Comparison of Cornea Endothelial Cells Density the After Aspiration of Dense Cataracts using Two Variants of Phacoemulsification Parameters

Purpose: to compare two types of phacoemulsification parameters (combination ultrasound and torsional US with IP) with estimating the number of postoperative complications caused by intraoperative trauma of corneal endothelial cells.

Patients and methods. 72 patients underwent phacoemulsification with IOL implantation. Patients were randomly divided into two groups (main n = 33 and control n = 39). During the aspiration of lens fragments in the main group the combination ultrasound was used, while torsional US with IP was used in the control group. Endothelial cell counting and other examinations were performed 1 day, 1 week and 6 months after the surgery.

Results. CDVA in the explored groups 1 week after the surgery was similar: the main group — 0.813 ± 0.228, the control group — 0.765 ± 0.250, There was also no statistically significant difference in the thickness of the cornea between the groups: the main group — 533.48 ± 12.41, the control group — 536.44 ± 10.92. At the same time, a statistically significant difference was found in the density of endothelial cells: the main group: 1871.30 ± 187.41 (after 1 week), 1865 ± 178.9 (after 6 months); control group: 1809.63 ± 225.43 (after 1 week), 1791 ± 230.82 (after 6 months). The percentage of cell loss was, respectively, lower in the main group at all times of observation: 3.90% (after 1 day), 4.54% (after 1 week), 4.9% (after 6 months). In the control group: 7.71% (after 1 day), 9.25% (after 1 week), 10.4% (after 6 months).

Conclusions. Data obtained in this study has showed the advantages of combination ultrasound in comparison with torsional US with IP, when performing aspiration of dense lenses. Due to lower consumption of ultrasound energy and higher aspiration rate of the fragments, combination ultrasound can reduce the loss of corneal endothelial cells and decrease the number and severity of postoperative complications associated with it. 

1. Азнабаев Б.М. Ультразвуковая хирургия катаракты — факоэмульсификация. Mосква: Август; 2005:136. [Aznabaev B.M. Ultrasound cataract surgery — phacoemulsification. Moscow: August; 2005:136. (In Russ)]

2. Буратто Л. Хирургия катаракты. Переход от экстракапсулярной экстракции катаракты к факоэмульсификации. Москва: Fabiano; 1999:474. [Buratto L. Cataract surgery. Transition from extracapsular extraction of cataract to phacoemulsification. Moscow: Fabiano; 1999:474. (In Russ)]

3. Kelman C.D. Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol. 1967;64(1):23–35. DOI: 10.1016/0002-9394(67)93340-5

4. Singh R., Vasavada A.R., Janaswamy G. Phacoemulsification of brunescent and black cataracts. J Cataract Refract Surg. 2001 Nov;27(11):1762–9. DOI: 10.1016/ S0886-3350(01)00839-2

5. Jun B., Berdahl J.P., Kim T. Thermal study of longitudinal and torsional ultrasound phacoemulsification: tracking the temperature of the corneal surface, incision, and handpiece. J Cataract Refract Surg. 2010 May;36(5):832–7. DOI: 10.1016/j. jcrs.2009.11.015

6. Zeng M., Liu X., Liu Y., Xia Y., Luo L., Yuan Z., Zeng Y., Liu Y. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol. 2008 Aug;92(8):1092-6, Epub 2008 Jun 20. DOI: 10.1136/bjo.2007.128504

7. Wang Y., Xia Y., Zeng M., Liu X., Luo L., Chen B., Liu Y., Liu Y. Torsional ultrasound efficiency under different vacuum levels in different degrees of nuclear cataract. J Cataract Refract Surg. 2009 Nov;35(11):1941–5. DOI: 10.1016/j.jcrs.2009.05.055

8. Fakhry M.A., Shazly M.I. Torsional ultrasound mode versus combined torsional and conventional ultrasound mode phacoemulsification for eyes with hard cataract. Clin Ophthalmol. 2011;5:973–8. Epub 2011 Jul 15. DOI: 10.2147/OPTH.S22879

9. Sippel K.C., Pineda R. Jr. Phacoemulsification and thermal wound injury. Semin Ophthalmol. 2002 Sep-Dec;17(3–4):102–9.

10. Nagy Z.Z., Takacs A.I., Filkorn T., Kránitz K., Gyenes A., Juhász É., Sándor G.L., Kovacs I., Juhász T., Slade S. Complications of femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2014 Jan;40(1):20–8. DOI: 10.1016/j.jcrs.2013.08.046

11. Астахов С.Ю. Кератопатия после факоэмульсификации. Новое в офтальмологии. 2014;3. [Astahov S.Y. Keratopathy after phacoemulsification. New in ophthalmology=Novoe v oftal’mologii. 2014;3. (In Russ)]

12. Копаев С.Ю., Борзенок С.А., Копаева В.Г., Алборова В.У. Состояние заднего эпителия роговицы после лазерной и ультразвуковой факофрагментации. электронно-микроскопическое исследование в эксперименте. Сообщение 3. Офтальмохирургия. 2014;(2):6–9. Kopayev S.Y., Borzenok S.A., Kopayeva V.G., Alborova V.U. Corneal endothelium cells response after laser and ultrasound phacofragmentation. electron microscopy in experiment. Report 3. Fyodorov Journal of Ophthalmic Surgery=Oftal’mokhirurgiya. 2014;(2):6–9. (in Russ.)] DOI: 10.25276/0235-4160-2014-2-6-9

13. Майчук Д.Ю. Асептические реакции при хирургии катаракты. Российская офтальмология онлайн. № 11. [Maychuk D.Y. Aseptic reactions in cataract surgery. Russian ophthalmology online. № 11. URL: http://www.eyepress.ru/article. aspx?11931

14. Иошин И.Э., Хачатрян Г.Т., Оздербаева А.А. Анализ результатов применения технологии Ozil IP при факоэмульсификации катаракты высокой плотности. Офтальмохирургия. 2011;2:59–63. [Ioshin I.E., Khachatryan G.T., Ozderbaeva A.A. Analysis of the results of application of Ozil IP technology in phacoemulsification of high density cataract. Fyodorov Journal of Ophthalmic Surgery=Oftal’mokhirurgiya. 2011;2:59–63. (In Russ)]

15. Tomilova E., Shukhaev S. A novel method to compare phacoemulsification parameters in vivo: two halves of one nucleus. Graefes Arch Clin Exp Ophthalmol. 2016 Aug;254(8):1579–84. DOI: 10.1007/s00417-016-3376-0

16. Трубилин В.Н., Ильинская И.А., Копаев С.Ю. Достоверность показателей приборов, измеряющих геометрические параметры роговицы. Офтальмохирургия. 2014;(4):50–54. [Trubilin V.N., Il´inskaya I.A., Kopayev S.Y. Reliability of indicators of devices measuring geometric parameters of cornea. Fyodorov Journal of Ophthalmic Surgery=Oftal’mokhirurgiya. 2014;(4):50–54. (In Russ.)] DOI: 10.25276/0235-4160-2014-4-50-54

17. Cionni R.J., Crandall A.S., Felsted D. Length and frequency of intraoperative occlusive events with new torsional phacoemulsification software. J Cataract Refract Surg. 2011 Aug 18. DOI: 10.1016/j.jcrs.2011.04.027

18. Ratnarajan G., Packard R., Ward M. Combined occlusion-triggered longitudinal and torsional phacoemulsification during coaxial microincision cataract surgery: effect on 30-degree mini-flared tip behavior. J Cataract Refract Surg. 2011 May;37(5):825– 9. Epub 2011 Mar 25. DOI: .10.1016/j.jcrs.2010.11.038