Clinical Observation of Phacoemulsification under the Low Perfusion Pattern and Low Negative Pressure in Patients with Low Corneal Endothelial Cell Density

Abstract

Abstract Background To observe the safety and effect of phacoemulsification combined with intraocular lens (IOL) implantation in patients with low corneal endothelial cell density (CD) under the low perfusion pattern with low negative pressure. Methods In this retrospective case series study, a total of 16 patients (17 eyes) were studied. They had all been diagnosed with low corneal endothelial CD and cataracts in the First Affiliated Hospital of Fujian Medical University from December 2019 to October 2021. They underwent phacoemulsification combined with IOL implantation under the low perfusion pattern with low negative pressure. The variations of corneal endothelial CD, coefficient of variation (CV) of the cell area, central corneal thickness (CCT), visual acuity, and intraocular pressure before and after the operation were observed, and the corresponding influencing factors were assessed. Then a paired t-test, repeated measures analysis of variance (RM ANOVA), and Pearson correlation analysis were adopted for data analysis. Results The mean intraocular pressure of the 17 eyes was 16.88 ± 6.47 mmHg before the operation and 14.41 ± 3.10 mmHg after the operation, showing a statistically significant difference of t = 2.222, and p = 0.041. Before the operation, the mean visual acuity was 0.16 ± 0.09, and after the operation, it was 0.45 ± 0.16, displaying a statistically significant difference of t = -9.917, p < 0.001. Before and after the operation, four of the 17 eyes had no detectable CD. In addition, CCT could not be measured in three eyes of them. The mean CD of the other 13 eyes at one day after the operation (645.62 ± 112.22 cells/mm2) and at one month after the operation (644.308 ± 106.24 cells/mm2) was lower than that before the operation (709.62 ± 119.19 cells/mm2), and the differences were statistically significant (F = 20.044, p < 0.001). However, no statistically significant differences were found in the mean CV before the operation (31.23 ± 4.21), at one day after the operation (31.92 ± 5.62), and at one month after the operation (32.62 ± 3.80; F = 2.130, p = 0.157). Moreover, the mean CCT of 14 eyes at one day after the operation (587.07 ± 35.00 µm) and one month after the operation (562.72 ± 27.82 µm) was larger than that before the operation (534.79 ± 24.69 µm), with statistically significant differences (F = 27.953, p < 0.001). Corneal endothelial decompensation did not occur in any case. Conclusions The low perfusion pattern with low negative pressure is safe and effective for corneal endothelial dysfunction patients complicated with cataracts, and appropriate measures should be taken to reduce the endothelial cell injury during the operation.