Factors related to corneal endothelial damage after phacoemulsification in eyes with occludable angles

Purpose: To evaluate the influence of preoperative variables and early postoperative intraocular pressure (IOP) on the loss of corneal endothelial cells after phacoemulsification in eyes with occludable angles. Setting: Taipei Veterans General Hospital, Taipei, Taiwan. Methods: Sixty patients with occludable angles having phacoemulsification were prospectively enrolled. Corneal endothelial cell evaluation was conducted preoperatively and 3 months postoperatively. Results: Three months postoperatively, the mean corneal endothelial cell density decreased by 14.5% ± 25.8% (SD) (P < .001). Greater corneal endothelial cell loss was associated with shorter axial length (AL) (P = .008), steeper anterior corneal curvature (P = .03), greater nuclear opalescence (P = .04), and higher IOP measured 4 to 8 hours after surgery (P = .04) and the following morning (P = .002). Multiple linear regression analysis identified AL and the IOP measured 4 to 8 hours after surgery as the best predictors of postoperative corneal endothelial cell loss after adjusting for nuclear opalescence and phacoemulsification time (R² = 0.40, P = .001). Conclusions: The corneal endothelial cell loss after phacoemulsification in eyes with occludable angles was associated with preoperative AL measurement and postoperative IOP within 24 hours. To minimize corneal endothelial cell damage, it is critical to avoid an IOP spike during the early postoperative period and to exercise extreme caution intraoperatively in eyes with an AL less than 22.6 mm.