EARLY POSTOPERATIVE ENDOTHELIAL-CELL LOSS FOLLOWING CORNEOSCLERAL TUNNEL INCISION AND PHACOEMULSIFICATION IN PSEUDOEXFOLIATION SYNDROME

Introduction: Corneal endothelial involvement can be found in pseudoex foliation syndrome (PEX).Evaluation of possible differences in endothe lial cell loss following cataract extraction was compared to normal ey es. Patients and methods:ln a controlled clinical study we prospective ly studied 20 patients with PEX and compared them with an age-matched control group with senile cataract. All patients were treated with a s tandardized self-sealing 7-mm corneoscleral tunnel incision, phacoemul sification and posterior intraocular lens implantation using sodium hy aluronate. In addition to a complete ophthalmological examination,quan titative and qualitative endothelial cell analysis of the central and peripheral cornea was performed preoperatively, at the first postopera tive day and after 4 weeks using non-contact specular microscopy (Kona n Noncon Robo-ca SP 8000, Konan, Ja pan). Results:ln eyes with PEX (23 94+/-271 cells/mm(2)) endothelial cell counts were 10.5% (P<0.05) lowe r than in the control group (2674+341 cells/mm(2)). Intraoperatively, ultrasound time (90+/-51 s) and power (38+/-17%) did not differ betwee n the two groups. After 4 weeks the mean endothelial cell loss in the two groups was 10.4% and 9.8%, respectively (P<0.001). The mean cell a rea increased by 55 and 48 mu m(2) (P<0.001), respectively. Polymegeth ism increased postoperatively in both groups and stabilized at 4 weeks at preoperative values. Pleomorphism increased significantly only in the PEX group. Conclusions:ln eyes with PEX no increased cell loss was found in the early postoperative period compared to normal eyes follo wing corneoscleral tunnel incision and phacoemulsification. Due to pre operative reduced endothelial cell densities, endothelium-protecting m easures are recommended in eyes with PEX.