Qualitative Alterations on Corneal Endothelial Cell Morphometry and Hexagonality After Cataract Surgery

AIM: To deeply analyze quantitative and qualitative changes of corneal endothelium after longitudinal phacoemulsification. METHODS: In this prospective interventional case series study, 50 eyes with age-related cataract have been evaluated preoperatively, intraoperatively and postoperatively. The measured parameters were surgically induced endothelial cell loss (ECL), average endothelial cell area (AVG) and hexagonality (HEX). RESULTS: The relationship among the measured parameters and the energy dissipated during the two phases of phacoemulsification, sculpting and quadrant removal, has been analyzed with regard to the 5-score harm scale, a new method suggested to categorize cataracts. Two phases of phacoemulsification are linearly related (r = 1.5, P < 0.001, r(2) = 79%). Plus, a quadratic model described the correlation between the percentages of ECL and AVG (P < 0.0001), while there was no specific model for the correlation between ECL and HEX. CONCLUSION: The 5-score harm scale allows to predict the mean changes in percentages of ECL, AVG and HEX of endothelial cells after longitudinal phacoemulsification. Also, this study confirms that the main damage on corneal endothelium is due to the energy delivered in the second phase of phacoemulsification.