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[Is endothelial microscopy necessary before cataract surgery?].

P Vivell1, O E Lund

  • 1Augenklinik der Universität München.

Klinische Monatsblatter Fur Augenheilkunde
|September 1, 1990
PubMed
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Specular microscopy is crucial before cataract surgery to assess corneal health and determine intraocular lens (IOL) suitability. This pre-operative evaluation helps prevent complications in patients with existing ocular conditions.

Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Ophthalmic Imaging

Background:

  • Cataract surgery often involves intraocular lens (IOL) implantation.
  • Corneal health is a critical factor in IOL suitability.
  • Pre-operative assessment of the cornea is essential for successful outcomes.

Purpose of the Study:

  • To evaluate the utility of specular microscopy in assessing corneal health prior to cataract surgery.
  • To determine the impact of pre-operative corneal assessment on IOL implantation decisions and outcomes.
  • To identify specific corneal conditions that contraindicate IOL implantation.

Main Methods:

  • Specular microscopy was performed on approximately 3,500 patients before cataract surgery.
  • Corneal conditions were assessed, noting cases where IOL implantation was deemed inappropriate.

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  • Patient groups were compared based on whether IOLs were implanted despite contraindications or omitted.

    • Main Results:

    • In about 4% of cases (127 patients), IOL implantation was considered inappropriate due to corneal condition.
    • Patients with additional ocular pathologies (retinal detachment, glaucoma, uveitis) were frequently in this group.
    • No significant difference in postoperative corneal complications was observed between groups with or without IOL implantation despite contraindications.

    Conclusions:

    • Specular microscopy is vital for identifying patients with conditions like cell polymorphism and severe cornea guttata, which compromise IOL suitability.
    • Assessing corneal cell polymorphism is challenging with slit-lamp examination alone.
    • Pre-operative specular microscopy is strongly recommended for patients undergoing cataract surgery, especially those with co-existing ocular diseases or visible corneal lesions.