Lens status as the single most important factor in endothelium protection after vitreous surgery: a prospective study.

Abstract

The aim of this study was to evaluate the effect of vitreous surgery on the corneal endothelium. A total of 113 eyes undergoing pars plana vitrectomy for variable indications at a tertiary care center were included prospectively. The mean age was 41 years (range, 9-84 years), and 60% were male. The endothelial cell count was measured preoperatively and on postoperative day 1, 30, 90, and 180. The rate of endothelial cell loss was measured and analysis performed based on gauge of surgery, lens status, and vitreous substitute used. About 7.6% of endothelial cells were lost at postoperative day 1. This rate had decreased to 2.5% in the first 30 days, 1.5% between days 30 and 90, and 1.4% between days 90 and 180. Significant difference in endothelial cell loss was noted on day 1 between phakic (7.2%), pseudophakic (6.4%), and aphakic (11.4%) eyes with similar results at 6 months. There was no significant difference between the gauges of surgery (20 G vs. 23 G) or the vitreous substitutes used (air vs. gas vs. silicone oil) on day 1 or at 6 months. Endothelial decompensation is an important complication of vitreoretinal surgery. Precautions should be taken in aphakics and patients requiring anterior segment manipulation. Although there is immediate cell loss, the rate of cell loss approaches normative values with time.