Comparison Of Low And Standard Intraocular Pressure Phacoemulsification In Advanced Cataracts: Impact On Endothelial Cell Density And Phaco Parameters

To compare the effects of low intraocular pressure (IOP) and standard IOP phacoemulsification on postoperative endothelial cell density (ECD) and phaco parameters in patients with advanced cataracts.

This study was conducted at the Ankara Bilkent City Hospital, Department of Ophthalmology

This retrospective comparative study included 51 patients who underwent phacoemulsification with either standard IOP settings (50–60 mmHg, n = 24) or low IOP settings (30 mmHg, n = 27). Preoperative and postoperative ECD were assessed using specular microscopy. Phaco parameters, including cumulative dissipated energy (CDE), phaco time, and total fluid usage (cc), were recorded. Statistical analyses were conducted using the Mann-Whitney U test and Wilcoxon signed-rank test, as appropriate. 

Postoperative ECD was significantly higher in the low IOP group than in the standard IOP group (p=0.02).Endothelial cell loss (preop ECD–postop ECD)was significantly lower in the low IOP group (p=0.033),indicating better endothelial preservation.However,there were no significant differences between the two groups in CDE(p=0.962),phaco time (p=0.396),or total fluid usage (p=0.231).Both groups demonstrated significant improvement in postoperative visual acuity compared to baseline(p<0.001).Additionally,CDE was negatively correlated with postoperative ECD(p=0.006),and phaco time was negatively correlated with endothelial cell loss (p=0.032),suggesting that higher energy usage and longer phaco duration contributed to greater endothelial damage.