Endothelial cell loss in intraocular lens placement

Endothelial cell counts were done on eyes selected to fall into four categories: unoperated, intracapsular cataract extraction without implantation, and intracapsular cataract extraction with easy or difficult insertion of an intraocular implant. Uncomplicated cataract extraction resulted in less than 9% cell loss. Implantation in "easy" eyes resulted in 12% cell loss (p greater than 0.3). Eyes in which implantation was difficult suffered an average loss of 65% of the endothelial cells (p less than .001). The reasons for cell loss are discussed and some improvements in techniques are mentioned with examples of the value of analysis of motion picture records of the surgery. The obvious lesson to be learned is that everything possible must be done to optimize routinely the conditions for lens implantation. The surgeon who finds conditions unfavorable for lens implantation must consider that persistence will mean sacrificing, on the average, two-thirds of the corneal endothelial cells.