Skip to main content Skip to main navigation menu Skip to site footer
MedNext Journal of Medical and Health Sciences
Review
DOI: 10.54448/mdnt23215
Submitted: 05-30-2023
Published: 05-30-2023

Phacoemulsification associated with loss of endothelial cells in cataract surgery: a systematic review of main surgical techniques

Perussi Ophthalmology, Guarujá, São Paulo, Brazil / Perussi Ophthalmology, São Vicente, São Paulo, Brazil / Unioftal - Ophthalmology And Eye Plastic, São José do Rio Preto, São Paulo, Brazil
Perussi Ophthalmology, Guarujá, São Paulo, Brazil
Phacoemulsification Techniques Cataract Endothelial cells Endothelial thickness

Abstract

Introduction: Phacoemulsification (PE) cataract surgery is the gold standard in ophthalmology, being effective in improving vision in more than 90.0% of patients. In this context, authors found that PE was associated with 16.67% of endothelial cell loss, which correlated with the degree of trauma during surgery. Endothelial changes are considered an important parameter for assessing trauma and for estimating the safety of a surgical technique. In this sense, more modern PE machines are capable of removing cataracts using optimized parameters such as high vacuum, aspiration flow, and low amount of ultrasonic energy. Objective: It was to present and discuss the main phacoemulsification techniques for optimizing the treatment of cataracts, in an attempt to reduce the loss of corneal endothelial cells. Methods: Experimental and clinical studies were included (case reports, retrospective, prospective, and randomized studies) with qualitative and/or quantitative analysis. Initially, the keywords were determined by searching the DeCS tool (Descriptors in Health Sciences, BIREME base) and later verified and validated by MeSH Terms. The search literature was carried out from January to April 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Results: A total of 122 articles involving phacoemulsification and endothelial cells were found. Initially, the existing title and duplications were excluded according to the interest described in this work. After this process, the abstracts were evaluated and a new exclusion was performed. A total of 80 articles were evaluated in full and 59 were included and discussed in this study. At the beginning of treatment with PE, without the endothelial protection of viscoelastic agents and the use of ultrasound in the anterior chamber, the endothelial loss was greater than in extracapsular cataract extraction. With the modernization of PE, the use of viscoelastic agents, the emergence of techniques for fracture of the nucleus within the capsular bag, and the use of ultrasound in the posterior chamber, the loss of endothelial cells reduced from 7 to 12% on average. Conclusion: Endothelial changes are considered an important parameter to assess trauma and estimate the safety of a surgical technique. Highlighted, the main predictors associated with the loss of corneal endothelial cells are the duration of the ultrasound used in the surgery, the turbulence of the liquid in the anterior chamber, and the mechanical trauma.

Metrics

Metrics Loading ...

