A Prospective Study on the Factors That Affect Changes in Endothelial Cell Density and Central Corneal Thickness Over a Three-month Period After Phacoemulsification at an Eye Hospital in Nairobi, Kenya

Abstract

Background: The ultrasonic energy during phacoemulsification cataract extraction results in pathophysiological mechanism that induce changes in endothelial cell density (ECD) and central corneal thickness (CCT). Objective: To evaluate the change in ECD and CCT over three months following phacoemulsification and selected factors that affects these changes. Methodology: Prospectively, we studied all consecutive eyes undergoing routine phacoemulsification over the 9-month study period. Preoperative ECD, CCT, anterior chamber depth, axial length, age and diabetic status were recorded in a data form. We recorded intra-operative infusion fluid type and volume, nucleus fraction technique, elapsed phaco time and ultrasound power. Serial postoperative ECD and CCT were recorded on day 1, month 1 and month 3 postoperatively. Results: After excluding 14 eyes, we analyzed46eligible eyes of 36 patients. The mean age was 66.69 years and male: female ratio was 1.4:1.At the third month the average decrease in ECD was 7% and in CCT was 6%. Older age and diabetic status; use of Balanced Salt Solution (BSS), higher effective phacoemulsification time (a product of elapsed phaco time and Ultrasound average) were found to correlate with more decrease in ECD. Deep ACD or long AL were found to be associated with less decrease in ECD. Onmultivariate analysis, patient factors had statistically significant effects on ECD up to the first month only. (p= <0.05) However, the intra-operative factors had a statistically significant effect on ECD up to three months postoperatively. Conclusion: Phacoemulsification is safe and was associated with minimal change in ECD and CCT. ECD cut off of 2000 cells/mm2was not associated with increase in postoperative CCT.