Comparative Analysis of Pre- and Post-Operative Central Corneal Thickness and Corneal Endothelial Cell Density in Uneventful Phacoemulsification: A Cross-Sectional Study

Abstract

Background: Phacoemulsification is the gold standard surgical technique for cataract extraction. Despite technical refinements, the procedure is associated with measurable loss of corneal endothelial cells and transient increases in Central Corneal Thickness (CCT). Understanding the magnitude and predictors of these changes is essential for optimizing surgical outcomes.

Aim: To compare pre- and post-operative CCT and corneal Endothelial Cell Density (ECD) in patients undergoing uneventful phacoemulsification, and to correlate these parameters with phacoemulsification power and duration.

Methods: This comparative cross-sectional study enrolled 100 patients with senile nuclear sclerosis grade II–III cataract at a tertiary care centre in Indore, India (September 2022–March 2024). All patients underwent phacoemulsification with the divide-and-conquer technique and Posterior Chamber Intraocular Lens (PCIOL) implantation by a single surgeon. Preoperative and one-month postoperative assessments included ECD, Coefficient of Variation (CV), polymegathism, and CCT measured using non-contact specular microscopy (Tomey EM-4000) and ultrasound pachymetry (PACSCAN-300), respectively. Intraoperative phacoemulsification power and duration were recorded. Statistical analysis was performed using the paired t-test and Spearman's rank correlation (SPSS v22).

Results: The mean patient age was 61.93 ± 9.50 years (range: 42–82 years). Mean preoperative ECD was 2428.59 ± 337.39 cells/mm², which decreased significantly to 2174.99 ± 417.74 cells/mm² postoperatively (10.44% reduction; p < 0.001). Mean CCT increased significantly from 508.68 ± 34.82 μm to 525.21 ± 40.41 μm (3.24% increase; p < 0.001). CV increased from 39.15 ± 6.13% to 41.96 ± 8.51% (p = 0.001) and polymegathism from 43.80 ± 6.96% to 45.78 ± 6.30% (p = 0.014). A statistically significant positive correlation was found between phacoemulsification power and endothelial cell loss (rho = 0.267; p = 0.007). No significant correlations were identified between phacoemulsification duration and any corneal parameter (p > 0.05).

Conclusion: Uneventful phacoemulsification with standardized technique produces statistically significant but clinically modest changes in corneal endothelial parameters and CCT at one month. Higher phacoemulsification power correlates significantly with greater endothelial cell loss, underscoring the importance of energy-minimizing surgical strategies. Postoperative corneal changes appear transient, with expected recovery over subsequent months.