A comparison of corneal endothelial damage according to two phacoemulsification procedures : Divide-and-Conquer versus Subluxation

Abstract

 

Purpose

 

We conducted a cross sectional study in order to evaluate the safety of “Subluxation” procedure in simple cataract surgery. Pachymetry and endothelial cell density measurement were realized to evaluate corneal damage according to distinct surgical procedures: Subluxation versus Divide-and-conquer.

 

Methods

 

All consecutive patients who underwent cataract surgery in our department from October to November 2014 were included. Patients with hypermature cataract and corneal pathology were excluded. Two groups have been constituted: Group 1 (Subluxation) and group 2 (Divide-and-Conquer). All surgeries have been realized under topical anesthesia with micro-coaxial mode on stellaris platform (Bauch&Lomb) by experimented surgeons. Pachymetry measurement and endothelial cells count (specular CEM530 Nidek) have been collected during pre-operative consultation, 4 days and one month after surgery. We also collected operative time and ultrasound used (power, time of use and time efficiency).

 

Results

 

We included 66 eyes of 40 patients, 32 from group 1 (Subluxation) and 34 from group 2 (Divide and Conquer). Mean age was 73 years-old in group 1 and 76 years-old in group 2. Mean efficiency time of ultrasound was 6.85± 4.86 seconds in group 1, and 7.73±3.71 seconds in group 2. Mean surgery duration was 6.4±2.1 minutes in group 1 and 10±4.7 minutes in group 2. Endothelial cell loss at 1 month was evaluated at 8.87± 7.96% in the group 1 and at 8.33±9.94% in group 2.

 

Conclusions

 

Phacoemulsification is known to be responsible of endothelial cells loss. Subluxation procedure is not actually considered as a gold standard because of higher hypothetic endothelial cell damage. In our study we noticed that surgery duration and ultrasound used are clearly lower in group 1 than in group 2. There is no significant difference concerning endothelial cell loss between the two procedures. According to our results subluxation procedure for cataract surgery seems to be as safe as other surgical procedures. A larger sample size will be necessary to demonstrate with statistic evidence the safety of subluxation procedure in cataract surgery.