Axial length, postop IOP linked to corneal endothelium damage after phaco

Corneal endothelial cell loss after phacoemulsification in eyes with occludable angles appears to be significantly associated with preoperative axial length and increases in IOP during the first 24 hours postop, according to a study by researchers in Taiwan.

"To minimize corneal endothelial cell damage, it is critical to avoid an IOP spike during the early postoperative period and to exercise extreme caution intraoperatively in eyes with an [axial length] less than 22.6 mm," the study authors said.

Yu-Chieh Ko, MD, and colleagues at Taipei Veterans General Hospital obtained pre- and postoperative corneal endothelial cell evaluations of 60 patients with occludable angles who underwent phacoemulsification cataract surgery.

At 3 months follow-up, the mean corneal endothelial cell density had significantly decreased by 14.5% (P < .001), according to the study.

Investigators found that greater corneal endothelial cell loss was associated with shorter axial lengths (P = .008), steeper anterior corneal curvatures (P = .03), a greater preop nuclear opalescence (P = .04) and higher IOPs measured up to 1 day after surgery (P = .002).

However, "multiple linear regression analysis identified [axial length] and the IOP measured 4 to 8 hours after surgery as the best predictors of postoperative corneal endothelial cell loss after adjusting for nuclear opalescence and phacoemulsification time (P = .001)," the authors said.

The study is published in the January issue of Journal of Cataract & Refractive Surgery.