Phacoemulsification with IOL implantation at a critical level of corneal endothelial cells

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Abstract

BACKGROUND: Cataract phacoemulsification is one of the most frequently performed surgical procedures, and a decrease in the corneal endothelial cell density (ECD) is the main postoperative complication leading to visual impairment. The average cell loss after phacoemulsification is 4.01–12.94% within a year, and within 2 months — 5.2–9.1%. The use of viscoelastics helps to reduce this loss, but it is impossible to completely prevent it.

AIM: Сomparison of ECD in the pre- and postoperative period of phacoemulsification using viscoelastic of different percentages at a critical level of corneal endothelial cells.

MATERIALS AND METHODS: The study included 60 eyes with emmetropic refraction: in the first group: 30 eyes with initial cataract and low ECD level (1694/1218 cells/mm2), an apyrogenic moderately cohesive viscoelastic 1.6% sodium hyaluronate solution (Kogevisk®, Solopharm) was used, in the second group: 30 eyes with mature cataract and ECD level (1646/1183 cells/mm2) an apyrogenic, highly purified viscoelastic was used, consisting of medium-molecular fractions of chondroitin sodium sulfate 4% and sodium hyaluronate 3% (Adhevisk®, Solopharm). Before surgery and a month after surgery, patients were tested for uncorrected visual acuity in the distance, ECD measurements, and intraocular pressure measurement.

RESULTS: In phacoemulsification with IOL implantation, the use of viscoelastics of different percentages shows that the condition of the cornea remained stable a month after surgery. Postoperative ECD loss in all clinical cases, regardless of the stage of cataract, was less than 3%.

CONCLUSIONS: Viscoelastics allow to solve the tasks set: in the case of cohesive — maintaining the depth of the anterior chamber and the width of the pupil, adhesive — protecting the corneal endothelium, good visualization. Rational consistent use of adhesive and cohesive components facilitates basic manipulations during phacoemulsification and IOL implantation. To do this, it is necessary to correctly use and select viscoelastic for a particular operation based on the number of endothelial cells.

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About the authors

Igor A. Loskutov

Moscow Regional Research and Clinical Institute

Email: zai4en@mail.ru
ORCID iD: 0000-0003-0057-3338
SPIN-code: 5845-6058

Professor, Ophthalmologist of the Moscow Region, Head of the Ophthalmological Department

Russian Federation, Moscow

Anastasia I. Fedorova

Moscow Regional Research and Clinical Institute

Author for correspondence.
Email: zai4en@mail.ru
ORCID iD: 0009-0008-7670-2910

Resident Doctor

Russian Federation, Moscow

References

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  7. Loskutov IA, Mamedov ZI, Fedorova AI, Tigranyan AK. Metodicheskoe posobie. Optimal’nyi vybor viskoehlastika v praktike oftal’mologa. Saint Petersburg: Groteks, 2023. P. 5–21. (In Russ.)
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Supplementary files

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2. Fig. 1. Average loss of endothelial cells compared to the previous examination in initial cataract; 2.8%, р < 0.05

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3. Fig. 2. Average loss of endothelial cells compared to the previous examination in mature cataract; 2.2%, р < 0.05

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