[Early postoperative endothelial cell loss after corneoscleral tunnel incision and phacoemulsification in pseudoexfoliation syndrome].

Introduction: Corneal endothelial involvement can be found in pseudoexfoliation syndrome (PEX). Evaluation of possible differences in endothelial cell loss following cataract extraction was compared to normal eyes.

Patients And Methods: In a controlled clinical study we prospectively studied 20 patients with PEX and compared them with an age-matched control group with senile cataract. All patients were treated with a standardized self-sealing 7-mm corneoscleral tunnel incision, phacoemulsification and posterior intraocular lens implantation using sodium hyaluronate. In addition to a complete ophthalmological examination, quantitative and qualitative endothelial cell analysis of the central and peripheral cornea was performed preoperatively, at the first postoperative day and after 4 weeks using non-contact specular microscopy (Konan Noncon Robo-ca SP 8000, Konan, Japan).

Results: In eyes with PEX (2394 +/- 271 cells/mm2) endothelial cell counts were 10.5% (P < 0.05) lower than in the control group (2674 + 341 cells/mm2). Intraoperatively, ultrasound time (90 +/- 51 s) and power (38 +/- 17%) did not differ between the two groups. After 4 weeks the mean endothelial cell loss in the two groups was 10.4% and 9.8%, respectively (P < 0.001). The mean cell area increased by 55 and 48 microns2 (P < 0.001), respectively. Polymegethism increased postoperatively in both groups and stabilized at 4 weeks at preoperative values. Pleomorphism increased significantly only in the PEX group.

Conclusions: In eyes with PEX no increased cell loss was found in the early postoperative period compared to normal eyes following corneoscleral tunnel incision and phacoemulsification. Due to preoperative reduced endothelial cell densities, endothelium-protecting measures are recommended in eyes with PEX.