Official ESCRS | European Society of Cataract & Refractive Surgeons


Cataract surgery in eyes with poor endothelium

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Session Details

Session Title: Presented Poster Session: Combined Cataract Surgery & Cataract Surgery Complications

Venue: Poster Village: Pod 1

First Author: : C.Grupcheva BULGARIA

Co Author(s): :    D. Grupchev   M. Radeva   M. Boyadzhieva   T. Mihova              

Abstract Details


To evaluate clinical and morphological parameters of the cornea after uneventful cataract surgery and correlate the pre-op endothelial morphology to the outcomes.


The subjects were prospectively recruited into observation and control groups. In the first cohort endothelial count was <1490 cells/mm2, hexagonality <44% and cells bigger than 50 µm. For the second age and gender matching group cell density was >1500 cells/mm2, hexagonality >45%, and cells were smaller than 50 µm.


All subjects completed questionnaires for vision and comfort, before, 1 and 4 weeks after the surgery. The standard clinical examination was reinforced by Optical Coherence Tomography(OCT) and laser scanning in vivo confocal microscopy. Upon consent the surgery was performed by single surgeon utilizing the mastered technique and special attention was given to the pre- and intraoperative preparation including viscoelastic, ultrasound parameters, position of the tip during the procedure and size and location of the incisions. All even minor complications, were excluded from the study.


Both groups comprised of 30 age matching subjects, 50% female. The preoperative visual acuity was similar at 0.134 and 0.106 respectively, but significantly worse(p=0.001) for group 1 at 0.54 in comparison to the group 2 at 0.66. Same tendency was encountered for comfort evaluation in 1 and 4 weeks. OCT thickness measurement highlighted significant stromal oedema in the observational group at all time points, which was confirmed by microstructural changes highlighted by in vivo confocal microscopy, such as epithelial cystic changes, keratocyte augmentation and conglomeration, nerve loss, and endothelial damage. Endothelial detachments (30%) were also significantly higher for group 1.


To achieve excellence, surgeon must be aware of endothelial morphology before cataract surgery. Complications related to endothelium might appear, therefore careful planning is essential especially in cases with recognized alterations or disease such as Fuchs’ dystrophy. Even than a 2-step procedure might be more beneficial than combined surgery.

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