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  • Cataract/Anterior Segment

    This prospective, nonrandomized study found that corneal endothelial cell loss was significantly greater after cataract surgery in eyes with pseudoexfoliation (PXF) than in eyes without it.

    The authors compared corneal endothelial cell damage and ocular inflammation after cataract surgery in 36 eyes with and 36 eyes without pseudoexfoliation (PXF).

    At three months postop, corneal endothelial cell loss was significantly greater in the PXF group (9 percent vs. 3.4 percent). In addition, the percentage of eyes with cell loss greater than 20 percent at three months was significantly higher in the PXF group than the non-PXF group (16.7 percent vs. 0 percent). Mean central corneal thickness was significantly greater in the PXF group at one month (P = 0.0152), but the difference disappeared by three months postop.

    A subgroup analysis of eyes with glaucoma vs. those without found no significant difference in mean endothelial cell density, endothelial cell loss, central corneal thickness or increase in central corneal thickness one month after surgery. Central corneal thickness increase three months after surgery was greater in eyes with glaucoma, but the difference was very small.

    The mean UDVA and CDVA in the PXF group were similar to those in the non-PXF group. In addition, the UDVA and CDVA were not significantly different in eyes with and without glaucoma. These results suggest that the vulnerability of the corneal endothelial cells in eyes with PXF does not affect visual acuity as long as the central visual field defects due to glaucoma are not prominent.

    The authors conclude that more challenging cases with PXF, including those with poor mydriasis or zonular instability, require the use of special surgical devices and procedures to prevent endothelial cell injury, including the soft-shell technique, pupil-enlargement devices and capsule-supporting devices. However, additional studies are required to evaluate corneal endothelial cell damage after glaucoma surgery in eyes with PXF.