Endothelial cell loss and trauma during intraocular lens implantation: a specular microscopic study

We analyzed the results of a retrospective specular microscopic study of 80 cases with unilateral medallion suture implants and contralateral unoperated eyes. In all cases a clinical estimation of operative endothelial trauma (ET), graded from 0 to 3+, was made at the time of surgery. The mean decrease in endothelial cell density (compared to the unoperated eye) for those 33 patients with ET 0 was 19%. There was a direct correlation between ET and decrease in endothelial cell density up to a mean of 59% for those 18 patients graded ET 2.5 to 3.0. The role of sample bias and small case sampling is significant in explaining the large discrepancy in endothelial cell loss after intraocular lens implantation reported in the literature.