CORNEAL ENDOTHELIAL CELL DENSITY AFTER PHACOEMULSIFICATION IN PATIENTS WITH AND WITHOUT PSEUDOEXFOLIATION SYNDROME

Background: Pseudoexfoliation syndrome is a systemic disease in which matrix of fibrotic material is deposited in many organs. In the eye, a basement membrane like fibrillogranular, whitish material is deposited on the cornea, Iris, lens, zonular fibres and trabecular meshwork. Aim: To assess and compare the corneal endothelial changes in terms of endothelial count in patients with and without pseudoexfoliation syndrome after routine uneventful Phacoemulsification. Methods: A profile of 100 patients in this hospital-based prospective, observational cohort study was studied in the Postgraduate Department of Ophthalmology, Government Medical College Srinagar over   a period of one and a half year. Study group consists of patients (GROUP A, n=50) with Pseudoexfoliation and control group consists of those patients (GROUP B, n=50) without Pseudoexfoliation Syndrome who have been diagnosed of visually significant cataract by slit lamp biomicroscopy and have underwent Phacoemulsification procedure for cataract extraction by using a standard technique with the same phacoemulsification equipment at similar setting by a single surgeon. Specular microscopy was done preoperatively and at 1 week, 1month, 6 months and 1 year postoperatively. The endothelial cell density (ECD) was evaluated and compared between PEX and control group. Results: There was significant endothelial cell loss in the patients with pseudoexfoliation syndrome than in the patients without pseudoexfoliation syndrome. In GROUP A patients with PEX, the preoperative median ECD significantly decreased from 2367.9 cells/mm2 to 2083.2 cells/mm2 postoperatively (P<0.05). In the control group, the preoperative median ECD decreased from 2665.4 cells/mm2 to 2545.8 cells/mm2 postoperatively at 1 year follow up. Conclusion: Although Cataract surgery in Pseudoexfoliation is challenging, if the surgeon is aware of the condition pre operatively and pays meticulous attention to the surgical technique during   cataract surgery, the intraoperative complications can be managed and good outcome can be expected.