Clinical endothelial cell loss following phacoemulsification and silicone or polymethylmethacrylate lens implantation

This study is a comparison of endothelial cell loss seen by two surgeons using the same surgical technique (posterior chamber phacoemulsification) with posterior chamber implants of two different materials (silicone and polymethylmethacrylate [PMMA]). One hundred four silicone lenses were implanted following phacoemulsification and compared with 160 PMMA lenses implanted during the same period. A significant feature of these procedures was the incidence of endothelial cell loss of greater than 1,200 cells/mm2. This occurred in 12.0% of cases with PMMA implants and in 15.4% of cases with silicone implants. When silicone implants were analyzed by insertion technique, flat insertion had only 7.7% cell loss of over 1,200 cells/mm2 whereas folding-bar insertion (14.3%) and syringe-style insertion (16.9%) showed a significant increase in the incidence of cell loss. Pachymetric results coincided with endothelial cell counts. Although silicone implants inserted flat produced less endothelial cell loss than PMMA implants inserted flat, silicone implants inserted folded produced greater loss. Improved insertion techniques should be developed.