Endothelial Stability After Bilateral Cataract Surgery In Corneal Guttate

To evaluate endothelial cell behavior following sequential cataract surgery in a patient with bilateral corneal guttata and moderate baseline endothelial counts.

Private ophthalmic practice.

A patient presented with bilateral visually significant cataract associated with corneal guttata. Preoperative slit-lamp examination revealed non-confluent central guttata without stromal edema. Specular microscopy showed endothelial cell density of 1910 cells/mm² in the right eye and 2098 cells/mm² in the left eye.

Both eyes underwent consecutive phacoemulsification using the Centurion system. Due to the compromised endothelium, a low-energy strategy was adopted utilizing a modified chip-and-flip technique to minimize ultrasound delivery and fluidic turbulence. Surgery was uneventful in both eyes.

Postoperative recovery was smooth with no persistent corneal edema. Follow-up specular microscopy demonstrated endothelial cell density of 1925 cells/mm² OD and 1940 cells/mm² OS. Variation remained within expected measurement variability despite pre-existing guttata.

Visual rehabilitation was achieved without need for endothelial keratoplasty.

Cataract surgery in corneal guttata does not necessarily mandate combined or staged endothelial keratoplasty. With adequate baseline endothelial reserve, appropriate case selection, and low-energy phacoemulsification techniques, clinically significant endothelial loss may be avoided. Surgical planning should be individualized rather than based solely on the presence of guttata.