Long-Term Comparison of Endothelial Changes Between Torsional and Longitudinal Phacoemulsification

The objective of this study was to evaluate endothelial changes between torsional and longitudinal phacoemulsification 2 years after cataract surgery.

This was a prospective, randomized, controlled clinical trial.

We enrolled 200 patients with senile cataract between August 2008 and December 2009 for surgery using either torsional (group A, n = 100) or longitudinal (group B, n = 100) phacoemulsification. Outcomes were central endothelial cell density and corrected distance visual acuity (CDVA) 3 months and in this follow-up 2 years after surgery. Statistical evaluation of endothelial cell loss (ECL) was performed according to statistical guidelines by creating a primary analysis (substitution of missing values by the median) and a secondary analysis (actual data).

The mean age was 71 (SD, 7.3) years. We were able to reexamine 46 patients in group A and 54 in group B 2 years after surgery. The median CDVA before surgery was 0.3 logMAR in group A and 0.35 logMAR in group B, improving to 0 logMAR postoperatively in both groups. The median ECL in the primary analysis was 6.9% after 3 months and 10.3% 2 years after surgery in group A. In group B, we found a loss of 6.6% after 3 months and 8.6% 2 years postoperatively. In the secondary analysis, the loss was 10.0% in group A and 8.5% in group B after 2 years. The difference was statistically not significant.

There is no difference between the ECL between torsional and longitudinal phacoemulsification up to 2 years after cataract surgery.