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Exfoliation Syndrome as a Risk Factor for Corneal Endothelial Cell Loss in Cataract Surgery

  • Original Article
  • Published:
Annals of Ophthalmology

Abstract

Purpose

To compare the influence of various cataract surgery pre-, intra-, and postoperative characteristics to cornea endothelium and thickness in patients with and without exfoliation syndrome (PEX).

Methods

In this prospective study 27 consecutive patients with and 26 patients without PEX as a control group scheduled for cataract surgery were studied. The corneal endothelial cells were evaluated preoperatively and postoperatively at 1 day and 1 month after surgery using noncontact specular microscopy. Intraoperative parameters of operation time, phacoemulsification (phaco) time, phaco power and amount of balanced salt solution (BSS) were recorded. The effects of age, axial length, anterior chamber depth (ACD), and lens thickness were evaluated.

Results

There were no significant preoperative differences in endothelium morphology between the two groups. The mean endothelial cell loss 1 month after surgery was 18.1% in the PEX group and 11.6% in the control group (p = 0.06). Phaco time and used BSS values were significantly higher in patients with PEX but had no significant influence on endothelial cell loss. In regression analysis phaco power (p = 0.02) and age (p = 0.004) had a significant influence on endothelial cell loss. PEX in interaction with overall phaco impact had a negative influence on endothelial cell loss (p = 0.05).

Conclusions

PEX as a main effect was not found to have a negative influence on endothelial cell loss. However, PEX in cases of high phaco impact significantly increases the risk of endothelial cell loss.

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References

  1. Abib FC, Barreto J. Jr. Behavior of corneal endothelial density over a lifetime. J Cataract Refract Surg 2000;27:1574–1578

    Article  Google Scholar 

  2. Murphy C, Alvarado J, Juster R, Maglio M. Prenatal and postnatal cellularity of the human corneal endothelium. A quantitative histologic study. Invest Ophthalmol Vis Sci 1984;25:312–322

    PubMed  CAS  Google Scholar 

  3. Joyce NC. Proliferative capacity of the corneal endothelium. Prog Retin Eye Res 2003;22:359–389

    Article  PubMed  CAS  Google Scholar 

  4. Scorolli L, Scorolli L, Campos EC, Bassein L, Meduri RA. Pseudoexfoliation syndrome: a cohort study on intraoperative complications in cataract surgery. Ophthalmologica 1998;212:278–280

    Article  PubMed  CAS  Google Scholar 

  5. Hayashi H, Hayashi K, Nakao F, Hayashi F. Anterior capsule contraction and intraocular lens dislocation in eyes with pseudoexfoliation syndrome. Br J Ophthalmol 1998;82:1429–1432

    Article  PubMed  CAS  Google Scholar 

  6. Shingleton BJ, Heltzer J, O’Donoghue MW. Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome. J Cataract Refract Surg 2003;29:1080–1086

    Article  PubMed  Google Scholar 

  7. Pohjalainen T, Vesti E, Uusitalo RJ, Laatikainen L. Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation. J Cataract Refract Surg 2001;27:426–431

    Article  PubMed  CAS  Google Scholar 

  8. Guzek JP, Holm M, Cotter JB, Cameron JA, Rademaker WJ, Wissinger DH, Tonjin AM, Sleeper LA. Risk factors for intraoperative complications in 1000 extracapsular cataract cases. Ophthalmology 1987;94:461–466

    PubMed  CAS  Google Scholar 

  9. Skuta GL, Parrish RK II, Hodapp E, Forster RK, Rockwood EJ. Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome. Arch Ophthalmol 1987;105:632–634

    PubMed  CAS  Google Scholar 

  10. Lumme P, Laatikainen L. Exfoliation syndrome and cataract extraction. Am J Ophthalmol 1993;116:51–55

    PubMed  CAS  Google Scholar 

  11. Wirbelauer C, Anders N, Pham DT, Wollensak J. Corneal endothelial cell changes in pseudoexfoliation syndrome after cataract surgery. Arch Ophthalmol 1998;116:145–149

