Evaluation Of Corneal Endothelial Cells Hysteresis After Phacoemulsification


BACKGROUND: The corneal endothelial cellular monolayer cannot regenerate after injury. Endothelial cell loss is a commonly studied relevant postoperative variable because it is associated with the long-term risk for corneal decompensation.Analysis of cell shape and pattern is a more sensitive indicator of endothelial damage than cell density alone.PURPOSE: To evaluate hysteresis changes that occur in the corneal endothelium at different times (one week, three months, six months) after cataract extraction with phacoemulsification using noncontact specular microscope .PATIENTS AND METHOD: Seventy-five patients scheduled for cataract extraction with phacoemulsification were examined with non contact specular microscopy (SP-3000P) performed at the center of the cornea. Corneal thickness (T), average cell area (AVG), cell density (CD), and percentage of cell hexagonality (HEX) were measured. Statistical analysis was performed using a 2-tailed Student t-test, Pearson correlation.RESULTS: In all patients there was an increase in corneal thickness, widening in cell area, decrease in cell density, and extreme variability in their hexagonality after surgery. The results were as follows:- mean T was 480.5µm, 526.8µm, 534.3µm, and 541.3µm; mean AVG was 380.25mm2, 465.4mm2, 492.97mm2, and 527.77mm2; mean CD was 2809.00 cell/mm2, 2220.72 cell/mm2 , 2053.56 cell/mm2 , and 1899.97 cell/mm2 ; mean HEX was 72.27%, 27.35%, 39.35%, and 51.76% preoperatively, one week, three months, and six months postoperatively respectively. P value was <0.01 for all the findings (significant).DISCUSSION: Although endothelial cell density in the early postoperative period is highly deranged but it is not the only valuable parameter to maintain corneal morphology. The ability of endothelial cells to function properly and rearrange themselves is a potential element for corneal architecture. Significant changes in the measured parameters were obtained during the entire period of the study reflecting the effect of phacoemulsification on the corneal endothelial features and function. CONCLUSION & RECOMMENDATIONS: Corneal endothelial cells can be damaged by many factors during and after cataract surgery. Future refinements of the phacoemulsification techniques should aim to minimize early postoperative compromise of corneal endothelial function. A comparative study of the effect of phacoemulsification and other variety of surgeries will be a good indicator of endothelial cell damage induced by either technique