Rose, Geoffrey Edward; (1990) Cataract surgery and the corneal endothelium: An appraisal of factors influencing endothelial cell losses during cataract surgery. Doctoral thesis (M.S), UCL (University College London).

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Abstract

A prospective investigation was designed to determine the factors that influence corneal endothelial cell losses during and after cataract surgery. An unselected cohort of patients due for routine cataract surgery were examined, by a single observer, one day prior to surgery and during the early (day 1 to 5) and late (week 10 to 30) postoperative period. Clinical assessment and endothelial specular photomicroscopy was performed for both the study eye and the partner eye; estimates of central corneal endothelial cell density being derived from the specular photomicrographs by a second, independent, observer. Two hundred and seventy patients were enrolled and 236 (84 male, 152 female) completed the study. The reproducibility of some clinical measurements was assessed by several tests, including variance analysis for repeated measurements in the partner (unoperated) eyes. The variability for estimates of central corneal thickness, anterior chamber depth and endothelial cell density were within accepted limits for these methods and a minor drift of some instrumental measurements was insufficient to impair subsequent results of investigation. Analysis of data by both paired comparisons and by multivariate variance analysis shows dense sclerosis of the lens nucleus to greatly increase cell losses after extracapsular surgery, or after intracapsular surgery with capsular rupture; this being the factor most influential in determining cell losses. The presence of diabetes further increases cell losses during extracapsular extraction of such cataracts. A peripheral corneal section used during extracapsular cataract surgery is associated with reduced cell losses, as would appear to be the absence of corneal guttata. The preoperative presence of a shallow anterior chamber or the loss of vitreous humour, however, both increase cell losses after intracapsular surgery. Mathematical functions characterizing the recovery of corneal thickness in the early and late postoperative period are proposed and formulae for the prediction of endothelial cell losses presented.

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