Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device
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2021
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Purpose: To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells. Setting: Department of Ophthalmology, Celal Bayar University, Manisa, Turkey. Design: Prospective randomized controlled trial. Methods: Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE. Results: This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P >.05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P >.05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P =.002, P =.002, and P =.001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P =.003, P =.001, and P =.001, respectively). CV increased and HEX decreased in both groups postoperatively (P >.05 for both). CCT showed a transient increase of less than 10 m at postoperative 1 month in both groups (P =.296). Conclusions: PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve. © 2021 Elsevier Inc.. All rights reserved.
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Anterior Chamber , Cell Count , Endothelial Cells , Endothelium, Corneal , Humans , Lens Implantation, Intraocular , Middle Aged , Phacoemulsification , Prospective Studies , bupivacaine , cyclopentolate , dexamethasone , epinephrine , gentamicin , lidocaine , moxifloxacin , prednisolone sodium phosphate , tropicamide , adult , Article , cell density , central corneal thickness , controlled study , cornea endothelium , corneal endothelial cell loss , endothelium cell , female , human , major clinical study , male , middle aged , phacoemulsification , postoperative complication , preoperative evaluation , prospective study , randomized controlled trial , senile cataract , specular microscopy , anterior eye chamber , cell count , lens implantation