Long-Term Results after Cataract Surgery in Patients with Low Corneal Endothelial Cell Density

Jung Han Choi; Han Jin Oh; Kyung Chul Yoon

doi:10.3341/jkos.2013.54.4.602

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Choi, Oh, and Yoon: Long-Term Results after Cataract Surgery in Patients with Low Corneal Endothelial Cell Density

Original Article

J Korean Ophthalmol Soc 2007;54(4):602-609.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.4.602

Long-Term Results after Cataract Surgery in Patients with Low Corneal Endothelial Cell Density

Jung Han Choi, MD, Han Jin Oh, MD, Kyung Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 24 February 201227 July 2012 Accepted 29 January 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the long-term results after cataract surgery in eyes with low endothelial cell density (ECD). Methods: A retrospective medical record review was performed of 19 patients with low ECD (lower than 1000 cells/mm²)

who 31 patients with a normal ECD (higher than 1600 cells/mm²) underwent cataract surgery. Clinical parameters including visual acuity, intraocular pressure (IOP), spherical equivalent refraction, anterior chamber depth, axial length and central corneal thickness (CCT) were measured and specular microscopy was performed to analyze the ECD and its morphology. The follow-up periods were 1 week, and 1, 3, 6 and 12 months postoperatively.

Results

Clinical parameters except ECD and CCT had no significant difference between the 2 groups until 12 months postoperatively. The decreasing rate of ECD and increase of CCT were significantly different between the 2 groups at 1 week and 1 month postoperatively. However, no significant difference was found after 3 months postoperatively. Only 1 eye in the low ECD group with 367 cells/mm² developed bullous keratopathy.

Conclusions

In the low ECD group, a significant decrease of ECD and increase of CCT were observed at 1 month after cataract surgery. However there were no significant differences compared with the control group after 3 months postoperatively. The results suggest that cataract surgery is safe postoperatively for a long-term for a patient with low ECD.

Keywords: Cataract surgery, Corneal decompensation, Low corneal endothelial cell

References

1. American Academy of Ophthalmology. Corneal endothelial photography. Three-year revision. Ophthalmology. 1997; 104:1360–5.

2. Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000; 26:727–32.

3. Powe NR, Schein OD, Gieser SC, et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol. 1994; 112:239–52.

4. Seitzman GD, Gottsch JD, Stark WJ. Cataract surgery in patients with Fuchs' corneal dystrophy: expanding recommendations for cataract surgery without simultaneous keratoplasty. Ophthalmology. 2005; 112:441–6.

5. Seitzman GD. Cataract surgery in Fuchs' dystrophy. Curr Opin Ophthalmol. 2005; 16:241–5.

6. Tarnawska D, Wylegała E. Effectiveness of the soft-shell technique in patients with Fuchs' endothelial dystrophy. J Cataract Refract Surg. 2007; 33:1907–12.

7. Chikamoto N, Takahashi N, Wakuta M, et al. Recovery of corneal thickness promoted by glucocorticoid administration after phacoemulsification in eyes affected by Fuchs' dystrophy. Jpn J Ophthalmol. 2008; 52:336–9.

8. Traish AS, Colby KA. Approaching cataract surgery in patients with Fuchs' endothelial dystrophy. Int Ophthalmol Clin. 2010; 50:1–11.

9. Yasukawa T, Suga K, Yokoo N, Asada S. Cataract surgery in a patient with severe chronic iritis and corneal endothelial damage. J Cataract Refract Surg. 1998; 24:885–8.

10. Olsen T. The endothelial cell damage in acute glaucoma. On the corneal thickness response to intraocular pressure. Acta Ophthalmol (Copenh). 1980; 58:257–66.

11. Malaise-Stals J, Collignon-Brach J, Weekers JF. Corneal endothelial cell density in acute angle-closure glaucoma. Ophthalmologica. 1984; 189:104–9.

12. Sihota R, Lakshmaiah NC, Titiyal JS, et al. Corneal endothelial status in the subtypes of primary angle closure glaucoma. Clin Experiment Ophthalmol. 2003; 31:492–5.

13. Ko YC, Liu CI, Lau LI, et al. Factors related to corneal endothelial damage after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg. 2008; 34:46–51.

14. van den Bruel A, Gailly J, Devriese S, et al. The protective effect of ophthalmic viscoelastic devices on endothelial cell loss during cataract surgery: a meta-analysis using mixed treatment comparisons. Br J Ophthalmol. 2011; 95:5–10.

15. Lee EK, Kim MK, Wee WR, Lee JH. Short-term outcome of cataract surgery using torsional-mode phacoemulsification for patients with low endothelial cell counts. J Korean Ophthalmol Soc. 2011; 52:434–41.

16. Hayashi K, Yoshida M, Manabe S, Hirata A. Cataract surgery in eyes with low corneal endothelial cell density. J Cataract Refract Surg. 2011; 37:1419–25.

17. Bourne RR, Minassian DC, Dart JK, et al. Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology. 2004; 111:679–85.

18. Bourne WM, Hodge DO, Nelson LR. Corneal endothelium five years after transplantation. Am J Ophthalmol. 1994; 118:185–96.

