Corneal endothelial evaluation after phacoemulsification in eyes with pseudoexfoliation syndrome

Abstract

Purpose The aim of this study was to evaluate the corneal endothelial cell changes after phacoemulsification in patients with age-related cataract and pseudoexfoliation (PEX) syndrome compared with control patients having age-related cataract using specular microscopy. Patients and methods In this prospective interventional case–control study, 20 eyes with cataract and PEX and 20 control eyes with cataract without PEX were subjected to phacoemulsification and posterior chamber foldable intraocular lens implantation at Minia University Hospital and Genaidy Eye Center, Minia, Egypt, between March 2019 and December 2020. Specular microscopy was done preoperatively and at 3 and 6 months postoperatively. The endothelial cell density (ECD), coefficient of variation, hexagonality (HEX%), pleomorphism, and corneal thickness were evaluated and compared between PEX and control eyes. Results The median best-corrected visual acuity improved significantly from a preoperative value of 0.3 in both groups to 0.5 and 0.6 in PEX and control groups, respectively, at 3 and 6 months postoperatively (P<0.001). In patients with PEX, the preoperative median ECD significantly decreased from 2790.5 cells/mm2 to 2387 at 3 months (P<0.001) and to 2380 cells/mm2 at 6 months (P<0.001). In the control group, the preoperative median ECD significantly decreased from 2599 to 2364 cells/mm2 at 3 months (P<0.001) and to 2353 cells/mm2 at 6 months (P<0.001). There was a statistically insignificant difference between the two groups regarding the preoperative and third and sixth postoperative month ECD (P=0.499, 0.850, and 0.860, respectively). The median of HEX% decreased significantly in the PEX eyes from a preoperative value of 45.5 to 39% at 3 months (P<0.001) and to 38% at 6 months (P<0.001). In the control eyes, the HEX% decreased significantly from a preoperative value of 42 to 38.5% at 3 months (P=0.009) and to 37% at 6 months (P<0.012). There was no statistically significant difference between the preoperative and postoperative values of the coefficient of variation % in either group, with no statistically significant difference between the two groups. In addition, there was no statistically significant difference between the two groups either before or after surgery in the central corneal thickness. Conclusion Although the percentage of reduction in ECD was more in the PEX eyes compared with the control eyes after phacoemulsification, there was no statistically significant difference in most of the studied parameters between the two groups.

Keywords

• corneal endothelium
• phacoemulsification
• pseudoexfoliation