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Bulgarian Review of Ophthalmology

Central corneal thickness and morphological changes in the cornea after uneventful phacoemulsification

Jana Simova, Mladena Radeva, Dimitar Grupchev, Tsvetelina Mihova, Christina Grupcheva

Abstract

Introduction:

Corneal endothelium can be altered during uneventful cataract surgery due to numerous factors. The endothelium is a monolayer of hexagonal cells, which have lost their replication ability, that maintain the dehydration of cornea, assuring its transparency. For this reason, corneal endothelium protection is a major concern during cataract surgery and is of significant importance for postoperative recovery and visual outcome. Transient increase in corneal thickness, which could be explained with moderate loss of endothelial cells, has been reported in several publications. However, results in terms of mean endothelial cell loss, change of central corneal thickness, and time for reaching baseline measurements, vary widely.

Aim

The aim of this article is to evaluate changes in endothelial cell density (ECD) and central corneal thickness (CCT) following uncomplicated cataract surgery.

Materials and Methods

 Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction under local anesthesia was used. Patients with previous ocular surgery or trauma, or other ocular pathology, as well as cases with complications, were not included in the study. Optical pachymetry of central cornea was performed using anterior segment optical coherence tomography (AS-OCT) (Topcon 3D SD OCT 2000). ECD and endothelial cell loss (ECL) in the central cornea were estimated using in vivo confocal microscopy (IVCM). All subjects were examined preoperatively and at three postoperative visits: day 1, day 7, and day 30. Statistical analysis was performed using SPSS statistics software package (v22.0) for Windows (IBM SPSS Inc., Chicago, IL,). Since the data were not normally distributed with the exception of patients’ age they are presented with their medians with nonparametric analyses being conducted.

Results

A total of 60 patients with a mean age of 70.56 years (SD=8.01), 29 men and 31 women were enrolled. Preoperatively CCT was 552 µm (range 480-659) and ECD was 2398 cells/mm2 (SD=1025-2965). A considerable rise in CCT was noted 24 hours after surgery (Z=-6.792, p<0.001). Endothelial cell count was 2302 cells/mm2 (range 945-2902); the decrease of cell density was 89 cells/mm2 (3.91%) compared to baseline. During the first week CCT decreased by 7.01% in comparison to the first postoperative visit, while ECD continued to decrease. Nearly preoperative values of CCT (566 µm, range= 481-807) were reached by the 30th postoperative day. The overall ECL compared to baseline was 108 cells/mm2 (5.2%).

Conclusion

Endothelial alteration is considered an important parameter of surgical trauma and essential for estimating the safety of the surgical technique. It can be roughly assessed measuring corneal thickness but modern technology for ultrastructural examination, such as OCT and IVCM, provides further information about the underlying morphological changes and could help choose the best approach according to the individual corneal characteristics of every patient.


Keywords

cornea; cataract surgery; CCT; ECD; IVCM; confocal microscopy

Full Text


References

Blindness and visual impairment [Internet]. World Health Organization. [cited 10 October 2018]. Available at: http://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment.

Lee CM, Afshari NA. The global state of cataract blindness. Curr Opin Ophthalmol. 2017;28(1):98–103. doi: 10.1097/ICU.0000000000000340.

Kenyon K, Bourne W. The Corneal Endothelium. Ophthalmology [Internet]. [cited 06 July 2018]; Available at: https://www.academia.edu/22880617/The_Corneal_Endothelium.

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(1):56–60. doi: 10.4103/0974-9233.124098.

Aribaba OT, Adenekan OA, Onakoya AO, Rotimi-Samuel A, Olatosi JO, Musa KO, et al. Central corneal thickness changes following manual small incision cataract surgery. Clin Ophthalmol. 2015;9:151–5. doi: 10.2147/OPTH.S75580.

Salvi SM, Soong TK, Kumar BV, Hawksworth NR. Central corneal thickness changes after phacoemulsification cataract surgery. J Cataract Refract Surg. 2007;33(8):1426–8. doi: 10.1016/j.jcrs.2007.04.010

Bolz M, Sacu S, Drexler W, Findl O. Local corneal thickness changes after small-incision cataract surgery. J Cataract Refract Surg. 2006;32(10):1667–71. doi: 10.1016/j.jcrs.2006.05.018.

Salvi SM, Soong TK, Kumar BV, Hawksworth NR. Central corneal thickness changes after phacoemulsification cataract surgery. J Cataract Refract Surg. 2007;33(8):1426–8. doi: 10.1016/j.jcrs.2007.04.010.

Lundberg B, Jonsson M, Behndig A. Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery. Am J Ophthalmol. 2005;139(6):1035–41. doi: 10.1016/j.ajo.2004.12.080.

Kim HY, Budenz DL, Lee PS, Feuer WJ, Barton K. Comparison of central corneal thickness using anterior segment optical coherence tomography versus ultrasound pachymetry. Am J Ophthalmol. 2008;145(2):228–32.

Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Corneal changes after small-incision cataract surgery in patients with diabetes mellitus. Arch Ophthalmol. 2004;122(7):966–9.

Ventura AC, Wälti R, Böhnke M. Corneal thickness and endothelial density before and after cataract surgery. Br J Ophthalmol. 2001;85(1):18–20.

