Influence of Preoperative Corneal Endothelial Status on Postoperative Corneal Endothelium Density after Cataract Surgery

Kim Patrick; Moon Sun Jung

doi:10.3341/jkos.2017.58.2.131

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Patrick and Jung: Influence of Preoperative Corneal Endothelial Status on Postoperative Corneal Endothelium Density after Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2017;58(2):131-139.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.2.131

Influence of Preoperative Corneal Endothelial Status on Postoperative Corneal Endothelium Density after Cataract Surgery

Kim Patrick, M.D., Moon Sun Jung, M.D., PhD

Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea

Address reprint requests to Moon Sun Jung, MD, PhD Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, #31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31151, Korea Tel: 82-41-570-2114, Fax: 82-41-592-3810 E-mail: inmydream@schmc.ac.kr

Received 28 July 201622 September 2016 Accepted 28 December 2016

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 analyze the influence of preoperative corneal endothelial status on postoperative corneal endothelium density after cataract surgery.

Methods

We evaluated 228 eyes of 158 patients who underwent cataract surgery. Corneal endothelial status and central cor-neal thickness were measured before surgery and 1 day, 1 month, 3 months and 6 months after surgery. Patients were classified by preoperative endothelial cell density (three groups) and their coefficients of variation and hexagonality (two groups). Clinical parameters, including corneal endothelial cell losses, visual acuity, intraocular pressure, spherical equivalent refraction and cen-tral corneal thickness were measured to compare the intergroup indices.

Results

There were no significant differences in corneal endothelial cell losses at 1 day, 1 month, 3 months and 6 months after surgery in any of the groups based on corneal endothelial cell density. There were increases in corneal thickness at 1 day and 1 month after surgery that were significantly higher in the low-endothelial cell density group than the 2,000−2,500 cells/mm² cell density group ( p < 0.05), but there were no differences after the 3-month time point. There were no significant differences in clin-ical parameters for the coefficient of variation and hexagonality groups until 6 months after surgery.

Conclusions

We observed reversible corneal edema in the low endothelial group; however, there were no significant intergroup differences in corneal endothelial cell loss due to preoperative corneal endothelial status. Our results suggest that cataract sur-gery is relatively safe for patients with morphologically abnormal corneal endothelium and/or low endothelial density; the safety is primarily due to improved equipment and surgery techniques.

Keywords: Coefficient of variation, Endothelial cell loss, Hexagonality, Phacoemulsification

References

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Figure 1.

Comparison of different clinical parameters within subject groups with different cell density. Comparison of best corrected visual acuity (A), spherical equivalent refraction (B), intraocular pressure (C), central corneal thickness (D) and en-dothelial cell loss (E) in subject groups with different cell density. There were no statistically significant differences among the three groups, except in central corneal thickness of 1 day and 1 month after surgery. ECD = endothelial cell den-sity; Pre op = preoperation. ^* Statistically difference between the ECD < 2,000 cells/mm² and 2,000-2,500 cells/mm².

Figure 2.

Comparison of different clinical parameters within subject groups with different coefficient of variation. Comparison of best corrected visual acuity (A), spherical equivalent re-fraction (B), intraocular pressure (C), central corneal thickness (D) and endothelial cell loss (E) in subject groups with different coefficient of variation. There were no statistically significant differences between the two groups. Pre op = preoperation; CV = coefficient of variation.

Figure 3.

Comparison of different clinical parameters within subject groups with different hexagonality. Comparison of best corrected visual acuity (A), spherical equivalent refraction (B), intraocular pressure (C), central corneal thickness (D) and endo-thelial cell loss (E) in subject groups with different hexagonality. There were no statistically significant differences between the two groups. Pre op = preoperation; HEX = hexagonality.

Table 1.