19. Ing JJ, Ing HH, Nelson LR, et al. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology. 1998; 105:1855–65.

20. Cornea Donor Study Investigator Group. Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation. Specular microscopy ancillary study results. Ophthalmology. 2008; 115:627–32.

21. Polack FM, Sugar A. The phacoemulsification procedure. III. Corneal complications. Invest Ophthalmol Vis Sci. 1977; 16:39–46.

22. Gwin RM, Warren JK, Samuelson DA, Gum GG. Effects of phacoemulsification and extracapsular lens removal on corneal thickness and endothelial cell density in the dog. Invest Ophthalmol Vis Sci. 1983; 24:227–36.

23. Sugar A, Fetherolf EC, Lin LL, et al. Endothelial cell loss from intraocular lens insertion. Ophthalmology. 1978; 85:394–9.

24. Kaufman E, Katz JI. Endothelial change from intraocular lens insertion. Invest Ophthalmol. 1976; 15:996–1000.

25. Edelhauser HF, Van Horn DL, Hyndiuk RA, Schultz RO. Intraocular irrigating solutions. Their effect on the corneal endothelium. Arch Ophthalmol. 1975; 93:648–57.

26. Yamazoe K, Yamaguchi T, Hotta K, et al. Outcomes of cataract surgery in eyes with a low corneal endothelial cell density. J Cataract Rrefract Surg. 2011; 37:2130–6.

27. Martin TP, Reed JW, Legault C, et al. Cataract formation and cataract extraction after penetrating keratoplasty. Ophthalmology. 1994; 101:113–9.

29. Ohguro N, Matsuda M, Kinoshita S. Effects of posterior chamber lens implantation on the endothelium of transplanted corneas. Br J Ophthalmol. 1997; 81:1056–9.

30. Kim EC, Kim MS. A comparison of endothelial cell loss after phacoemulsification in penetrating keratoplasty patients and normal patients. Cornea. 2010; 29:510–5.

31. Wilson SE, Bourne WM. Fuchs' dystrophy. Cornea. 1988; 7:2–18.

Figure 1.

Comparison of visual acuity (A), intraocular pressure (B), spherical equivalent refraction (C) and anterior chamber depth (D) between the low ECD and control groups. There were no statistically significant differences between the two groups. ECD = endothelial cell density.

Figure 2.

Changes of ECD after cataract surgery in the low ECD (A) and control (B) groups. ECD = endothelial cell density. ^*p < 0.05 compared with preoperative levels.

Figure 3.

Comparison of the decreasing rate of ECD after cataract surgery between the low ECD and control groups. ECD = endothelial cell density. ^*Statistically difference between the low ECD and control groups.

Figure 4.

Comparison of hexagonality (A) and variation coefficient of endothelial cell size (B) between the low ECD and control groups. There were no statistically significant differences between low ECD and control groups. ECD = endothelial cell density.

Figure 5.

Changes of central corneal thickness after cataract surgery in the low ECD (A) and control (B) groups. ECD = endothelial cell density. ^*p < 0.05 compared with preoperative levels.

Figure 6.

Comparison of central corneal thickness after cataract surgery between the low ECD and control groups. ECD = endothelial cell density. ^*Statistically difference between the low ECD and control groups.

Table 1.

Demographics of patients who underwent cataract surgery

Parameters	Groups	p value
Low ECD (n=19)	Control (n=31)
Mean age (years)	67.0 ± 13.78	65.2 ± 13.04	0.64
Sex (M:F)	12:7	14:17	0.23
Mean visual acuity (log MAR)	1.14 ± 0.72	0.78 ± 0.61	0.15
Spherical equivalent refraction (D)	-1.16 ± 3.12	-1.97 ± 3.10	0.64
Mean IOP (mm Hg)	15.42 ± 3.49	14.04 ± 1.51	0.83
Anterior chamber depth (mm)	2.59 ± 0.43	2.72 ± 0.31	0.53
Mean axial length (mm)	24.40 ± 4.03	23.33 ± 1.42	0.19
Mean CCT (μm)	514.20 ± 85.30	526.60 ± 62.81	0.61
Mean ECD (cells/mm²)	860.59 ± 194.72	2394.50 ± 489.69	<0.01
Range of ECD	376-986	1605-2985
Nucleus sclerosis (LOCS III grade)	2.63 ± 0.50	2.55 ± 0.51	0.58
Phacoemulsification time (sec)	50.76 ± 33.59	50.35 ± 35.11	0.85
Cumulative dissipated energy (sec)	12.62 ± 8.19	8.55 ± 4.73	0.15

Values are presented as mean ± SD or number.

ECD = endothelial cell density; IOP = intraocular pressure; CCT = central corneal thickness; LOCS = Lens Opacities Classification System, version III.

Table 2.

Causes of low endothelial cell density

Diagnosis	No. of eyes	(%)
Previous penetrating keratoplasty	7	36.8
Keratitis	3	15.8
Intraocular inflammation	3	15.8
Band keratopathy	1	5.3
Others	5	26.3
Total	19	100

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