Regional Variability of Endothelial Cell Density and Corneal Edema After Cataract Surgery

Purpose: To investigate regional variability in endothelial cell density (ECD) and corneal thickness (CT) after cataract surgery, and to investigate which patient characteristics and surgical parameters correlate with cell loss and edema. Methods: This prospective study assessed ECD and CT of patients undergoing cataract surgery with intraocular lens implantation. Exclusion criteria included diagnosis of Fuchs corneal dystrophy or keratoconus, diagnosis of pseudoexfoliation, prior ophthalmic surgery, any prescription eyedrop use, or planned combined surgical procedure (including MIGS). Age, intraocular pressure, visual acuity, ECD, and CT were recorded preoperatively (baseline), 1 day after surgery (postop), and 3 to 6 weeks after surgery (follow-up). ECD was measured with noncontact specular microscopy, and CT with tomography. Central, superior temporal, inferior temporal, superior nasal, and inferior nasal measurements were taken. Surgical parameters and patient characteristics were recorded. Results: In the 39 eyes that met inclusion criteria and completed follow-up, CT increased from baseline to postop and decreased from postop to follow-up, returning to baseline. ECD decreased from baseline to postop and increased from postop to follow-up, although ECD did not return to baseline. Associations were seen between cumulative dissipated energy and changes in CT and ECD from baseline to postop. Conclusions: ECD decreased at all sites postoperatively, with less recovery toward baseline at temporal sites, suggesting corneal endothelial cell loss occurs in a site-dependent manner after cataract surgery. In contrast to ECD, by follow-up, CT returns to baseline showing that CT recovery occurs in the setting of decreased ECD postcataract surgery.