    PubMed  CAS  Google Scholar 

  12. Puska P, Vasara K, Harju M, Setälä K. Corneal thickness and corneal endothelium in normotensive subjects with unilateral exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2000;238:659–663

    Article  PubMed  CAS  Google Scholar 

  13. Inoue K, Tokuda Y, Inoue Y, Amano S, Oshika T, Inoue J. Corneal endothelial cell morphology in patients undergoing cataract surgery. Cornea 2002;21:360–363

    Article  PubMed  Google Scholar 

  14. Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg 2000;26:727–732

    Article  PubMed  CAS  Google Scholar 

  15. Küchle M, Viestenz A, Martus P, Händel A, Jünemann A, Naumann GOH. Anterior chamber depth and complications during cataract surgery in eyes with pseudoexfoliation syndrome. Am J Ophthalmol 2000;129:281–285

    Article  PubMed  Google Scholar 

  16. Bovelle R, Kaufman SC, Thompson HW, Hamano H. Corneal thickness measurements with the Topcon SP-2000P specular microscope and an ultrasound pachymeter. Arch Ophthalmol 1999;117:868–870

    PubMed  CAS  Google Scholar 

  17. Modis L Jr, Langenbucher A, Seitz B. Corneal endothelial cell density and pachymetry measured by contact and noncontact specular microscopy. J Cataract Refract Surg 2002;28:1763–1769

    Article  PubMed  Google Scholar 

  18. Wirbelauer C, Anders N, Pham DT, Holschbach A, Wollensak J. [Early postoperative endothelial cell loss after corneoscleral tunnel incision and phacoemulsification in pseudoexfoliation syndrome] Der Ophthalmologe 1997;94:332–336

    Article  PubMed  CAS  Google Scholar 

  19. Milla E, Verges C, Cipres M. Corneal endothelium evaluation after phacoemulsification with continous anterior chamber infusion. Cornea 2005;24:278–282

    Article  PubMed  Google Scholar 

  20. Puska P, Tarkkanen A. Five-year follow-up of lens opacities in exfoliation syndrome. J Cataract Refract Surg 2001;27:1992–1998

    Article  PubMed  CAS  Google Scholar 

  21. Kaljurand K, Puska P. Exfoliation syndrome in Estonian patients scheduled for cataract surgery. Acta Ophthalm Scand 2004;82:259–263

    Article  Google Scholar 

  22. Inoue K, Okugawa K, Oshika T, Amano S. Morphological study of corneal endothelium and corneal thickness in pseudoexfoliation syndrome. Jpn J Ophthalmol 2003;47:235–239

    Article  PubMed  Google Scholar 

  23. Stefaniotou M, Kalogeropoulos C, Razis N, Psilas K. The cornea in exfoliation syndrome. Doc Ophthalmol 1992;80:329–333

    Article  PubMed  CAS  Google Scholar 

  24. Sobottka Ventura AC, Wälti R, Böhnke M. Corneal thickness and endothelial density before and after cataract surgery. Br J Ophthalmol 2001;85:18–20

    Article  Google Scholar 

  25. Tarkkanen AHA. Exfoliation syndrome. Trans Ophthalmol Soc UK 1986;105:233–236

    PubMed  Google Scholar 

  26. Lagreze WD, Bomer TG, Funk J. Effect of surgical technique on the increase in intraocular pressure after cataract extraction. Ophthalmic Surg Lasers 1996;27:169–173

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

Authors

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Correspondence to Kuldar Kaljurand MD.

Additional information

Drs. Kaljurand and Teesalu are from the Department of Ophthalmology, University of Tartu, Tartu, Estonia.

The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.

The authors have no financial or proprietary interest in any material or method mentioned.

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Kaljurand, K., Teesalu, P. Exfoliation Syndrome as a Risk Factor for Corneal Endothelial Cell Loss in Cataract Surgery. Ann Ophthalmol 39, 327–333 (2007). https://doi.org/10.1007/s12009-007-9012-1

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  • DOI: https://doi.org/10.1007/s12009-007-9012-1

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