, Hotta K, Satake Y, Konomi K, Den S, et al. Outcomes of cataract surgery in
eyes with a low corneal endothelial cell density. Journal of cataract and refractive surgery. 2011; 37(12):
-6. doi: 10.1016/j.jcrs.2011.05.039.
Conrad-Hengerer I, Al Juburi M, Schultz T, Hengerer FH, Dick HB. Corneal endothelial cell loss and
corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month
follow-up. Journal of cataract and refractive surgery. 2013; 39(9): 1307-13. doi:
1016/j.jcrs.2013.05.033.
Mencucci R, Ponchietti C, Virgili G, Giansanti F, Menchini U. Corneal endothelial damage after cataract
surgery: Microincision versus standard technique. Journal of cataract and refractive surgery. 2006; 32(8):
-4. doi: 10.1016/j.jcrs.2006.02.070.
Holzer MP, Tetz MR, Auffarth GU, Welt R, Volcker HE. Effect of Healon5 and 4 other viscoelastic
substances on intraocular pressure and endothelium after cataract surgery. Journal of cataract and refractive
surgery. 2001; 27(2): 213-8. doi: 10.1016/S0886-3350(00)00568-X.
Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during
phacoemulsification. Journal of cataract and refractive surgery. 1996; 22(8): 1079-84. doi: 10.1016/S0886- 3350(96)80121-0.
Joussen AM, Barth U, Çubuk H, Koch HR. Effect of irrigating solution and irrigation temperature on the
cornea and pupil during phacoemulsification. Journal of Cataract & Refractive Surgery. 2000; 26(3): 392-7.
doi: 10.1016/S0886-3350(99)00470-8.
Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and
intraoperative parameters. Journal of cataract and refractive surgery. 2000; 26(5): 727-32. doi:
1016/S0886-3350(99)00462-9.
Lundberg B, Jonsson M, Behndig A. Postoperative corneal swelling correlates strongly to corneal
endothelial cell loss after phacoemulsification cataract surgery. American journal of ophthalmology. 2005;
(6): 1035-41. doi: 10.1016/j.ajo.2004.12.080.
Behndig A, Lundberg B. Transient corneal edema after phacoemulsification: comparison of 3 viscoelastic
regimens. Journal of cataract and refractive surgery. 2002; 28(9): 1551-6. doi: 10.1016/S0886- 3350(01)01219-6.
Glasser DB, Schultz RO, Hyndiuk RA. The role of viscoelastics, cannulas, and irrigating solution additives
in post-cataract surgery corneal edema: a brief review. Lens and eye toxicity research. 1992; 9(3-4): 351-9.
PMID: 1301791.
O'Neal MR, Polse KA. Decreased endothelial pump function with aging. Investigative ophthalmology &
visual science. 1986; 27(4): 457-63. PMID: 3957564.
Kim J, Jo M, Brauner S, Ferrufino-Ponce Z, Ali R, Cremers S, et al. Increased intraocular pressure on the
first postoperative day following resident-performed cataract surgery. Eye. 2011; 25(7): 929-36. doi:
1038/eye.2011.93. PMID: 21527959, PMCID: PMC3178167.
Hugod M, Storr-Paulsen A, Norregaard JC, Nicolini J, Larsen AB, Thulesen J. Corneal endothelial cell
changes associated with cataract surgery in patients with type 2 diabetes mellitus. Cornea. 2011; 30(7):
-53. doi: 10.1097/ICO.0b013e31820142d9.
Mathew PT, David S, Thomas N. Endothelial cell loss and central corneal thickness in patients with and
without diabetes after manual small incision cataract surgery. Cornea. 2011; 30(4): 424-8. doi:
1097/ICO.0b013e3181eadb4b.
Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Corneal Changes After Small-Incision Cataract
Surgery in Patients With Diabetes Mellitus. Archives of ophthalmology. 2004; 122(7): 966-9. doi:
1001/archopht.122.7.966.
Cook C. How to improve the outcome of cataract surgery. Community Eye Health.
;13(35):37.DOI.PMCID: PMC1705972.
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