The Effects of Anterior Chamber Depth to Endothelial Cell Loss Using Tranversal Phacoemulsification

Background: Phacoemulsification surgery is the most frequent cataract surgery performed in developed countries because of its effectiveness and safety. However, some degree of endothelial loss is inevitable in any type of cataract surgery, including phacoemulsification. Anterior chamber depth (ACD) could be considered as one of important anatomical parameters for preserving endothelial loss from the mechanical and thermal damage that can occur during the procedure. Purpose: To evaluate the effects of ACD on endothelial cell density, hexagonality, coefficient variation (CV) and central corneal thickness (CCT) at one and four weeks after phacoemulsification using transversal ultrasound. Method: This was a prospective study conducted at Cicendo National Eye Hospital Indonesia from April to August 2018, where we performed phacoemulsification in 148 patients with ACD < 3 mm group, ACD ≥ 3 mm group. Specular microscopy examination was performed prior to phacoemulsification and repeated at one and four weeks after surgery. The changes in endothelial density, percentage of hexagonality, CV and CCT between two groups were evaluated and compared. Result: Mean (SD) endothelial density in ACD < 3 mm group and ACD ≥ 3 mm group at 1-week evaluation was 1761.9 (503.3) and 1966.1 (530.6) cells/mm2 respectively, with p value 0.030. At 4-week evaluation, endothelial cell density in ACD < 3 mm group and ACD ≥ 3 mm group was 1537.8 (504.9) and 1798.7 (554.0) cells/mm2 respectively, with p value 0.010. There was no statistical difference regarding hexagonality, CV and CCT between both groups at 1-week and 4-week evaluation. Endothelial density changes percentage also higher in ACD < 3 mm group at 1-week and 4-week evaluation. Conclusion: Endothelial cell density in ACD < 3 mm group was significantly lower compared to ACD ≥ 3 mm group at 1-week and 4-week evaluation after phacoemulsification.