Cataract surgery in eyes with a low corneal endothelial cell density

Poster Details

First Author: N.Matsuki JAPAN

Co Author(s):    T. Watanabe   Y. Ninomiya   I. Namiki   M. Inoue   T. Nagamoto  

Abstract Details

Purpose:

To evaluate the surgical outcome of cataract surgery in eyes with a low preoperative corneal endothelial cell density (ECD).

Setting:

Kyorin Eye Center, Kyorin University School of Medicine, Mitaka, Tokyo, Japan

Methods:

Twenty-three eyes of 18 patients (mean age; 74 years old, 4 men and 14 women) with a preoperative ECD of less than 1500 cells/mm2 that had cataract surgery between April 2000 and April 2011 and had followed at least 3 months were identified. Standard phacoemulsification with intraocular lenses was performed using the soft-shell technique. The rate of endothelial cell loss, visual outcome, and incidence of bullous keratopathy were retrospectively assessed.

Results:

The mean preoperative ECD was 1062±277 cells/mm2 (686 to 1445 cells/mm2). The preoperative grades of nuclear sclerosis with Emery-Little classification was one eye with Grade 1, 11 eyes with Grade 2, 18 eyes with Grade 3, 2 eyes with Grade 4, and one eye with Grade 5. Preoperative mean depth of anterior chamber was 2.88±0.50 mm. The causative factors of ECD loss was laser iridectomy to treat acute glaucoma attack in 2 eyes, prophylactic laser iridectomy in 3 eyes, psudoexfoliation in 2 eyes, traumatic injury with corneal opacity in 2 eyes, syphilis in 5 eyes, Fuch’s corneal dystrophy in 2 eyes, and diabetes in 4 eyes. The postoperative ECD loss was uneven in each eye and the mean ECD increased postoperatively to 6.57±49.8?. Postoperative vision improved in 22 eyes and decreased in one eye. In 10 eyes with postoperative ECD loss of more than 20%, postoperative bullous keratophathy developed in 3 eyes after 2 to 5 years. The causative factor in these eyes was post-traumatic injury in one eye, post-glaucoma attack in one eye, diabetes in one eye with preoperative ECD of 1148, 686, and 752 cells/mm2, respectively.

Conclusions:

These results suggest that recent modern techniques for cataract surgery provide excellent visual improvement in many patients with a low preoperative ECD. However ECD loss was uneven in each eye and possible development of bullous keratopathy should be explained preoperatively to the patients. FINANCIAL DISCLOSURE?: No