COMPARATIVE ANALYSIS OF ENDOTHELIAL CELL LOSS IN MATURE CATARACTS FOLLOWING PHACOEMULSIFICATION AND MANUAL SMALL INCISION CATARACT SURGERY
Main Article Content
Keywords
Endothelial Cell, Specular Microscope, Pachymetry, Mature Cataract, Phacoemulsification, Small Incision Cataract Surgery
Abstract
Background: Corneal transparency depends on the corneal endothelium's structural soundness and functionality. The range of corneal endothelial cell count (ECC) in the adult population is 2000–2500 cells/mm2. ECC continues to decline with age.
Purpose: To compare the structural and functional endothelial cell (EC) changes in mature cataracts after phacoemulsification (PKE) and small incision cataract surgery (SICS).
Methods: In the current Prospective double-masked observational study a total of 200 eyes of 200 patients between 60 & 90 years of age with senile cataracts of nuclear sclerosis grade IV and above were enrolled. Patients were randomly assigned into two groups of 100 eyes each in Group A (SICS) & Group B (PKE). Corneal EC count and central corneal thickness (CCT) were done preoperatively and postoperatively on day 7 and day 30.
Results: The mean EC loss on postoperative day 7 in Group A was 14.54% and in Group B was 7.92% which was statistically significant. Though EC count improved in both the groups at 30 days post-operative visit, significantly more EC loss continued in Group A. The mean increase in CCT on postoperative day 7 in Group A was 3.04%, and in Group B was 1.69% which was statistically significant. On postoperative day 30, CCT improved in both groups and the difference was not statistically significant.
Conclusion: In the case of mature cataracts, PKE done by direct chop technique leads to lesser EC loss and thinner corneas postoperatively as compared to SICS.
Purpose: To compare the structural and functional endothelial cell (EC) changes in mature cataracts after phacoemulsification (PKE) and small incision cataract surgery (SICS).
Methods: In the current Prospective double-masked observational study a total of 200 eyes of 200 patients between 60 & 90 years of age with senile cataracts of nuclear sclerosis grade IV and above were enrolled. Patients were randomly assigned into two groups of 100 eyes each in Group A (SICS) & Group B (PKE). Corneal EC count and central corneal thickness (CCT) were done preoperatively and postoperatively on day 7 and day 30.
Results: The mean EC loss on postoperative day 7 in Group A was 14.54% and in Group B was 7.92% which was statistically significant. Though EC count improved in both the groups at 30 days post-operative visit, significantly more EC loss continued in Group A. The mean increase in CCT on postoperative day 7 in Group A was 3.04%, and in Group B was 1.69% which was statistically significant. On postoperative day 30, CCT improved in both groups and the difference was not statistically significant.
Conclusion: In the case of mature cataracts, PKE done by direct chop technique leads to lesser EC loss and thinner corneas postoperatively as compared to SICS.
References
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[2] Buys YM, Chipman ML, Zack B, et al. Prospective randomized comparison of one- versus two-site phacotrabeculectomy two-year results. Ophthalmology 2008;115:1130–3.
[3] Kim DH, Wee WR, Hyon JY. The pattern of early corneal endothelial cell recovery following cataract surgery: Cellular migration or enlargement? Graefes Arch Clin Exp Ophthalmol 2015;253:2211‑6.
[4] Faramarzi A, Javadi MA, Karimian F, et al. Corneal EC loss during PKE. J Cataract Refract Surg 2011;37:1971-6.
[5] Kumar R, Wahi D, Tripathi P. Comparison of changes in endothelial cell count and central corneal thickness after phacoemulsification and small-incision cataract surgery: a prospective observational study at a tertiary care center of eastern Uttar Pradesh. Indian J Ophthalmol 2022;70:3954-9.
[6] Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: Relation to preoperative and intraoperative parameters. J Cataract Refract Surg 2000;26:727‑32.
[7] Maggon R, Bhattacharjee R, Shankar S, et al. Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes. Indian J Ophthalmol 2017;65.
[8] Gogate P, Ambardekar P, Kulkarni S. Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small incision cataract surgery: Six week results of a randomized control trial. J Cataract Refract Surg 2010;36:247 53.
[9] Singh R, Sharma AK, Katiyar V, et al. Corneal endothelial changes following cataract surgery in hard nuclear cataract: Randomized trial comparing phacoemulsification to manual small-incision cataract surgery. Indian J Ophthalmol 2022;70:3904-9.
