CONTINUED ENDOTHELIAL-CELL LOSS 10 YEARS AFTER LENS IMPLANTATION

Purpose: To investigate the effects of cataract extraction and lens im plantation on the central corneal endothelium 10 years after surgery. Methods: The authors conducted a prospective study of 253 consecutive eyes that underwent cataract extraction with or without lens implantat ion by one surgeon from 1976 to 1982. Three types of lens implant were used during this period. The protocol included ophthalmic examination s and specular microscopy on all eyes preoperatively, and 2 months and 1, 3, 5, and 10 years postoperatively. Results: The 10-year analysis was conducted on 67 (26%) of the 253 total eyes. The remaining patient s died (86 eyes [34%]), were unable to return 10 years later (93 eyes [37%]), or had secondary implants (5 eyes [2%]) or penetrating keratop lasty (2 eyes [1%]). There were no statistically significant differenc es among the median 10-year endothelial cell losses of 36% in 17 contr ol cataract extractions without lens implantation (15 extracapsular an d 2 intracapsular), 40% in 15 medallion iris suture implants, 32% in 2 8 transiridectomy clip implants, and 32% in 7 posterior chamber implan ts. The median exponential rate of chronic cell loss from 1 to 10 year s after surgery was 2.5% per year, which did not differ significantly among the three implant groups or between the implants (2.4% per year) and controls (2.7% per year). The chronic cell loss rate was signific antly higher (7.2% per year) in six eyes with cornea guttata, which wa s the only preoperative endothelial morphologic feature that was signi ficantly associated with the chronic cell toss rate. Conclusions: Ten years after cataract extraction, eyes continued to lose endothelial ce lls from the central cornea at a rate of 2.5% per year, 2.5 to 8.0 tim es the rate in healthy unoperated eyes. The rate was not affected sign ificantly by the presence of the three types of lens implants that the authors used. Postoperative eyes with cornea guttata continued to los e cells at more than twice this rate. Preoperative specular microscopy did not provide additional information helpful in predicting postoper ative endothelial status or outcome.