Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device

Purpose: To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells. Setting: Department of Ophthalmology, Celal Bayar University, Manisa, Turkey. Design: Prospective randomized controlled trial. Methods: Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE. Results: This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ? 10.6 years in the OVD group, 64.0 ? 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 mm at postoperative 1 month in both groups (P = .296). Conclusions: PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve. J Cataract Refract Surg 2021; 47:612?617 Copyright ? 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS