| Abstract: |
This article gives an overview of the corneal endothelial cell loss in phacoemulsification. Although Phacoemulsification is the most common method used in cataract surgery in the world, and brings significant advantages to the great majority of patient, there is some disadvantage of phacoemulsification especially on endothelial cell (Lavin and Ormond, 2001).Documented risk factors for endothelial cell loss include advanced patient age, Fuchs’ dystrophy and corneal guttata, shallow anterior chambers, a history of previous ocular trauma, inflammation or surgery, and glaucoma (angle closure, pseudo exfoliation) (Seitzman,2005).A complete inquiry and evaluation for these risk factors will allow for appropriate planning to reduce the potential of an undesirable post-surgical outcome. Clinical examinations that focus on the presence of corneal guttata with or without the presence of stromal edema are useful in classifying the clinical entity and surgical planning. Evaluation of the visual significance and grading of the density of the cataract are also vital factors to consider in the pre-op planning stages. Early timing of extraction prior to advanced maturation of the cataract should be given strong consideration to avoid a more complicated, energy-dependent procedure later. Patient reports of morning blur with improvement throughout the course of day as well as slit lamp evidence of corneal epithelial edema, stromal folds, and haze should raise the suspicion of poor endothelial function. Pachymetry measures of central and mid-peripheral corneal thickness serve as guidelines in surgical planning for any patient with potential risk factors. Central pachymetry readings greater than 620 microns or changes more than 10% between late-day and morning readings generally are reasonable guides when incorporating pachymetry readings into the pre-op planning process, but one also must go by clinical findings. If corneas are thick but there is no evidence of corneal edema, then one still can proceed with cataract surgery first. Along the same line, endothelial cell counts are also just a guide and no longer necessary to perform pre-op (Braga-Mele, 2006).
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