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Yumi Hasegawa, Ryohei Nejima, Yosai Mori, Toshihiro Sakisaka, Keiichiro Minami, Kazunori Miyata, Tetsuro Oshika; Risk factors for corneal endothelial cell loss after cataract surgery in eyes with pseudoexfoliation syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2037.
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It has been reported that the presence of pseudoexfoliation syndrome (PES) is associated with a greater risk of corneal endothelial cell density (ECD) loss after cataract surgery, but there has been no study on its risk factors. We investigated the risk factors for ECD loss after phacoemulsification and intraocular lens implantation in eyes with PES.
Clinical records of 106 eyes of 86 patients with PES who had undergone cataract surgery from June 2010 through May 2013 were retrospectively reviewed. ECD was examined preoperatively and 3 months postoperatively with a specular microscope. Aqueous flare intensity was measured postoperatively with laser flare mater. Subjects were divided into two groups, i.e., group A (ECD loss > 5.0 %) and group B (ECD loss ≤ 5.0 %), and the influences of following factors were evaluated using unpaired t-test or Fisher's exact probability test; age, preoperative ECD, mydriatic pupil diameter, cataract grade (Emery-Little classification), presence of glaucoma or diabetes mellitus, preoperative anterior chamber depth (ACD), axial length, operation time, phacoemulsification time, postoperative intraocular pressure (1 day), and aqueous flare intensity (1 day, 1 week, 3 months).
The pre- and post-operative ECDs were 2477.8 ± 320.2 and 2405.9 ± 346.2 cells/mm2, respectively, and mean ECD loss was 2.9 ± 5.9 %. There was 27 (25.5%) eyes in group A, in which ECD loss was significantly associated with shorter preoperative ACD (P = 0.011), longer phacoemulsification time (P = 0.015) and higher flare intensity 1 week after surgery (P = 0.040).
It was demonstrated that preoperative ACD, phacoemulsification time, and postoperative flare intensity are risk factors for greater EDC loss after cataract surgery in eyes with PES. It was suggested that corneal endothelium was damaged by surgical invasion caused by phacoemulsification.
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