Mechanical protective effect of lens anterior capsule flap on corneal endothelial cells during femtosecond laser-assisted cataract surgery in a rabbit model

Abstract

Abstract Purpose To evaluate the effects of a novel technique using an isolated lens anterior capsule flap (LACF) to protect corneal endothelial cells in rabbit eyes during femtosecond laser-assisted cataract surgery. Methods Experimental study. 40 rabbits were divided into endothelium-protected (experimental) and control groups, with 20 rabbits in each group. In the experimental group, after femtosecond laser capsulotomy, the isolated capsule flap was lifted to the corneal endothelium by an ophthalmic viscosurgical device. The endothelium was damaged for 1 minute with an ultrasonic probe. The control group underwent the same surgery, except that the flap was removed immediately after capsulorhexis. Corneal endothelioscopy was performed preoperatively and on postoperative days (PODs) 3 and 7 to observe endothelial cell counts (ECC) and endothelial cell loss rate (ECL). Central corneal thickness (CCT) was measured before and at PODs 1, 3 and 7. Results There were 3.59%±1.88% (p < 0.001) and 2.92%±2.14% (p < 0.001) loss of ECC in experimental group at POD3 and POD7, respectively, while those in the control group were 11.62%±7.43% and 10.34%±5.77%, respectively. On POD 1, the difference in central corneal thickness was significantly (P = 0.019) between the two groups. At POD 3 and POD 7, CCT was not significantly different (P = 0.597;0.913) between the two groups. Conclusions The isolated LACF technique significantly reduces damage to the endothelium caused by ultrasonic energy and protects corneal endothelial cells during phacoemulsification.