References

  1. Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet. 2023 Feb 4;401(10374):377-389. doi: 10.1016/S0140-6736(22)01839-6.
  2. He L, Cui Y, Tang X, He S, Yao X, Huang Q, Lei H, Li H, Liao X. Changes in visual function and quality of life in patients with senile cataract following phacoemulsification. Ann Palliat Med. 2020 Nov;9(6):3802-3809. doi: 10.21037/apm20-1709.
  3. Kelkar A, Kelkar J, Chougule Y, Bolisetty M, Singhvi P. Cognitive workload, complications and visual outcomes of phacoemulsification cataract surgery: Threedimensional versus conventional microscope. Eur J Ophthalmol. 2022 Sep;32(5):29352941. doi: 10.1177/11206721211062034.
  4. Perone JM, Boiche M, Lhuillier L, Ameloot F, Premy S, Jeancolas AL, Goetz C, Neiter E. Correlation Between Postoperative Central Corneal Thickness and Endothelial Damage After Cataract Surgery by Phacoemulsification. Cornea. 2018 May;37(5):587-590.
  5. Tan CS, Lim LW, Ting DS. Changes in retinal vasculature after phacoemulsification evaluated using optical coherence tomography angiography. J Cataract Refract Surg. 2018, Oct;44(10):1297-1298.
  6. Trikha S, Turnbull A, Morris R, Anderson D, Hossain P. The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn? Eye 2013;27:461.
  7. Thompson J, Lakhani N. Cataracts. Primary Care: Clinics in Office Practice 2015;42:409-23.
  8. Feldman BH. Femtosecond laser will not be a standard method for cataract extraction ten years from now. Survey of ophthalmology 2015;60:360-5.
  9. Abell RG, Kerr NM, Vote BJ. Femtosecond laser assisted cataract surgery compared with conventional cataract surgery. Clinical & experimental ophthalmology 2013;41:455-62.
  10. De Silva, S; Riaz Y; Evans JR. Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract (Review). The Cochrane Library, n.1, 2014.
  11. Pirazzoli G, D’Eliseo D, Ziosi M, Acciarri R. Effects of phacoemulsification time on the corneal endothelium using phacofracture and phaco chop techniques. J Cataract Refract Surg 1996;22:967-9.
  12. Guttman C, Fine IH. Novos aparelhos de faco estabelecem novos padrões para catarata. Ophthalmol Times Am Latina 2000;4(1):14-6.
  13. Kwitko S. Endotélio e cirurgia de catarata: grandes desafios. Arq Bras de Oftalmol. 2000;63(3):235-9.
  14. Vieira M. A terceira geração em aparelhos de facoemulsificação. Oftalmologia Foco 2000;67:53-4.
  15. Dillman DM. Techniques, thoughts, challenges. In: Fine, I.H. Clear corneal lens surgery. Thorofare: Slack.; 1999.
  16. Dillman DM. Endocapsular phaco quick chop. In: Masket S, Crandall AS. Atlas of cataract surgery. London: Martin Dunitz; 1999.
  17. Crema AS. O meu jeito de realizar facoemulsificação. In: Centurion V. Faco total. 2ª ed. Rio de Janeiro: Cultura Médica; 2000.
  18. Nagahara KB. Phaco chop. [video]. San Francisco: American Society of Cataract and Refractive Surgery 1993.
  19. Crema AS. Estudo comparativo do astigmatismo corneano induzido a da perda de células endoteliais após facoemulsificação por incisões auto-selantes escleral superior e corneana temporal [tese]. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 1996.
  20. Ravalico G, Tognetto D, Palomba M A, Lovisato A, Baccara F. Corneal endothelial function after extracapsular cataract extraction and phacoemulsification. J. Cataract Refract Surg.1997;23(7):1000-5.
  21. Stumpf S. Extração extracapsular vs. facoemulsificação em cataratas duras. Oftalmol Foco. 2000;68:21.
  22. Binder PS, Sternberg H, Wickham MG, Worthen DM. Corneal endothelial damage associated with phacoemulsification. Am J Ophthalmol. 1976;82(1): 48-54.
  23. Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology. 1994;101(6):1014-22; discussion 1022-3. 13. Irvine AR, Kratz RP, O’Donnell JJ. Endothelial damage with phacoemulsification and intraocular lens implantation. Arch. Ophthalmol. 1978;96(6): 1023-6.
  24. Galin MA, Lin LL, Fetherrolf E, Obstbaum SA, Sugar A. Time analysis of corneal endothelial cell density after cataract extraction. Am J Ophthalmol. 1979;88(1):93-6.
  25. Olsen T, Gimbel H. Phacoemulsification, capsulorhexis, and intraocular lens power prediction accuracy. J Cataract Refract Surg. 1993;19(6):695-9.
  26. Schultz RO, Glasser DB, Matsuda M, Yee RW, Edelhauser HF. Response of the corneal endothelium to cataract surgery. Arch Ophthalmol 1986;104(8): 1164-9.
  27. Schmitt-Bernard CF, Arnaud B. Factors of endothelial cell loss during phacoemulsification. Update. J Fr Ophtalmol. 1997;20(8):628-39. Francese.
  28. Krey H. Ultrasonic turbulences at the phacoemulsification tip. J Cataract Refract Surg. 1989;15(3):343-4.
  29. Sugar J, Mitchelson J, Kraff M. The effect of phacoemulsification on corneal endothelial cell density. Arch Ophthalmol. 1978;96(3):446-8.
  30. Weiser M. Phacoemulsification endocapsulaire. Ophthalmologie. 1990;4:454-5.
  31. Werblin TP. Long-term endothelial cell loss following phacoemulsification: model of evaluating endothelial damage after intraocular surgery. Refract Corneal Surg. 1993;9(1):29-35.
  32. Zetterstrom C, Laurell CG. Comparison of endothelial cell loss and phacoemulsification energy during endocapsular phacoemulsification surgery. J Cataract Refract Surg. 1995;21(1):55-8.