Hugod M, Storr-Paulsen A, Norregaard JC, Nicolini J, Larsen AB, Thulesen J. Corneal endothelial cell changes associated with cataract surgery in patients with type 2 diabetes mellitus. Cornea. 2011;30(7):749–53. doi: 10.1097/ICO.0b013e31820142d9.

Bamdad S, Bolkheir A, Sedaghat MR, Motamed M. Changes in corneal thickness and corneal endothelial cell density after phacoemulsification cataract surgery: a double-blind randomized trial. Electron Physician. 2018;10(4):6616–23. doi: 10.19082/6616.

Assaf A, Roshdy MM. Comparative analysis of corneal morphological changes after transversal and torsional phacoemulsification through 2.2 mm corneal incision. Clin Ophthalmol. 2013;7:55–61. doi: 10.2147/OPTH.S39019.

Kim D-H, Wee W-R, Lee J-H, Kim M-K. The comparison between torsional and conventional mode phacoemulsification in moderate and hard cataracts. Korean J Ophthalmol. 2010;24(6):336–40. doi: 10.3341/kjo.2010.24.6.336.

Reuschel A, Bogatsch H, Barth T, Wiedemann R. Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification. J Cataract Refract Surg. 2010;36(11):1855–61. doi: 10.1016/j.jcrs.2010.06.060.

Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000;26(5):727–32.

Mathew PT, David S, Thomas N. Endothelial cell loss and central corneal thickness in patients with and without diabetes after manual small incision cataract surgery. Cornea. 2011;30(4):424–8. doi: 10.1097/ICO.0b013e3181eadb4b.

Li MH, Fu XL, Yang WF. Effect and risk factors for corneal endothelial cells after phacoemulsification in diabetic cataract patients. Guoji Yanke Zazhi. 2016;16(6):1048–151. doi: 10.3980/j.issn.1672-5123.2016.6.11.

Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Corneal changes after small-incision cataract surgery in patients with diabetes mellitus. Arch Ophthalmol. 2004;122(7):966–9. doi: 10.1001/archopht.122.7.966.

Tang Y, Chen X, Zhang X, Tang Q, Liu S, Yao K. Clinical evaluation of corneal changes after phacoemulsification in diabetic and non-diabetic cataract patients, a systematic review and meta-analysis. Sci Rep. 2017;7(1):14128. doi: 10.1038/s41598-017-14656-7.

Mencucci R, Ponchietti C, Virgili G, Giansanti F, Menchini U. Corneal endothelial damage after cataract surgery: Microincision versus standard technique. J Cataract Refract Surg. 2006;32(8):1351–4. doi: 10.1016/j.jcrs.2006.02.070.

Holzer MP, Tetz MR, Auffarth GU, Welt R, Völcker HE. Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery. J Cataract Refract Surg. 2001;27(2):213–8.

Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during phacoemulsification. J Cataract Refract Surg. 1996;22(8):1079–84.

Joussen AM, Barth U, Cubuk H, Koch H. Effect of irrigating solution and irrigation temperature on the cornea and pupil during phacoemulsification. J Cataract Refract Surg. 2000;26(3):392–7.

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(1):118–25.

Cheng H, Bates AK, Wood L, McPherson K. Positive correlation of corneal thickness and endothelial cell loss. Serial measurements after cataract surgery. Arch Ophthalmol. 1988;106(7):920–2.

Schultz RO, Glasser DB, Matsuda M, Yee RW, Edelhauser HF. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol. 1986;104(8):1164–9.

Zhu N, Zhang ZC, Hao XL. Influence of phacoemulsification on corneal endothelial cell of cataract patients with diabetes or hypertension. Guoji Yanke Zazhi. 2014;(14):480–3. doi: 10.3980/j.issn.1672-5123.2014.03.29

Lin J, Zhao G. Changes of corneal endothelium in diabetes patients after cataract phacoemulsification surgery by confocal microscopy. Acta Ophthalmol. 2013;(13):876–9. doi:10.1111/j.1755-3768.2014.S084.x.

Yang R, Sha X, Zeng M, Tan Y, Zheng Y, Fan F. The influence of phacoemulsification on corneal endothelial cells at varying blood glucose levels. Eye Sci. 2011;26(2):91–5. doi: 10.3969/j.issn.1000-4432.2011.02.018.

Dhasmana R, Singh IP, Nagpal RC. Corneal changes in diabetic patients after manual small incision cataract surgery. J Clin Diagn Res. 2014;8(4):VC03–6. doi: 10.7860/JCDR/2014/7955.4288.

Cook C. How to improve the outcome of cataract surgery. Community Eye Health. 2000;13(35):37–8.




DOI: http://dx.doi.org/10.14748/bro.v62i4.5631

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About The Authors

Jana Simova
Medical University of Varna
Bulgaria

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

Mladena Radeva
Medical University of Varna
Bulgaria

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

Dimitar Grupchev
Medical University of Varna
Bulgaria

TRS Medical Optician, Medical College

Tsvetelina Mihova
Medical University of Varna
Bulgaria

TRS Medical Optician, Medical College

Christina Grupcheva
Medical University of Varna
Bulgaria

Department of Ophthalmology and Visual Sciences, Faculty of Medicine

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