Investigation of the Effects of Phacoemulsification Surgery on Corneal Endothelium

Öz

Aim: To investigate corneal endothelial cell changes and risk factors
for damage in patients who had undergone phacoemulsification
surgery.
Material and Method: Thirty-five cases with cataract who had
undergone uncomplicated phacoemulsification surgery were
enrolled in this study. Central corneal thickness (CCT) and endothelial
cell count of the patients were measured by specular microscope
preoperatively and 1st week, 1st month, 3rd month postoperatively.
Results: The mean age of the patients was 64.8 ± 10.7 years and
the mean preoperative endothelial cell density (ECD) was 2344.8 ±
340.7 cells / mm². The mean ECD at the 3rd month after the surgery
was 1920.4 ± 456.0 cells / mm2. The mean ECD loss was 18.3 %. The
coefficient of variation of the endothelial cell (CV) was found to be
32.9 ± 7.3 preoperatively, and 30 ± 3.7 in the postoperative 3rd month.
The value of hexagonal cell percentage (HG) was found to be 60 ±
10.2 % preoperatively, 55.1 ± 8.9 % in the postoperative 3rd month. It
was found that in the postoperative 3rd month the CV and HG values
were statistically lower than the preoperative values (p<0.05). The
mean CCT values were measured as 535 ± 32.30 μm preoperatively,
568.74 ± 43.46 μm at 1st week after the surgery, 539.60 ± 37.51 μm
at 1st month, and 533.46 ± 34.78 μm at 3rd month. It was observed
that the mean CCT increased at postoperative 1st week and returned
to its preoperative value at 1st month, and these changes were
statistically significant (p <0.001). As risk factors for endothelial cell
loss; age (p = 0.002), total ultrasound time (p = 0.004), effective phaco
time (p = 0.001) and grade of cataract (p <0.001) showed a statistically
significant and positive correlation with the loss of endothelial cell
density percentage.
Conclusion: Specular microscopic evaluation, especially in elderly
patients with advanced cataracts, will be effective in preventing
unwanted corneal complications.

Anahtar Kelimeler

• Phacoemulsification
• specular microscopy
• endothelial cell damage
• corneal edema

Fakoemülsifikasyon Cerrahisinin Kornea Endoteli Üzerine Etkilerinin İncelenmesi

Öz

Amaç: Fakoemülsifikasyon cerrahisi yapılan hastalarda kornea endotel hücre değişikliklerini ve hasar risk faktörlerini araştırmak.
Gereç ve Yöntem: Katarakt tanısı alıp komplikasyonsuz fakoemülsifikasyon cerrahisi yapılan 35 vaka çalışma kapsamına  alındı. Hastaların santral kornea kalınlığı (SKK) ile endotel hücre
verileri preoperatif ve postoperatif birinci hafta, birinci ay, üçüncü ayda speküler mikroskopla ölçüldü.
Bulgular: Hastaların yaş ortalaması 64.8±10.7 yıl, endotelin ameliyat öncesi hücre yoğunluğu (HY) ortalaması 2344.8±340.7 hücre/mm² idi. Ameliyat sonrası 3. aydaki HY ortalaması 1920.4±456.0 hücre/mm² olarak bulundu. Ortalama %18.3’lük bir HY kaybı gözlendi. Endotel hücre varyasyon katsayısı (VK), preoperatif ortalama 32.9±7.3 ve postoperatif 3. ayda ortalama 30±3.7 olarak bulundu. Hekzagonal hücre yüzdesi (HG) preoperatif ortalama 60±10.2 %, postoperatif 3. ayda 55.1±8.9 % olarak bulundu. VK ve HG postoperatif 3. ayda preoperatif değerlerine göre istatiksel olarak anlamlı düşük bulundu (p<0.05). Ortalama SKK, ameliyat öncesinde 535±32.30 μm, 1. haftada 568.74±43.46 μm, 1. ayda 539.60±37.51 μm ve 3. ayda 533.46±34.78 μm olarak ölçüldü. SKK ortalamasının 1. haftada artıp 1. ayda preoperatif değerine döndüğü ve bu değişimlerin istatistiksel olarak anlamlı olduğu görüldü (p<0.001). Endotel hücre kaybı risk faktörü olarak; yaşın (p=0.002), toplam ultrason zamanının (p=0.004), efektif fako süresinin (p=0.001) ve katarakt evresinin (p<0.001) endotel hücre yoğunluğu kayıp yüzdesiyle istatiksel olarak anlamlı ve pozitif bir korelasyon sergilediği saptandı.
Sonuç: Speküler mikroskopik değerlendirme, özellikle ileri kataraktı olan yaşlı hastalarda, istenmeyen kornea komplikasyonlarının önlenmesinde etkili olacaktır. 

Anahtar Kelimeler

• Fakoemülsifikasyon
• speküler mikroskopi
• endotel hücre hasarı

Kaynakça

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