The changing fate of the corneal endothelium in cataract surgery

Corneal endothelial cell loss remains a well known, undesirable side-effect of cataract surgery that may, in severe cases, negatively impact patients' postoperative visual outcomes. This article reviews the current literature and describes in detail how the degree of corneal endothelial cell loss is influenced by specific patient risk factors, as well as the arrival of newer surgical techniques and technologies.

Recent studies have demonstrated a reduction in corneal endothelial cell loss after phacoemulsification with the use of viscoelastic materials and modifications in phacoemulsification technology. Some patient characteristics may predispose patients to increased endothelial cell loss during cataract surgery.

Advances in surgical technique, the implementation of newer surgical technologies such as torsional ultrasound and viscoelastic devices, and aspects of patients' preexisting medical history may lead to varying degrees of endothelial cell loss after cataract surgery. Appropriately addressing these issues during the perioperative period may improve the rate of endothelial cell loss, and thus further enhance the visual outcome of patients undergoing cataract surgery.