Risk factors for corneal endothelial cell loss by cataract surgery in eyes with pseudoexfoliation syndrome

Yumi Hasegawa,1,2 Ryohei Nejima,1 Yosai Mori,1 Toshihiro Sakisaka,1 Keiichiro Minami,1 Kazunori Miyata,1 Tetsuro Oshika2 1Miyata Eye Hospital, Miyazaki, 2Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan Purpose: The aim of this study was to investigate the factors associated with decreases in corneal endothelial cell density (ECD) resulting from cataract surgery in eyes with pseudoexfoliation syndrome (PEX). Methods: The clinical records of 78 eyes of 78 patients with PEX who had undergone cataract surgery were reviewed. ECD was measured preoperatively and at 3 months postoperatively with specular microscopy. Multiple regression analysis was used to assess the factors that were significantly related to the rate of ECD loss. Explanatory variables included age, preoperative ECD, pupil diameter, cataract grade, concomitance of glaucoma or diabetes mellitus, preoperative anterior chamber depth, surgery time, total time and power of ultrasound, performance of intraoperative pupillary enlargement manipulation, and postoperative aqueous flare intensity at 1 week and 1 month. Results: ECD before and after surgery was 2,464±337 cells/mm2 and 2,400±347 cells/mm2, respectively, with an ECD loss rate of 2.6%±5.1% (mean ± SD). Multiple regression analysis revealed that ECD loss was significantly associated with the cataract grade (P=0.019) and preoperative anterior chamber depth (P=0.023). Conclusion: With modern small incision cataract surgery, the ECD loss varied with surgical invasions due to severe cataract and shallow anterior chamber, and the presence of PEX was least affected. Keywords: pseudoexfoliation syndrome, corneal endothelial cell loss, cataract surgery