Risk factors for corneal endothelial cell damage after phacoemulsification

This prospective study aimed to identify risk factors for endothelial cell loss (ECL) after phacoemulsification surgery. A total of 194 eyes from 136 patients undergoing phacoemulsification were included. Demographic data and biometric parameters were evaluated preoperatively. Corneal endothelial cell parameters were obtained at the mid-stage (1–3 months postoperatively) and late-stage (≥ 6 months postoperatively). The primary endpoint was absolute ECL at the late-stage follow-up. Statistical analyses used linear mixed-effects models to account for inter-eye correlation and repeated measures. Multivariable analyses were performed to identify factors associated with ECL. We found that the mean corneal endothelial cell density decreased significantly from preoperative values at both follow-ups ( P < 0.001). At mid-stage, factors significantly associated with ECL were shorter lens position (LP, a composite of anterior chamber depth and half lens thickness), smaller white-to-white distance (WTW, horizontal corneal diameter), and higher average phaco energy (all P < 0.05). At late-stage, smaller WTW and higher average phaco energy were significantly associated with ECL ( P < 0.05). In conclusion, LP was associated with ECL at mid-stage but not at late-stage, whereas WTW and average phaco energy were associated with ECL at both follow-ups. These findings describe factors associated with ECL at different postoperative follow-up stages.