Comparison of corneal endothelial cell loss in FLACS: impact on endothelial cells in different regions

J Cataract Refract Surg. 2024 Sep 1;50(9):912-918. doi: 10.1097/j.jcrs.0000000000001474.

Abstract

Purpose: To compare changes in corneal endothelial parameters after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) in different corneal regions.

Setting: Chang Gung Memorial Hospital, Linkou, Taiwan.

Design: Single-center, retrospective.

Methods: Before and 1, 3, and 6 months postoperatively, specular microscopy was performed to measure endothelial cell density (ECD), corneal thickness, hexagonal cell rate (Hex), and coefficient of variation (CoV). Position 1 referred to the central cornea, position 2 was nearest to the main wound, and position 3 was at the peripheral zone diagonal to the main wound.

Results: This study analyzed 96 eyes in the FLACS group and 110 eyes in the CPS group. Preoperatively, position 1 had lower ECD and CoV and higher Hex compared with the peripheral regions. FLACS patients had a significantly less phacoemulsification time and cumulative dissipated energy. At 1 month, FLACS patients showed a significantly smaller increase in corneal thickness at positions 1 and 2. At 3 months, FLACS patients had lower endothelial cell loss (ECL) at positions 1 and 3. ECL remained lower in FLACS patients at 6 months. The highest ECL was observed at position 2 in both groups and was progressive up to 6 months.

Conclusions: After phacoemulsification, ECL varied in different corneal regions. At 3 months, the FLACS group exhibited significantly less ECL at the central cornea; however, the continued ECL at 6 months near the main wound suggested ongoing endothelial remodeling in the region.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cataract Extraction
  • Cell Count
  • Corneal Endothelial Cell Loss* / diagnosis
  • Corneal Endothelial Cell Loss* / etiology
  • Corneal Pachymetry
  • Endothelium, Corneal* / pathology
  • Female
  • Humans
  • Laser Therapy / methods
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Phacoemulsification*
  • Retrospective Studies
  • Visual Acuity / physiology