Demographics of the subject groups with different cell density

	Group 1	Group 2	Group 3
	ECD < 2,000 cells/mm²	ECD 2,000-2,500 cells/mm²	ECD > 2,500 cells/mm²	p-value^*
	(n = 26)	(n = 76)	(n = 126)
Age (years)	72.50 ± 9.42	71.67 ± 9.66	63.48 ± 14.92	<0.001
Sex (M:F)	11:15	22:54	42:84	0.451
Best corrected visual acuity (logMAR)	0.40 ± 0.22	0.43 ± 0.26	0.43 ± 0.25	0.923
Spherical equivalent refraction (D)	-2.41 ± 4.73	-1.25 ± 3.53	-1.84 ± 5.32	0.570
IOP (mmHg)	15.31 ± 2.53	14.03 ± 3.03	14.36 ± 2.48	0.112
CCT (μ m)	544.89 ± 37.80	535.65 ± 33.34	530.75 ± 29.94	0.108
ECD (cells/mm²)	1,600.58 ± 424.58	2,271.82 ± 132.32	2,789.84 ± 211.13	<0.001
CV	37.38 ± 15.25	35.74 ± 9.51	34.13 ± 10.01	0.063
HEX (%)	45.15 ± 22.39	55.78 ± 29.35	54.00 ± 22.97	0.175
Nucleus sclerosis (LOCS III grade)	2.88 ± 0.59	2.96 ± 0.77	2.73 ± 0.75	0.096
Average phaco power (%)	24.99 ± 3.35	22.54 ± 4.29	23.49 ± 4.25	0.092
Total phaco energy	12.21 ± 7.06	11.16 ± 9.57	9.83 ± 12.22	0.514

Values are presented as mean ± SD unless otherwise indicated.

ECD = endothelial cell density; IOP = intraocular pressure; CCT = central corneal thickness; CV = coefficient of variation; HEX = Hexagonality; LOCS = lens opacities classification system; SD = standard deviation.

^* One-way analysis of variance (ANOVA).

Table 2.

Demographics of the subject groups with different coefficient of variation

	Groups		p-value^*
	CV < 40 (n = 166)	CV ≥ 40 (n = 62)	p-value^*
Age (years)	66.51 ± 13.90	69.50 ± 11.75	0.148
Sex (M:F)	48:118	25:37	0.134
Best corrected visual acuity (logMAR)	0.42 ± 0.24	0.43 ± 0.27	0.899
Spherical equivalent refraction (D)	-1.92 ± 4.61	-1.09 ± 5.00	0.326
IOP (mmHg)	14.38 ± 2.75	14.27 ± 2.56	0.781
CCT (μ m)	532.81 ± 32.65	537.54 ± 30.88	0.342
ECD (cells/mm²)	2,510.54 ± 448.90	2,392.50 ± 464.02	0.091
CV	29.90 ± 5.80	47.77 ± 9.04	<0.001
HEX (%)	54.02 ± 25.93	51.98 ± 23.04	0.618
Nucleus sclerosis (LOCS III grade)	2.79 ± 0.74	2.93 ± 0.76	0.232
Average phaco power (%)	23.36 ± 4.44	23.30 ± 3.50	0.936
Total phaco energy	10.71 ± 11.02	10.08 ± 10.47	0.712

Values are presented as mean ± SD unless otherwise indicated.

CV = coefficient of variation; IOP = intraocular pressure; CCT = central corneal thickness; ECD = endothelial cell density; HEX = hex-agonality; LOCS = lens opacities classification system; SD = standard deviation.

^* Independent t-test.

Table 3.

Demographics of the subject groups with different hexagonality

	Groups		p-value^*
	HEX < 50 (n = 109)	HEX ≥ 50 (n = 119)	p-value^*
Age (years)	67.36 ± 11.88	66.96 ± 14.71	0.823
Sex (M:F)	38:71	37:82	0.575
Best corrected visual acuity (logMAR)	0.44 ± 0.25	0.41 ± 0.24	0.379
Spherical equivalent refraction (D)	-1.70 ± 3.98	-1.73 ± 5.27	0.982
IOP (mmHg)	14.38 ± 2.71	14.29 ± 2.65	0.805
CCT (μ m)	537.01 ± 31.89	531.32 ± 32.53	0.188
ECD (cells/mm²)	2,424.87 ± 513.98	2,536.79 ± 387.11	0.067
CV	35.27 ± 10.89	33.13 ± 9.09	0.109
HEX (%)	31.38 ± 14.50	67.33 ± 14.91	<0.001
Nucleus sclerosis (LOCS III grade)	2.91 ± 0.76	2.74 ± 0.72	0.084
Average phaco power (%)	22.96 ± 4.34	23.71 ± 4.08	0.274
Total phaco energy	10.07 ± 9.92	10.79 ± 11.52	0.624

Values are presented as mean ± SD unless otherwise indicated.

HEX = hexagonality; IOP = intraocular pressure; CCT = central corneal thickness; ECD = endothelial cell density; CV = coefficient of var-iation; LOCS = lens opacities classification system; SD = standard deviation.

^* Independent t-test.

Table 4.

Multiple regression model for predicting endothelial cell loss (R² = 0.675)

Variables	Beta	t	p-value
Age	0.533	2.27	0.033
Total phaco energy	5.903	3.46	0.041

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