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T.M. Haller, C.B. Haller; Variations in Corneal Endothelial Cell Damage During Phacoemulsification. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):298.
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Purpose: Phacoemulsification has been shown to damage the corneal endothelium. Various studies and assumptions have estimated the cell loss at approximately10–15%. A random sampling of patients in our clinic seem to have experienced a higher degree of loss. The purpose of our study was to examine a significant pool of patients and compare our findings with those of previous studies. Methods: The study examined 175 patient eyes that had uncomplicated cataract extractions, with phacoemulsification and insertion of a foldable intra–ocular lens implant. A similar surgical technique was performed on all patients. Procedures that experienced complications, such as capsular tears and vitreous loss, were excluded from the study so as not to skew the results. The patients were examined and photographed pre–operatively using the Konan Specular Microscope SP–4000, for cell size, morphology and number and were then re–examined 3 weeks post–operatively. Endothelial cell sizes, morphology and numbers were then compared. Results: In 100% of the patients cell counts were reduced post operatively as compared to pre–surgical counts. The numbers ranged from 0.10% to 87.4%, with an average loss of 33.82%. Cell sizes often enlarged and areas of cornea appeared with gaps in endothelial lining, which were often later filled in by spreading and enlarging of surrounding cells. Conclusions: The degree of endothelial damage during phacoemulsification may actually be larger than previous estimates. Variations in individual surgical experience, technique, phacoemulsification time and the application of differing amounts and types of viscoelastic, can impact the endothelial integrity and may account for significant fluctuations in cell damage and loss.
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