A Prospective Study on the Impact of Phacoemulsification on Corneal Endothelial Cell Count and Morphology in Different Grades of Nucleus

Abstract

Background: Phacoemulsification, a widely used surgical technique for cataract removal, can impact the corneal structure, particularly the corneal endothelium. During cataract surgery, significant changes in endothelial cell density, corneal thickness, and endothelial cell morphology often occur. In some cases, patients with senile cataracts may develop corneal edema after phacoemulsification, which can progress to corneal opacity, resulting in irreversible visual impairment.
Method: This longitudinal observational study evaluated 524 patients who underwent phacoemulsification surgery in one eye from October 2024 to February 2025. A comprehensive eye examination was performed, including best-corrected visual acuity (BCVA, decimal notation), slit-lamp, corneal endothelial profiles, encompassing endothelial cell density (ECD), hexagonality (Hex.), cell number (CN), coefficient of variance of cell size (CV), and central corneal thickness (CCT), were assessed using a Nidek non-contact specular microscope.
Results: Grade 4 had 19% cell loss, while grade 1 had only 06%. Grades 2 and 3 (10–15% loss) suggest moderate endothelial vulnerability. Recovery was better in mild cataracts (Grade 1) compared to grade 4.
Conclusion: Phacoemulsification causes significant but mostly transient corneal endothelial changes. Higher-grade cataracts (Grades 3 and 4) have more pronounced and prolonged damage. Surgical strategies (lower energy, optimized fluidics) should be prioritized in dense cataracts to minimize endothelial injury.