Clinical specular microscopy and intraocular surgery.

Area of Science:

• Ophthalmology
• Corneal Surgery
• Endothelial Cell Biology

Background:

• The corneal endothelium is crucial for maintaining corneal clarity.
• Surgical interventions can impact endothelial cell density and function.
• Understanding cell loss is vital for predicting visual outcomes.

Purpose of the Study:

• To compare the effects of different cataract and corneal surgery techniques on corneal endothelial cells.
• To evaluate cell loss following intracapsular cataract extraction (ICCE), ICCE with intraocular lens (IOL) implantation, phacoemulsification, and penetrating keratoplasty.

Main Methods:

• Prospective study of 70 patients.
• Clinical specular microscopy used to assess corneal endothelium.
• Comparison of cell loss across four surgical groups.

Main Results:

• Intracapsular cataract extraction (ICCE) resulted in 6% cell loss.
• Intraocular lens (IOL) implantation led to 12% cell loss.
• Phacoemulsification showed 14% cell loss.
• Penetrating keratoplasty (both phakic and aphakic grafts) resulted in 21% cell loss.
• Aphakic keratoplasty with intact vitreous face had 10% cell loss vs. 26% with anterior vitrectomy.

Conclusions:

• Penetrating keratoplasty, particularly with anterior vitrectomy, causes significant endothelial cell loss.
• Phacoemulsification and IOL implantation also induce notable cell loss compared to ICCE.
• Surgical technique choice influences corneal endothelial cell survival.