Evaluation of endothelial cell loss after cataract surgery in patients with pseudoexfoliative syndrome

Introduction: Despite modern techniques and technologies for cataract surgery, pseudoexfoliative syndrome poses a challenge to surgeons due to weakness of the zonular apparatus and limited pupillary dilation. Quantitative and qualitative morphological changes in the corneal endothelium have been demonstrated by several studies. An accumulated risk of endothelial cell loss can be expected in these patients following more complicated and prolonged surgery, often requiring complex manipulation of the cataract, iris, and IOL. Our present work aims to compare the loss of endothelial cells after uncomplicated phacoemulsification in patients without and with pseudoexfoliative syndrome. Materials and methods: We conducted a prospective comparative study collected at the Rabat specialty hospital, spanning from August to December 2023. Were included in this study 60 candidates for cataract surgery: - 30 patients with pseudoexfoliation syndrome (PXF) and - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. Discussion: In our series, we did not find a statistically significant difference in the density of preoperative endothelial cells between the 2 groups, this result is similar to that obtained by KALJURAND et al, on the other hand for ken hayashi et al, and wirbelauer et al, the difference between the 2 groups was statistically significant. Regarding postoperative cell loss, our results agreed with those obtained by Ken Hayashi et al, who also reported greater endothelial cell loss in the PXF group compared to the control, unlike Wirbelauer et al, for whom the loss of endothelial cells was similar between the 2 groups. In the study by Kaljurand et al, the average percentage loss was 18% in the PXF group versus 11.6 in the control group, this difference had a statistically low significance. Conclusion: The loss of corneal endothelial cells after phacoemulsification in eyes with capsular pseudoexfoliation was significantly greater than in eyes without PXF, these results suggest that corneal endothelial cells of patients with pseudoexfoliation syndrome are more vulnerable to cataract surgery than healthy endothelial cells. To prevent serious endothelial lesions, a precise preoperative evaluation of the corneal endothelial state by specular microscopy seems necessary in these patients, with more precision and precautions during the procedure.