Just how safe is otherwise uneventful cataract surgery, particularly regarding corneal health? That’s what a retrospective case series recently investigated, hoping to identify the extent and etiology of long-term corneal endothelial density (ECD) decrease in these patients.

Researchers looked at 81 eyes of 48 patients who had undergone cataract surgery more than10 years previously; to limit some possible causes of variability, they only looked at cases performed by a single surgeon and with the same intraocular lens. Long-term changes in visual outcome and ECD after uncomplicated cataract surgery were evaluated. To analyze factors correlated with endothelial cell loss, preoperative biometric variables—cataract grade, anterior chamber depth, axial length, postoperative corneal edema—were evaluated.

The mean preoperative and long-term postoperative ECD was 2793 ± 351 and 2148 ± 478 cells/mm², respectively. The 10-year mean cell loss rate was about 20%, plus or minus a standard deviation of 13.6%. Preoperative nuclear firmness was most statistically correlated with 10-year ECD loss. The degree of postoperative corneal edema was also a significant predictive factor of 10-year ECD loss after cataract surgery.

The authors concluded that preoperative nuclear firmness and postoperative corneal edema were predictors of long-term endothelial cell loss and severe loss after cataract surgery. “It is important to remember,” they wrote in their paper, “that eyes with increased nuclear firmness have a significantly higher risk of long-term enhanced ECL.”