Does Fluidics Matter In Pseudoexfoliation? Lessons From Low And High Fluidics Phacoemulsification

To evaluate the impact of high versus low fluidics settings during phacoemulsification on intraoperative fluid usage, corneal thickness, and endothelial cell density (ECD) in eyes with pseudoexfoliation syndrome (PEX), where surgery is often challenging.

Ankara Bilkent City Hospital, Department of Ophthalmology

Eighty eyes of 80 patients with PEX undergoing uneventful phacoemulsification using an active fluidics system were analyzed. Eyes were divided into high fluidics (H, n = 40) and low fluidics (L, n = 40) groups according to intraoperative settings. During phacoemulsification and cortical removal, fluidics parameters were maintained according to group assignment. Primary outcome was total intraoperative fluid usage. Secondary outcomes included central corneal thickness (CCT) change and ECD loss at one month postoperatively.

Mean age was comparable between the high and low fluidics groups (74.4 ± 5.8 vs 72.9 ± 5.7 years; p = 0.66). Baseline endothelial cell density was similar between groups (2352 ± 364 vs 2386 ± 449 cells/mm²; p = 0.71). Despite the higher fluid demands characteristic of PEX eyes, total intraoperative fluid usage was lower with low fluidics settings (78.7 ± 26.3 mL vs 85.9 ± 42.9 mL; p = 0.36).CDE showed a non-significant trend toward lower values in the high fluidics group (11.28 ± 7.93 vs 14.47 ± 9.36; p = 0.10). Corneal thickness changes were minimal and comparable between groups at one week (p = 0.55) and one month (p = 0.92). At one month, endothelial cell loss was lower in the low fluidics group (4.20% vs 6.89%; p = 0.44).

Low fluidics phacoemulsification in PEX achieved lower intraoperative fluid usage with favorable endothelial outcomes while maintaining corneal stability. Despite the inherent surgical challenges and increased fluid demands of pseudoexfoliation eyes, low fluidics settings provided stable and efficient intraoperative conditions, supporting their use even in challenging cases. These findings position low fluidics as a practical strategy to reduce intraoperative stress and optimize corneal preservation in pseudoexfoliation and other demanding cataract surgeries