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N. Ghaznawi, J. Solomon; Endothelial Cell Count After Phacoemulsification: Review of Resident Cases at a Teaching Institution. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6111.
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To determine the correlation between phacoemulsification surgery performed by residents at various stages of training and post operative change in endothelial cell count at a teaching institution.
Endothelial cell counts (ECC) of 98 eyes of 77 patients who had undergone phacoemulsification surgery at one site, from July 2007 to June 2008 were determined using specular microscopy. (Specular Microscope ,Topcon SP-2000P; Topcon America Corp, Paramus, NJ) Only charts with available pre operative ECC available were included in the study. Post operative ECC were measured at least 1 month following phacoemulsification surgery. Fellow unoperated eyes were used as controls. Data was categorized based on month of surgery.
Mean ECC of pre operative eyes was 2339. The mean post operative ECC was 1709. The difference between pre operative ECC and ECC of fellow unoperated eyes was not significant. The change in ECC of the fellow unoperated eye after phacoemulsification of the study eye was also not significant. Phacoemulsification surgery performed in August 2007 was associated with the greatest change in ECC: 33% decline. Phacoemulsification surgery performed in May 2008 was associated with the least post operative decline in ECC: 15% loss.
Phacoemulsification surgery is known to place the corneal endothelium under stress, with resultant endothelial cell loss. As the resident surgeon gains dexterity throughout the course of surgical training, damage to the corneal endothelium is also considerably less, as evidenced by this study. Possible implications of this study may influence patient selection as a function of stage of surgical experience. Additionally, endothelial cell loss may be used as a parameter where by resident physicians can judge their surgical progress.
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