Influence of anterior chamber depth, anterior chamber volume, axial length, and lens density on postoperative endothelial cell loss.

PURPOSE: To evaluate the influence of anterior chamber depth (ACD), anterior chamber volume (ACV), lens density (LD), and axial length (AL) as risk factors on endothelial cell loss 3 months after cataract surgery. METHODS: We enrolled 47 patients with senile cataract who were operated between July 2012 and March 2013 by the same surgeon using torsional phacoemulsification. Preoperatively, we measured ACD, ACV, and LD using the Oculus Pentacam®. The AL was determined using the IOL Master®. Primary outcomes were central endothelial density (ECD) and corrected distance visual acuity (CDVA) 3 months after surgery We evaluated the effect of ACD, ACV, LD, and AL as possible risk factors of postoperative percentage endothelial cell loss (ECL). RESULTS: The median age was 72 years. The median CDVA before surgery was 0.5 improving to 1.0 postoperatively. The median ECL was 5.2 % (range 1.7 %-7.6 %). These results are comparable to our previous study (median ECL 6.9 % after 3 months) [Reuschel et al. (2010) J Cataract Refract Surg]. The median ACD in our study was 2.56 mm (range 2.26 mm-2.8 mm). Median ACV was 144 mm(3) (range 121 mm(3)-158 mm(3)]. The median LD was 12.4 (range 11.4-13.7). Median AL was 23.1 mm (range 22.7 mm-23.9 mm). Our correlation analysis showed no significant correlation between ACD, ACV, LD, AL, and postoperative ECL. CONCLUSION: ACD, ACV, AL, and LD were not identified as risk factors of postoperative endothelial cell loss in our analysis.

Long-Term Comparison of Endothelial Changes Between Torsional and Longitudinal Phacoemulsification.

PURPOSE: The objective of this study was to evaluate endothelial changes between torsional and longitudinal phacoemulsification 2 years after cataract surgery. DESIGN: This was a prospective, randomized, controlled clinical trial. METHODS: We enrolled 200 patients with senile cataract between August 2008 and December 2009 for surgery using either torsional (group A, n = 100) or longitudinal (group B, n = 100) phacoemulsification. Outcomes were central endothelial cell density and corrected distance visual acuity (CDVA) 3 months and in this follow-up 2 years after surgery. Statistical evaluation of endothelial cell loss (ECL) was performed according to statistical guidelines by creating a primary analysis (substitution of missing values by the median) and a secondary analysis (actual data). RESULTS: The mean age was 71 (SD, 7.3) years. We were able to reexamine 46 patients in group A and 54 in group B 2 years after surgery. The median CDVA before surgery was 0.3 logMAR in group A and 0.35 logMAR in group B, improving to 0 logMAR postoperatively in both groups. The median ECL in the primary analysis was 6.9% after 3 months and 10.3% 2 years after surgery in group A. In group B, we found a loss of 6.6% after 3 months and 8.6% 2 years postoperatively. In the secondary analysis, the loss was 10.0% in group A and 8.5% in group B after 2 years. The difference was statistically not significant. CONCLUSIONS: There is no difference between the ECL between torsional and longitudinal phacoemulsification up to 2 years after cataract surgery.

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification.

PURPOSE: To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. SETTING: Department of Ophthalmology, University of Leipzig, Germany. DESIGN: Randomized single-center clinical trial. METHODS: Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. RESULTS: The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P<.001). CONCLUSION: The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract.