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Advances in cataract surgery

preserving the corneal endothelium

Ho, Joanne W.; Afshari, Natalie A.

Current Opinion in Ophthalmology: January 2015 - Volume 26 - Issue 1 - p 22–27
doi: 10.1097/ICU.0000000000000121

Purpose of review Cataract surgery is known to lead to some degree of corneal endothelial cell loss (ECL). The purpose of this review is to describe how recent technological advancements such as femtosecond laser-assisted cataract surgery (FLACS) affect corneal endothelium during cataract surgery.

Recent findings It has been suggested that FLACS may reduce the amount of required ultrasound energy used in cataract surgery, a factor known to be directly related to ECL. Several recent studies demonstrate either no difference or less ECL with FLACS than with standard phacoemulsification 1–3 months after surgery. However, results at 6 months show comparable ECL between the two techniques. Other recent advancements in surgical technique, such as biaxial microincision surgery, result in similar ECL rates to that of standard phacoemulsification. The use of ultraviolet light in the newly developing light-adjustable intraocular lenses does not increase ECL. Studies show either similar results or less ECL with the use of the newer viscous–dispersives when compared with other viscoelastic devices. Other aspects such as the use of intracameral injections have no adverse effects on corneal endothelium.

Summary Newly emerging cataract surgical techniques cause comparable ECL to that of conventional phacoemulsification. Femtosecond laser-assistance may reduce ECL, but likely only in the early postoperative period. Further studies are needed to better elucidate short and long-term effects of FLACS on the corneal endothelium. Viscous dispersives may offer equal or increased protection of the corneal endothelium during surgery compared with viscoelastic devices currently in wide use, but further studies are required to support these results.

Shiley Eye Center, University of California, La Jolla, San Diego, California, USA

Correspondence to Natalie A. Afshari, MD, FACS, Shiley Eye Center, University of California, San Diego, 9415 Campus Point Dr #0946, La Jolla, San Diego, CA 92093-0946, USA. Tel: +1 858 822 1569; fax: +1 858 822 1514; e-mail:

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