ENDOTHELIAL-CELL LOSS AFTER 4 MM CATARACT-SURGERY

To assess whether a 4 mm scleral tunnel incision with a 1.5 mm interna l corneal lip: (three-step procedure) causes increased endothelial cel l loss and damage to the cornea, we retrospectively evaluated the outc omes of 20 patients (40 eyes) who had a standard 4 mm scleral tunnel i ncision (two-step procedure) in one eye followed by a three-step incis ion in the second eye, with in situ phacoemulsification and insertion of a foldable silicone lens in each eye. Mean phacoemulsification time was 2.4 +/- 1.1 minutes for the two-step incisions and 3.4 +/- 1.4 mi nutes for the three-step incisions, Preoperative and postoperative end othelial cell counts were obtained to determine the effects of surgery on the corneal endothelium. Although the three-step procedure had a t rend toward increased endothelial cell loss from the central corneal r egion compared with the two-step incision, the result was neither clin ically nor statistically significant. The difference between the three -step and two-step incisions in postoperative endothelial cell counts from the superior corneal region was statistically significant. The di fference in postoperative counts from the inferior region was not stat istically significant. Although the three-step 4 mm incision does seem to affect the corneal endothelium, its clinical significance is unkno wn.