DENSITY AND MORFOLOGY OF THE ENDOTHELIAL CELLS

AFTER UNCOMPLICATED PHACO-EMULSIFICATION

CATARACT SURGERY Authors: Adriana Stanila * **, Elena Mihai **, A. Teodoru *, V. Rusu **, N. Sarbu **, D. Stanila *

* Lucian Blaga University of Sibiu, Victor Papilian Faculty of Medicine Sibiu** Clinical Emergency Hospital, Department of Ophthalmology Sibiu

Research Centre of Ocular Surface Diseases

Introduction

The cataract is one of the most frequent ocular disease. The removal of the opacified lens is made in modern times through the phacoemulsificationtechnique. The removal of the lens presumes his replacement with an artificial lens with optimal safety and minimum invasiveness

This procedure can have different effects on the endoocular structures and especially on the cornea ( endothelial cells layer)

The corneal endothelium is a single layer of polygonal cells

Its role is essential in maintaining the integrity of the cornea. Its cells can’t regenarate. Starting with the second decade of life the density of the cells decrease from 3000 – 4000 cells/mm2 to 2500 – 2700 cells/mm2 in the eight decade of life. The loss of cells because of the age causes the expansion of the neighbor cells in order to fill the empty spaces.

Corneal transparency is controlled by the active endothelial ionic pumps, which maintain a low level of stromal hydration

When the endothelial cell count drops below 600 to 800 cells/mm2,cornealdecompensation, and corneal edema occuras a result of the compromised pump function

The aim of the study

The purpose is to show the effects of the cataract operation through the phacoemulsification technique on the corneal endothelium and corneal thickness.

Material and Methods

Our study is based on 80 patients which where operated through this type of surgery in the clinic of ophthalmology of the Sibiu hospital. The age of the patients was between 55 and 90 years. All cases where age related cataract.

Exclusion criteria where the ocular diseases , systemic diseases , corneal pachymetry greater than 0,70mm and the preoperative endothelial cells count less than 1200.

The pachymetry presumes the measuring of the cornea which is an indicator of the integrity of the corneal endothelium ( normal thickness in the central area is between 0,49 – 0,56 mm )

All the surgeries where performed by the same surgeon and by the same technique.

The surgical procedure Topical anaesthesia , with tetracaine 0,5 %

administrated 10 minutes before surgery the clear corneal microincision (2,2mm)

using OVD (ophthalmic viscosurgical device) cohesive and dispersive

phacoemulsification with the Infinity machine.

Implantation of foldable artificial lens

The number of the endothelial cells and the pachymetry of the cornea where performed through specullar microscopy in the day before and 7-14 days after thesurgery

OD Corneal Thickness

555.03571.89

0

100

200

300

400

500

600

700

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37

Patients

mic

rom

ete

r

preoperative postoperative

OD Cell Density

2033.971759.03

0

500

1000

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1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37

Patients

cells/m

m2

preoperative postoperative

OS Corneal Thickness

564.82576

0

100

200

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400

500

600

700

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46

Patients

Mic

rom

ete

r

preoperative postoperative

OS Cell Density

2186.441911.56

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500

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3000

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46

Patients

Ce

lls

/mm

2

preoperative postoperative

Results and Discussions

The pachymetry of the cornea and the density of the endothelial cells sufferd no significant modification

Through the surgical technique through microincision and the usage of OVD the after surgical results were very good.

The average corneal modification in thickness was from 0,568 mm to 0,573 mm and the number of endothelial cells decreased from 2059to 1835

Conclusions

The number of the endothelial cells has a very slow average decrease (11,10%)

The thickness of the cornea has increased with an average of only 1,09%

The phacoemulsification technique in the ”good hands” through microincision and the usage of OVD is safe for the cornea.

References

A. Stanila , Cristalinul 2001 ( pg. 164 – 175) B. K. Nayak and Elesh Kumar Jain , Comparison

of corneal endothelial cell loss during phacoemulsification – Indian Journal of ophthalmology ; Sept 24 2008

Steve A. Arshinoff , Cataract surgery is unsafe without the protection of OVD’s – Cataract and refractive surgery today ; april 2010 vol.5 nr. 4 (pg. 21-26

Mohamed AE Soliman, Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery

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