Endothelial cell integrity after phacoemulsification with 2 different handpieces

Abstract

Purpose: To investigate corneal endothelial cell loss in fresh phakic human autopsy cadaver eyes after phacoemulsification (PE) with a conventional handpiece or a new oscillatory handpiece. Setting: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. Methods: Twenty fresh phakic human autopsy globes were randomized to PE with a conventional handpiece (n = 10) or an oscillatory handpiece (n = 10). The main parameters evaluated were age, nucleus density, amount of ophthalmic viscosurgical device (OVD) used, and mean PE time and ultrasound (US) power. After surgery, the corneas were excised and the endothelia were vitally stained with trypan blue and alizarin red. Light microscopy was used to assess the endothelial cell loss. Results: The mean age, density of the nucleus, OVD used, and US power were similar between the groups. The mean PE time was less with the NeoSoniX handpiece (0.71 minutes ± 0.39 [SD]) than with the conventional handpiece (1.05 ± 0.53 minutes). The mean number of dead endothelial cells was significantly lower in the oscillatory handpiece group (31.3 ± 24.2 cells/mm 2) than in the conventional handpiece group (60.4 ± 46.8 cells/mm 2) ( P<.001, Mann-Whitney rank sum test). Conclusions: Less corneal endothelial cell loss occurred after PE with an oscillatory handpiece than with a conventional handpiece. Further randomized clinical trials are recommended to validate this study.