Protecting the corneal endothelium during cataract surgery using the anterior capsule: a prospective randomised double-masked study

Session Details

Session Title: Presented Poster Session: Cataract Complications & Special Cases

Venue: Poster Village: Pod 1

First Author: : K.Stjepanek AUSTRIA

Co Author(s): :    N. Hirnschall   S. Amir-Asgari   O. Findl                 

Abstract Details

Purpose:

Classification and quantification of swirling lens fragments during phaco- emulsification as well as using the capsulorhexis flap as an endothelial protection shield and to determine the effects on endothelial cell loss and corneal thickness during cataract surgery compared to a control group.

Setting:

Vienna Institute for Ocular Surgery (VIROS), a Karl-Landsteiner institute, Hanusch Hospital, Vienna, Austria

Methods:

Patients with nuclear cataracts of LOCS grade 3 or 4, scheduled for cataract surgery were randomly allocated to study and control groups (2:1). During surgery, optical coherence tomography (OCT) recordings were performed to score swirling lens fragments that hit the corneal endothelium. Endothelial cell density was measured preoperatively, 1 hour (1h), 1 day (1d) and 2 months (2m) postoperatively, central corneal thickness preoperatively and 2m postoperatively. In the study group the anterior capsule 'flap' from the capsulorhexis was pushed against the endothelium using OVD to serve as an endothelial protection shield during phacoemulsification using a horizontal chop technique.

Results:

Fourty-nine eyes of 49 patients were included. Of altogether 176 fragments, 99 hit the central cornea and 77 hit the periphery. The mean number of fragments per eye was 4.8 in the control, and 2.8 in the study group. There was no significant change of endothelial-cell-count from preoperatively (2586.0 cells/mm2, SD: ±297) to 2months postoperatively (2533.2 cells/mm2, SD: ± 305, p=0.389). Mean central-corneal-thickness (CCT) increased not significantly from preoperatively (518.9μm, SD: ±44.7) to 1h postoperatively (557.6μm, SD: ±57.2) (p=0.028) and from preoperatively to 1d postoperatively (545.0μm, SD: ±50.7) (p=0.019). There was no significant difference in CCT between groups.

Conclusions:

As we found no significant benefit in endothelial cell loss, or central corneal thickness in the study group compared to the control group, we were not able to prove that using the capsulorhexis as a protection shield is an effective method of protecting the corneal endothelium. Possibly this technique may be beneficial when using other phacoemulsification techniques and/or in patients with more severe grades of cataract.

Financial Disclosure:

None