Investigation of the Effects of Phacoemulsification Surgery on Corneal Endothelium

Yıl 2020, Cilt: 10 Sayı: 4, 573 - 577, 30.12.2020

Ekrem Kadıoğlu Önder Feyza

https://doi.org/10.16899/jcm.739876

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

• 1. Perone JM, Boiche M, Lhuillier L, Ameloot F, Premy S, Jeancolas AL, Goetz C, Neiter E: Correlation Between Postoperative Central Corneal Thickness and Endothelial damage After Cataract Surgery by Phacoemulsification. Cornea. 2018 May;37(5):587-590.
• 2. Ventura AS, Walti R, Böhnke M: Corneal thicness and endothelial density before and after cataract surgery. Br J Ophthalmol 2001; 85:18-20.
• 3. Yee RW, Matsuda M, Schultz RO, Edelhauser HF. Changes in the normal corneal endothelial cellular pattern as a function of age. Curr Eye Res 1985;4:671‑8.
• 4. Carlson KH, Bourne WM, McLaren JW, Brubaker RF. Variations in human corneal endothelial cell morphology and permeability to fluorescein with age. Exp Eye Res 1988;47:27‑41.
• 5. Shimazaki J, Amano S, Uno T, et al. National survey on bullous keratopathy in Japan. Cornea. 2007;26:274–278.
• 6. Keenan TD, Jones MN, Rushton S, et al. Trends in the indications for corneal graft surgery in the United Kingdom: 1999 through 2009. Arch Ophthalmol. 2012;130:621–628.
• 7. Tuft SJ, Coster DJ: The corneal endothelium. Eye 1990; 4:389-424.
• 8. Mishima S: Clinical investigations on the corneal endothelium. Am J Ophtalmol 1982; 93:1-29.
• 9. Committee on Ophthalmic Procedures Assesment. Corneal Endothelial Photography. Ophtalmol 1991 Sep;98(9):1464-68.
• 10. Sparrow JM, Bron AJ, Brown NA, et al. The Oxford Clinical Cataract Classification and Grading System. Int Ophthalmol 1986;9:207–25.
• 11. Bourne RRA, Minassian DC, Dart JKG, Rosen P, Kaushal S, Wingate N: Effect of cataract surgery on the corneal endothelium. Modern phacoemulsification compared to extracapsular cataract surgery. Ophthalmology 2004; 111:679-85.
• 12. Beltrame G, Salvetat ML, Driussi G, Chizzolini M: Effect of incision size and site on corneal endothelial changes in cataract surgery. J Cataract Refract Surg. 2002; 28:118-25.
• 13. He X, Diakonis VF, Alavi Y, Yesilirmak N, Waren D, Donaldson K: Endothelial Cell Loss in Diabetic and Nondiabetic Eyes After Cataract Surgery. Cornea. 2017 Aug;36(8):948-951.
• 14. Mathys K, Cohen K, Armstrong B: Determining factors for corneal endothelial cell loss by using bimanual microincision phacoemulsification and power modulation: Cornea 2007; 26:1049-55.
• 15. Hayashi K, Hayashi H, Nakao F, Hayashi F: Risk factors for corneal endothelial injury during phacoemülsification. J Cataract Refract Surg 1996; 22:1079-84.
• 16. Diaz-Valle D, Benitez del Castillo Sanchez JM, Castillo A, et al. Endothelial damage with cataract surgery techniques. J Cataract Refract Surg 1998; 24:951-5.
• 17. Schultz RO, Glasser DB, Matsuda M, et al. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol 1986;104:1164–9.
• 18. Lee JS, Lee JE, Choi HY, Oum BS: Corneal endothelial cell change after phacoemulsification relative to the severity of diabetic retinopathy. J Cataract Refract Surg 2005; 31:742-49.
• 19. Lundberg B, Jonsson M, Behndig A: Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification surgery. Am J Ophthalmol 2005; 139:1035-41.
• 20. Gagnon MM, Boisjoly HM, Brunette I, et al. Corneal endothelial cell density in glaucoma. Cornea. 1997;16:314–318. 9.
• 21. Novak-Stroligo M, Alpeza-Dunato Z, Kovacevic D, et al. Specular microscopy in glaucoma patients. Coll Antropol. 2010;34:209–210.
• 22. O’Brien WJ, Palmer ML, Guy J, et al. Endothelial barrier function and Na+/K(+)-ATPase pump density in herpetic stromal disease. Invest Ophthalmol Vis Sci. 1996;37:29–36.
• 23. Macdonald JM, Geroski DH, Edelhauser HF. Effect of inflammation on the corneal endothelial pump and barrier. Curr Eye Res. 1987;6:1125– 1132. 12.
• 24. Ghita AC, Ghita AM, Noaghi M, et al. The corticosteroids effect on corneal endothelial cell in pulse therapy, specific to the cataract surgery. J Med Life. 2014;4:46–53.
• 25. Cheng H, Bates AK, Wood L, et al. Positive correlation of corneal thickness and endothelial cell loss.Arch Ophthalmol 1988;106:920–2.
• 26. O’brein P, Fitzpatrick P, Kilmartin D, Beatty S: Risk factors for endothelial cell loss after phacoemulsification surgery by a junior resident. J Cataract Refract Surg 2004; 30:839-43.