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Changes in corneal endothelium cell characteristics leading to corneal edema after cataract surgery

Poster Details

First Author: B.Ivanovska Adjievska MACEDONIA

Co Author(s):    N. Gineva   S. Boskurt                 

Abstract Details

Purpose:

Corneal edema is a common complication of cataract surgery, although improvements in the surgical techniques decreased surgical eye trauma and complication rates. Normal endothelial cell density is 2000-3000 cells/mm2 in older individuals, which maintains the corneal clarity. Even �â�€�˜perfect�â�€�™ cataract surgery does some damage to the endothelium. Significant postoperative endothelium density decrease can impair its ability to maintain corneal clarity, resulting in corneal edema, blurring of vision and ocular pain. The cells may recover over the first few months after surgery with aggressive topical treatment. We evaluated the effects of the cataract surgery on the characteristics of the corneal endothelium.

Setting:

Prospective clinical study of 30 patients, mean age 65�Â�±12 years, operated in 2016 at European Eye Hospital-Skopje. All patients had senile cataract, over 80% were difficult cataracts: 18% hypermature, 36% brunescent, 30% grade 4 and 16% grade 3 cataracts. Uneventful phacoemulsification with IOL implantation was performed by one phaco-surgeon.

Methods:

Preoperative parameters included: best-corrected visual acuity (BCVA) in Snellen decimal units, IOP, cataract density, corneal endothelium cell density (ECD) and hexagonality measured with specular microscope (Topcon SP-3000P). Intraoperative parameters included: phacoemulsification time and energy, irrigation�â�€�“aspiration suction time. The cataract surgery included: topical anesthesia (0,5% Alkaine), temporal clear-cornea incision (2.6�Ã�—2.5mm), two side-ports, anterior chamber injection of DisCoVisc ophthalmic viscosurgical device (OVD), anterior capsulorhexis, hydrodissection, pha-coemulsification (Alcon INFINITI�Â�® Vision System), IOL implantation (Alcon AcrySof�Â�®) in-the-bag with single-use injector, intracameral antibiotic (cefuroxime). Exclusion criteria were: corneal pathologies (cornea guttata, scars), intraocular inflammatory diseases, macular degeneration, proliferative vitreoretinopathy, unregulated glaucoma etc.

Results:

Mean baseline parameters were: BCVA=0.1�Â�±0.13, IOP=15.7�Â�±2.7 mmHg, ECD=2,497�Â�±290 cells/mm2, cell hexagonality=54.3�Â�±9.4%. Mean surgical parameters were: surgical time=9,3�Â�±2.9 minutes, phaco-energy=13.3�Â�±10.9J, irrigation�â�€�“aspiration time=81.3�Â�±45.9 seconds. 1 week postoperatively BCVA was 0.5�Â�±0.2. 9 eyes (30%) had corneal edema (VA�â�‰�¤0.5). The aggresive treatment in first week included: antibiotic (moxifloxacine), corticosteroid (dexamethasone), hypertonic eye drops (sodium chloride, mannitol) administered every hour and antiglaucomatose medications. After 1 month VA increased to 0.85�Â�±0.15. IOP remained 15.4�Â�±2.0 mmHg. ECD decreased to 1996�Â�±612 cells/mm2 (19.1% cell loss), hexagonality dropped to 43.6�Â�±12.5%. None progressed to chronic edema.

Conclusions:

Corneal edema is a common complication after surgery of difficult cataracts. Even though the cataract density directly influences the postoperative condition of the corneal endothelium, surgical trauma is still considered the most common cause of endothelial decompensation. Preoperative specular microscopy is important in order to predict possible postoperative complications of the corneal endothelium and apply appropriate surgical approach. Modern phaco-techniques (low phaco-energy, small incision, new irrigation solutions and OVDs) can significantly reduce endothelial cell loss after cataract surgery. To prevent chronicity, postoperative corneal edema should be treated aggressively with corticosteroids and hypertonic drops. IOP should be controlled below 20 mmHg.

Financial Disclosure:

NONE

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