[10] Ganekal S, Nagarajappa A. Comparison of morphological and functional endothelial cell changes after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery. Middle East Afr J Ophthalmol 2014;21:56-60.
[11] Subudhi P, Khan Z, Subudhi BNR, et al. Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts. Saudi J Ophthalmol 2020;34(1):18-24.
[12] Muralikrishnan R, Venkatesh R, Prajna NV, et al. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004;11:369‑80.
[13] Bhargava R, Kumar P, Sharma SK, et al. Phacoemulsification versus small incision cataract surgery in patients with uveitis. Int J Ophthalmol. 2015;8(5):965-70.
[14] Floyd M, Valentine J, Coombs J, et al. Effect of incisional friction and ophthalmic viscosurgical devices on the heat generation of ultrasound during cataract surgery. J Cataract Refract Surg 2006;32:1222‑6.
[15] Mencucci R, Ponchietti C, Virgili G, et al. Corneal endothelial damage after cataract surgery: Microincision versus standard technique. J Cataract Refract Surg 2006;32:1351‑4.
[16] Orski M, Synder A, Pałenga‑Pydyn D, et al. The effect of the selected factors on corneal endothelial cell loss following phacoemulsification. Klin Oczna 2014;116:94‑9.
[17] Jagani SN, Lune AA, Magdum RM, et al. Comparison of endothelial cell loss by specular microscopy between phacoemulsification and manual small incision cataract surgery. Niger J Ophthalmol 2015;23:54 9.
[18] Beltrame G, Salvetat ML, Driussi G, et al. Effect of incision size and site on corneal endothelial changes in cataract surgery. J Cataract Refract Surg 2002;28:118‑25.
[19] Guedes J, Pereira SF, Amaral DC, et al. Phaco-chop versus divide-and-conquer in patients who underwent cataract surgery: a systematic review and meta-analysis. Clin Ophthalmol 2024;18:1535-1546.
[20] Perone JM, Boiche M, Lhuillier L, et al. Correlation between postoperative central corneal thickness and endothelial damage after cataract surgery by phacoemulsification. Cornea 2018;37:587 90.
[21] Deshpande S, Agarwal A, Shah P, et al. Study of central corneal thickness (CCT) before and after small-incision cataract surgery (SICS) and phacoemulsification surgery. Niger J Ophthalmol 2018;26:35-9.
[22] Salvi SM, Soong TK, Kumar BV, et al. Central corneal thickness changes after phacoemulsification cataract surgery. J Cataract Refract Surg 2007;33:1426 8.
[23] Gharaee H, Kargozar A, Daneshvar‑Kakhki R, et al. Correlation between corneal endothelial cell loss and location of phacoemulsification incision. J Ophthalmic Vis Res 2011;6:13‑7.
[2] Buys YM, Chipman ML, Zack B, et al. Prospective randomized comparison of one- versus two-site phacotrabeculectomy two-year results. Ophthalmology 2008;115:1130–3.
[3] Kim DH, Wee WR, Hyon JY. The pattern of early corneal endothelial cell recovery following cataract surgery: Cellular migration or enlargement? Graefes Arch Clin Exp Ophthalmol 2015;253:2211‑6.
[4] Faramarzi A, Javadi MA, Karimian F, et al. Corneal EC loss during PKE. J Cataract Refract Surg 2011;37:1971-6.
[5] Kumar R, Wahi D, Tripathi P. Comparison of changes in endothelial cell count and central corneal thickness after phacoemulsification and small-incision cataract surgery: a prospective observational study at a tertiary care center of eastern Uttar Pradesh. Indian J Ophthalmol 2022;70:3954-9.
[6] Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: Relation to preoperative and intraoperative parameters. J Cataract Refract Surg 2000;26:727‑32.
[7] Maggon R, Bhattacharjee R, Shankar S, et al. Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes. Indian J Ophthalmol 2017;65.
[8] Gogate P, Ambardekar P, Kulkarni S. Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small incision cataract surgery: Six week results of a randomized control trial. J Cataract Refract Surg 2010;36:247 53.
[9] Singh R, Sharma AK, Katiyar V, et al. Corneal endothelial changes following cataract surgery in hard nuclear cataract: Randomized trial comparing phacoemulsification to manual small-incision cataract surgery. Indian J Ophthalmol 2022;70:3904-9.
