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Katusya Yamazoe, Takefumi Yamaguchi, Kazuki Hotta, Seika Den, Jun Shimazaki; Outcome of Cataract Surgery in Cases with Low Endothelial Cell Density. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6240.
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To investigate surgical outcome of cataract surgery with a low preoperative corneal endothelial cell density (ECD).Factors affecting the prognosis were also analyzed.
Sixty-two eyes in 52 patients with a preoperative ECD of less than 1000 cells/mm2 were retrospectively analyzed. Cataract surgery was performed in all cases with the soft-shell technique. Variables such as pre- and post-operative visual acuity, intraocular pressure, ECD, causes of low ECD, axial length, nucleus grading, systemic disease and intraoperative complications were assessed. Main outcome measures were rate of endothelial cell loss and incidence of bullous keratopathy (BK).
Phacoemulsification and aspiration were performed in 61 cases and unplanned extra capsular cataract extraction in one. Preoperative diagnoses or factors regarded as causative of endothelial cell loss included Fuchs’ dystrophy (20 eyes), laser iridotomy (17 eyes), keratoplasty (10 eyes), traumatic injury (3 eyes), trabeculectomy (3 eyes), corneal endotheliitis (2 eyes) and other (7 eyes). Best corrected visual acuity (logMAR) was improved from 0.61 ± 0.51 before surgery to 0.34 ± 0.50 after surgery (P < 0.001). Pre- and postoperative mean ECD were 691 ± 172 cells/mm2 and 611 ± 203 cells/mm2, respectively (11.6% loss, P=0.001). Greater ECD loss was associated with shorter axial length (<23 mm) or diabetes mellitus. Ten eyes (16.1%) developed BK., and development of BK was associated with a hard nucleus. Postoperative incidence of BK was significantly lower in Fuchs’ dystrophy (P=0.049) compared with eyes that had previous keratoplasty or laser iridotomy. All cases with posterior capsular rupture developed BK.
These results suggested that modern techniques for cataract surgery allow for excellent visual rehabilitation in many of the patients with a low ECD. A hard nucleus, shorter axial length and diabetes mellitus were risk factors for greater ECD loss or development of BK.
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