Endothelial damage with cataract surgery techniques

Purpose: To evaluate intraoperative endothelial damage after planned extracapsular cataract extraction (ECCE) with different capsulotomy techniques and phacoemulsification. Setting: San Caries University Hospital, Castroviejo institute, Madrid, Spain. Methods: In this prospective, randomized study, 60 patients with senile cataract scheduled for cataract surgery were divided into three groups of 20 each: Group 1 had phacoemulsification; Group 2, planned ECCE with continuous curvilinear capsulorhexis; and Group 3, ECCE with letter-box capsulotomy. Preoperatively and, 3 months postoperatively, endothelial cell density, percentage of hexagonality, and the cell size variation coefficient were determined by contact specular microscopy; endothelial permeability was examined by anterior segment fluorophotometry and central corneal thickness, by ultrasonic pachymetry. Results were analyzed using the two-tailed Student's t-test and analysis of variance. Results: In all three groups, endothelial permeability acid cell loss increased significantly from the preoperative values, but there were no significant differences among the postoperative values. Mean cell loss was 11.8% in Group 1, 12.8% in Group 2, and 10.1% in Group 3.There were no differences between the preoperative and postoperative morphometric indexes. Postoperative pachymetric measurements were not significant. Conclusions: Endothelial response was not statistically significantly different among the surgical techniques, although endothelial damage was lower in Group 3, which could indicate a protective effect of the anterior capsule during cataract extraction. Endothelial barrier function remained disturbed despite the apparent morphological stabilization.