Morphological Changes in the Endothelium of Cornea after Cataract Surgery: A Comparison between Phacoemulsification and Manual Small Incision Cataract Surgery

Abstract

Background: Endothelial cell loss and corneal decompensation after cataract surgery is well-documented. After endothelial cell loss, the adjacent cells enlarge and slide over to maintain endothelial cell continuity, which is observed as a change in the endothelial cell density and morphology of the cornea.

Objective: The study aims to assess and compare morphological changes (i.e., endothelial cell loss) in cornea after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation.

Methods: This observational study was conducted in the Department of Ophthalmology of Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh, between January and July of 2016. A total of 80 patients of age-related cataract were randomly selected based on inclusion and exclusion criteria. All patients underwent complete ophthalmic evaluation pre- and post-operatively (at day 1, after 1 week and 3 months) specifically for observation of the endothelial changes in cornea. Specular microscopy was done to assess corneal endothelial change.

Results: The mean endothelial cell count was found decreased at day 1 (2585.07±355.65/mm² vs. 2598.07±385.76/mm²), after 1 week (2564.72±347.23/mm² vs. 2388.77±326.46/mm²) and after 3 months (2476.72±346.69/mm² vs. 2248.77±354.47/mm²) following phacoemulsification and MSICS from their preoperative values (2745.35±395.27/mm² vs. 2673.04±388.28/mm²) respectively. However, no significant difference was observed in mean endothelial cell count of both groups (P>0.05). The mean percentage of endothelial cell loss were observed 5.84±10.02% and 2.80±0.65% at day 1, 6.58±12.15% and 10.63±15.92% at 1 week, 9.78±12.29% and 15.87±8.71% at 3 months after phacoemulsification and MSICS. However, the difference observed in amount of endothelial cell loss between the groups was not statistically significant (P>0.05).

Conclusion: To summarize, a decreased endothelial cell count was observed after cataract surgery in both phacoemulsification and MSICS procedures from their preoperative values respectively. However, the difference was not significant between two procedures. 

Mugda Med Coll J. 2023; 6(1): 11-15