Impact Of Phaco Tip Exposure On Corneal Endothelium And Central Corneal Thickness In Hard Cataract.
Published 2026 - 44th Congress of the ESCRS
Reference: POCAT281 | Type: Free paper | DOI: 10.82333/mx31-ep32
Authors: Dr Ayesha Musthafa* 1 , Dr Naren Shetty 1 , Dr Arkasubhra Ghosh 2 , Dr Shreya Saraogi 1
1Cataract and Refractive Surgery ,Narayana Nethralaya Eye Hospital,bengaluru,India, 2grow lab,Narayana Nethralaya Eye Hospital,bengaluru,India
Purpose
To evaluate the role of phacoemulsification probe tip exposure on corneal endothelial cell loss and central corneal thickness (CCT) in hard cataracts, comparing between more and less tip exposure.
Setting
A prospective study conducted at a Tertiary Care Eye Hospital
Methods
A prospective study was conducted on 57 eyes in each group undergoing phacoemulsification for hard cataracts using either a more tip exposure or a less tip exposure on phaco probe. Tip exposure was measured from the phaco tip till the silicone sleeve, with the less tip exposure set at 0.5 mm and more tip exposure at 1.25 mm. Corneal endothelial cell density (ECD) and Central corneal Thickness (CCT) were measured preoperatively and on postoperative days 1 (POD1) and 30 (POD 30). Intraoperative cumulative dissipated energy (CDE) was also recorded. Median [IQR] values were calculated, and intergroup comparisons were performed.
Results
In this prospective single-centre study of hard cataracts, outcomes were compared between greater phaco tip exposure (1.25 mm; long tip) and less tip exposure (0.5 mm; short tip). Cumulative dissipated energy (CDE) was similar between groups.The short tip group had significantly better endothelial preservation at POD 30, with lower endothelial cell loss than the long tip group (−140 vs −406 cells/mm²; p = 0.009). Central corneal thickness (CCT) increased in both groups on day 1, but the rise was significantly smaller with less tip exposure (+14 vs +36 µm; p = 0.001). Viscoelastic was more often noted on the endothelium in the short tip group, which may have contributed to the protective effect
Conclusions
Reducing phaco tip exposure in hard cataract surgery was associated with superior corneal endothelial safety, characterized by significantly lower endothelial cell loss and reduced early postoperative corneal edema, with faster stabilization in the postoperative period. These findings support minimizing tip exposure as a practical technique to enhance corneal protection during phacoemulsification of dense nuclei.
Financial Disclosure: The authors report no financial or proprietary interests in any material or method mentioned