Risk factors for reduced corneal endothelial cell density before cataract surgery

To assess the prevalence and risk factors for reduced endothelial cell density before cataract surgery.

Ohtsuki Eye Clinic, Sendai, Japan.

The records of 1304 eyes of 700 consecutive Japanese patients who had cataract surgery from 1995 through 2000 were retrospectively reviewed. The incidence of reduced endothelial cell density to less than 2000 cells/mm(2) was calculated, and potential risk factors for the reduced density were analyzed using logistic regression analysis.

The mean preoperative endothelial cell density was 2561.4 cells/mm(2) +/- 375.2 (SD). Reduced endothelial cell density was observed preoperatively in 123 eyes (9%) of 85 patients (12%). In these patients, factors responsible for the decrease were identified in 37 eyes (30%) of 28 (33%) patients. Logistic regression analysis revealed that corneal diseases (P =.003), angle-closure glaucoma (P =.004), pseudoexfoliation (P =.031), and a history of trauma (P <.001) were significantly associated with reduced endothelial cell density. Advanced nuclear cataract and chronic pulmonary disease were also significant risk factors (both P <.001). A subset quantitative comparison study showed that the mean endothelial cell densities in the subgroups of eyes with these risk factors were significantly less than those in a control group (P <.05, analysis of variance).

Approximately 10% of patients had reduced endothelial cell density before cataract surgery; the reason for the reduction was unknown in two thirds. Advanced nuclear cataract and chronic pulmonary disease were significant risk factors for reduced density. Although the mechanisms are unknown, cataract surgeons should recognize that patients with these risk factors may have a poor endothelial reserve.