  33. Gimbel HV. Divide and conquer nucleofractis phacoemulsification: development and variations. J Cataract Refract Surg. 1991;17(3):281-91.
  34. Domingues FGP, Crema AS, Yamane Y. Complicações intra-operatórias da facoemulsificação durante a residência médica. Rev Bras de Oftalmol. 2000; 59(4):275-9.
  35. Shepherd JR. In situ fracture. J Cataract Refract Surg. 1990;16(4):436-40.
  36. Hayashi K, Nakao F, Hayashi F. Corneal endothelial cell loss after phacoemulsification using nuclear cracking procedures. J Cataract Refract Surg. 1994; 20(1):44-7.
  37. Dumitrache M, Nicula C. Tratat de oftalmologie, Cristalinul, Volumul II, 2012, București, Ed. Universitară Carol Davila, 752-770.
  38. Kimura H, Kuroda S, Mizoguchi N, Terauchi H, Matsumura M, Nagata M. Extracapsular cataract extraction with a sutureless incision for dense cataracts. J Cataract Refract Surg. 1999;25(9):1275-9.
  39. Centurion V, Caballero JC, Carrari MJ, Lacava AC. Catarata nigra e facoemulsificação. Rev Bras Oftalmol. 2001;60(10):713-7.
  40. Singh R, Vasavada AR, Janaswamy G. Phacoemulsification of brunescent and black cataracts. J Cataract Refract Surg. 2001; 27(11):1762-9.
  41. Watson A, Sunderraj P. Comparison of small-incision phacoemulsification with standard extracapsular cataract surgery: post-operative astigmatism and visual recovery. Eye. 1992;6(Pt 6):626-9.
  42. Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during phacoemulsification. J Cataract Refract Surg. 1996;22(8):1079-84.
  43. Graether JM, Davison JA, Harris GW, Watt RH, Widner RR, Sposito V. A comparison of the effects of phacoemulsification and nucleus expression on endothelial cell density. J Am Intraocul Implant Soc. 1983;9(4):420-3.
  44. Colin J, Bonnet P. [Comparison of phacoemulsification and manual extracapsular extraction of the lens] Ophtalmologie. 1989;3(3):233-4.
  45. Ohrloff C, Zubcov AA. Comparison of phacoemulsification and planned extracapsular extraction. Ophthalmologica. 1997;211(1):8-12.
  46. Ravalico G, Tognetto D, Palomba MA, Lovisato A, Baccara F. Corneal endothelial function after extracapsular cataract extraction and phacoemulsification. J Cataract Refract Surg. 1997;23(7):1000-5. Comment in: J Cataract Refract Surg. 1997;23(7):967-8.
  47. Diaz-Valle D, Benitez del Castillo Sanchez JM, Castillo A, Sayagues O, Moriche M. Endothelial damage with cataract surgery techniques. J Cataract Refract Surg. 1998;24(7):951-5.
  48. Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000;26(5):727-32.
  49. Al-Osaily AM, Al-Jindan MY. Intra-correlations between cataract density based on Scheimpflug image, phacodynamics, surgery duration, and endothelial cell loss after phacoemulsification. Saudi J Ophthalmol. 2018 Jul-Sep;32(3):188-193. doi: 10.1016/j.sjopt.2018.04.004. Epub 2018 Apr 10.
  50. Maggon R, Bhattacharjee R, Shankar S, Kar RC, Sharma V, Roy S. Comparative analysis of endothelial cell loss following phacoemulsification in pupils of different sizes. Indian J Ophthalmol. 2017 Dec; 65(12):1431-1435.
  51. Macarie SS, Macarie DM. Phacoemulsification in adult patients with post-uveitis complicated cataract. Rom J Ophthalmol. 2018 Apr-Jun;62(2):135-137.
  52. Hwang HB, Lyu B,Yim HB, Lee NY. Endothelial Cell Loss after Phacoemulsification according to Different Anterior Cham ber Depths. J Ophthalmol. 2015; 2015:210716.
  53. Nayak BK, Shukla RO. Effect on corneal endothelial cell loss during phacoemulsification: fortified balanced salt solution versus Ringer lactate. J Cataract Refract Surg. 2012 Sep;38(9):1552-8.
  54. Schmidt S, Hubich S, Vetter JM, Wirbelauer C. Effectivity and Safety of a Modified Tip Design in Torsional Phacoemulsification. Klin Monbl Augenheilkd. 2018 Aug;235(8):889-893.
  55. Sorrentino FS, Matteini S, Imburgia A, Bonifazzi C, Sebastiani A, Parmeggiani F. Torsional phacoemulsification: A pilot study to revise the "harm scale" evaluating the endothelialdamage and the visual acuity after cataract surgery. PLoS One. 2017 Oct 26;12(10):e0186975.
  56. Tang Y, Chen X, Zhang X, Tang Q, Liu S, Yao K. Clinical evaluation of corneal changes after phacoemulsification in diabetic and non-diabetic cataract patients, a systematic review and meta-analysis. Sci Rep. 2017 Oct 26;7(1):14128.
  57. Stănilă DM, Florea AM, Stănilă A, Panga AA. Endothelial cells loss to the hyperopic pacients during phacoemulsification. Rom J Ophthalmol. 2017 Oct-Dec;61(4):256-260.
  58. Teoh LS, Foo SW, Mansurali VN, Ang EL, Md Noh UK, Bastion MC. Evaluation of Corneal Endothelial Cell Loss After Uncomplicated Phacoemulsification Cataract Surgery With Intracameral Phenylephrine. Asia Pac J Ophthalmol (Phila). 2017 JulAug;6(4):318-325.
  59. Domingues FGP, Haroldo Vieira de Moraes Jr. Riuitiro Yamane. Corneal endothelial cell density comparative study after phacoemulsification by “divide and conquer” and “quick chop” techniques. Arq Bras Oftalmol. 2005; 68(1):109-15.

How to Cite

Garcia, A. P., & Liedtke, F. S. (2023). Phacoemulsification associated with loss of endothelial cells in cataract surgery: a systematic review of main surgical techniques. MedNEXT Journal of Medical and Health Sciences, 4(2). https://doi.org/10.54448/mdnt23215