Title: Evaluation of the Effect of Various Intra Operative Surgical Complications on Central Corneal Endothelial Cell Density and Central Corneal Thickness- A Prospective Study

Authors: Dr Sachin Tammannavar, Dr Ramesh, Janice Reema Lewis, Harshitha, Hemanth Raju M R

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.174

Abstract

Purpose: To evaluate the effect of various intra operative surgical complications on Central Corneal Endothelial Cell Density and Central Corneal Thickness

Methods: A prospective study comprising of 222 patients who underwent small incision cataract surgery, which were divided into three groups.

G1 -Irrigating vectis technique-73 patients

G2-Sandwich technique-75 patients

G3 -Visco expression technique-74 patients.

All patients underwent complete ophthalmic examination and biometry followed by measurement of central corneal thickness, specular microscopy (endothelial images) was performed at baseline (preoperative) and postoperatively at 1week, 2 weeks, 1 month and 3 months.

Results: In our study, out of 222 patients, 180 patients had uneventful and 42 patients had complicated surgeries. In that 42 complicated surgeries,

-11 patients had instrumental trauma (26.2%) which caused 25.2% endothelial cell loss (p value 0.001) and 5% increase in CCT.

-14 patients had Iris prolapse (33.3%) which caused 19.1% cell loss (p value 0.001) and 0.9% increase in CCT

-7 patients had IOL Contact (16.7%) which caused 13.1% cell loss (p value 0.003) and 1.9% increase in CCT

-9 patients had vitreous loss (21.4%) which caused 11.5% cell loss (p value 0.039)  and 0.9% increase in CCT and 1 patient had Iris posterior capsular rent  (2.4%) which caused 11.3% cell loss and 0.9% increase in CCT at 3 months post operatively.

In all 42 complicated surgeries, average 10.6% cell loss and 5.8% increase in CCT was found.

In all 180 uneventful surgeries, average 9.5% cell loss and 3.48% increase in CCT was found.

Conclusion: Percentage of endothelial cell loss and increase in central corneal thickness was more in complicated surgeries, than uneventful surgeries.

References

  1. A K Khurana, Indu Khurana Anatomy and Physiology of Eye 2nd edition, 2006
  2. Rupert R. A. Bourne, BSc, FRC Ophth, 1, 2 Darwin C. Minassian, FRCOphth, MSc (Epidem). Effect of cataract surgery on corneal endothelium: modern phacoemulsification compared with extra capsular cataract surgery.  Ophthalmology 2004;111:679–685 © 2004 by the American Academy of Ophthalmology
  3. Alyaa Abood Kareem. M.B.Ch.B, F.I.C.M.S ophth. C.A.B ophth. Medical College-Kufa University Maan Abdul Ameer Kitab Alged. M.B.Ch.B. Evaluation of Corneal Endothelial Cells Hysteresis after Phacoemulsification Kufa Med. Journal 2012.VOL.15.No.1. 362
  4. Mohamed AE Soliman Mhdy, Mohamed Zeid, Mohamed Abdel BadeiMohammed, Amr Hafez and Jagdish Bhatia. Relationship between endothelial cell loss and micro axial phacoemulsification parameters in no complicated cataract surgry. PMCID; PMC3334211Clin Ophthal.2012;6503-510
  5. Shultz RO,Matsuda M,Yee RW, Corneal endothelium changes in type-I and type-II Diabetes mellitus American journal of ophthal mology 1984;98;401-410.
  6. Hayashi K, Yoshida M, Manabe S, Hiarata A. Cataract surgery in eyes with low endothelial cell density J cataract refract surg.2011;37(8) 1419-1425
  7. Mohammad Nasser Hashemian, Sasan Moghimi, Masood Aghsaie, Fard, Mohammad Reza Fallah and Mohammad Reza Mansouri Corneal endothelial cell density and morphology in normal Iranian eyes. BMC Ophthalmology 2006,6;9 doi;10.1186/1471-2415-6-9.
  8. Storr-Paulsen A, Norregaard JC, Ahmed S, Storr-Paulsen T, Pedersen TH.Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique. Department of Ophthalmology, Frederiksberg University Hospital, Frederiksberg, Denmark..Endothelial cell damage with phacoemulsification techniques. [J Cataract Refract Surg. 2009
  9. Gogate P, Ambardekar P, Kulkarni S, Deshpande R, Joshi S, Deshpande M. Comparison of endothelial cell loss after cataract surgery: phacoemulsification versus manual small-incision cataract surgery: six-week results of a randomized control trial. V. Desai Eye Hospital, 73/2 Tarawade Wasti, Mohammadwadi, Hadapsar, Pune-411028, India. J Cataract Refract Surg. 2010 Feb;36(2):247-53. doi: 10.1016/j.jcrs.2009.09.023.
  10. Dafna Goldenberg, Zohar Habot-Wilner, Yoseph Glovinsky, Irina S. Barequet Endothelial cells and central corneal thickness after modified sutureless manual small-incision cataract surgery European Journal Oph
  11. Albert DM, Henkind P. Men of Vision. Lives of Notable Figures in Ophthalmology. WB Saunders, 1993
  12. Kelman CD “Phacoemulsification and aspiration: a new technique of cataract removal. A preliminary report” Am J Ophthalmol1967;64:23-35
  13. James A Davison, Leo T Chylack. Clinical application of the lens opacities classification system III in the performance of phacoemulsification. Journal of Cataract and Ref Surgery; 2003 Jan; 29 (1): 138-145
  14. Smith, Gurung R, Hennig A. Small incision cataract surgery: Tips for avoiding surgical complications. Community Eye Health 2008; 21: 4-5
  15. Jacobs PM Bellucci R, Morselli S et al. Nucleus viscoexpression compared with other techniques of nucleus removal in extra capsular cataract extraction with capsulorrhexis. Ophthalmic Surgery 1994; 25(7): 432-7
  16. Rao GN Ravi Thomas et al. Methods of nucleus extraction; ECCE – Surgical techniques.IJO 1993; 4(4): 202-206 127
  17. Sunil Ganekal. J Akura et al. “Manual Sutureless Cataract Surgery using Claw Vectis” Journal of cataract and Refractive surgery; 2000(26): 491-496.

Corresponding Author

Dr Sachin Tammannavar

Karwar Institute of Medical Sciences, Karwar- 581301(India)