Exfoliation syndrome as a risk factor for corneal endothelial cell loss in cataract surgery

Purpose. To compare the influence of various cataract surgery pre-, intra-, and postoperative characteristics to cornea endothelium and thickness in patients with and without exfoliation syndrome (PEX). Methods. In this prospective study 27 consecutive patients with and 26 patients without PEX as a control group scheduled for cataract surgery were studied. The corneal endothelial cells were evaluated preoperatively and postoperatively at I day and 1 month after surgery using noncontact specular microscopy. Intraoperative parameters of operation time, phaco-emulsification (phaco) time, phaco power and amount of balanced salt solution (BSS) were recorded. The effects of age, axial length, anterior chamber depth (ACD), and lens thickness were evaluated. Results. There were no significant preoperative differences in endothelium morphology between the two groups. The mean endothelial cell loss I month after surgery was 18.1% in the PEX group and 11.6% in the control group (p = 0.06). Phaco time and used BSS values were significantly higher in patients with PEX but had no significant influence on endothelial cell loss. In regression analysis phaco power (p = 0.02) and age (p = 0.004) had a significant influence on endothelial cell loss. PEX in interaction with overall phaco, impact had a negative influence on endothelial cell loss (p = 0.05). Conclusions. PEX as a main effect was not found to have a negative influence on endothelial cell loss. However, PEX in cases of high phaco impact significantly increases the risk of endothelial cell loss.