[10] Ganekal S, Nagarajappa A. Comparison of morphological and functional endothelial cell changes after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery. Middle East Afr J Ophthalmol 2014;21:56-60.
[11] Subudhi P, Khan Z, Subudhi BNR, et al. Phacoemulsification vs manual small incision cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III cataracts. Saudi J Ophthalmol 2020;34(1):18-24.
[12] Muralikrishnan R, Venkatesh R, Prajna NV, et al. Economic cost of cataract surgery procedures in an established eye care centre in Southern India. Ophthalmic Epidemiol 2004;11:369‑80.
[13] Bhargava R, Kumar P, Sharma SK, et al. Phacoemulsification versus small incision cataract surgery in patients with uveitis. Int J Ophthalmol. 2015;8(5):965-70.
[14] Floyd M, Valentine J, Coombs J, et al. Effect of incisional friction and ophthalmic viscosurgical devices on the heat generation of ultrasound during cataract surgery. J Cataract Refract Surg 2006;32:1222‑6.
[15] Mencucci R, Ponchietti C, Virgili G, et al. Corneal endothelial damage after cataract surgery: Microincision versus standard technique. J Cataract Refract Surg 2006;32:1351‑4.
[16] Orski M, Synder A, Pałenga‑Pydyn D, et al. The effect of the selected factors on corneal endothelial cell loss following phacoemulsification. Klin Oczna 2014;116:94‑9.
[17] Jagani SN, Lune AA, Magdum RM, et al. Comparison of endothelial cell loss by specular microscopy between phacoemulsification and manual small incision cataract surgery. Niger J Ophthalmol 2015;23:54 9.
[18] Beltrame G, Salvetat ML, Driussi G, et al. Effect of incision size and site on corneal endothelial changes in cataract surgery. J Cataract Refract Surg 2002;28:118‑25.
[19] Guedes J, Pereira SF, Amaral DC, et al. Phaco-chop versus divide-and-conquer in patients who underwent cataract surgery: a systematic review and meta-analysis. Clin Ophthalmol 2024;18:1535-1546.
[20] Perone JM, Boiche M, Lhuillier L, et al. Correlation between postoperative central corneal thickness and endothelial damage after cataract surgery by phacoemulsification. Cornea 2018;37:587 90.
[21] Deshpande S, Agarwal A, Shah P, et al. Study of central corneal thickness (CCT) before and after small-incision cataract surgery (SICS) and phacoemulsification surgery. Niger J Ophthalmol 2018;26:35-9.
[22] Salvi SM, Soong TK, Kumar BV, et al. Central corneal thickness changes after phacoemulsification cataract surgery. J Cataract Refract Surg 2007;33:1426 8.
[23] Gharaee H, Kargozar A, Daneshvar‑Kakhki R, et al. Correlation between corneal endothelial cell loss and location of phacoemulsification incision. J Ophthalmic Vis Res 2011;6:13‑7.
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Published
Jan 31, 2025
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How to Cite
Dr. Parthapratim Mandal, & Dr Raghudev Bhattacharjee. (2025). COMPARATIVE ANALYSIS OF ENDOTHELIAL CELL LOSS IN MATURE CATARACTS FOLLOWING PHACOEMULSIFICATION AND MANUAL SMALL INCISION CATARACT SURGERY. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 402-409. https://doi.org/10.53555/2qv7ys72
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Author Biographies
Dr. Parthapratim Mandal
Associate Professor, Department of Ophthalmology, Sri Ramkrishna Institute of Medical Sciences & Sanaka Hospitals, Durgapur, West Bengal, India.
Dr Raghudev Bhattacharjee
Assistant Professor, Department of Ophthalmology, Sri Ramkrishna Institute of Medical Sciences & Sanaka Hospitals, Durgapur, West Bengal, India.
How to Cite
Dr. Parthapratim Mandal, & Dr Raghudev Bhattacharjee. (2025). COMPARATIVE ANALYSIS OF ENDOTHELIAL CELL LOSS IN MATURE CATARACTS FOLLOWING PHACOEMULSIFICATION AND MANUAL SMALL INCISION CATARACT SURGERY. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 402-409. https://doi.org/10.53555/2qv7ys72