Abstract:

Objective

To investigate the risk factors of corneal endothelial cell injury in phacoemulsification of hard nucleus cataract.

Methods

From January 2022 to December 2024，100 patients（100 eyes）with hard nuclear cataract underwent phacoemulsification and intraocular lens implantation in the Department of Ophthalmology of Beijing Fengtai Hospital were collected.There were 53 males（53 eyes）and 47 females（47 eyes）with an average age of（70.0±9.3）years（ranging from 49 to 86 years）.The patients whose corneal endothelial cell count decreased more than 20% one month after operation were selected as the observation group，and those whose corneal endothelial cell count decreased less than 20% were selected as the control group.Corneal endothelial cell counts were measured before and 1 month after surgery in all patients.The intraocular lens nucleus hardness，anterior chamber depth，effective phacoemulsification time and perfusion time were examined and recorded.The corneal endothelial cell count of patients before and 1 month after surgery conformed to normal distribution，which was expressed as±s and compared by independent sample t test for between groups.The number of eyes in each category of age（＜70 years old，≥70 years old），gender（male，female），diabetes mellitus（yes，no），anterior chamber depth（＜2.9 mm，≥2.9 mm），effective phacoemulsification time（＜10 s，≥10 s），perfusion time（＜180 s，≥180 s）of all patients were summarized and described by the number of eyes and percentage.Chi-square test was used for comparison between groups.Multivariate logistic regression was used to screen the risk factors of corneal endothelial cell count with age，gender，diabetes mellitus，anterior chamber depth，effective phacoemulsification time and perfusion time as independent variables.The Spearman correlation coefficient r was calculated by correlation analysis.

Results

Before surgery，the corneal endothelial cell count in the observation group and the control group were（2541.33±509.35）cells/mm² and（2577.60±428.72）cells/mm²，respectively，with no significant difference（t=0.38，P＞0.05）.One month after operation，the corneal endothelial cell count in the observation group and the control group were（1880.40±426.85）cells/mm² and（2157.78±393.27）cells/mm²，respectively，with significant difference（t=-3.26，P＜0.05）.The age（＜70 years old，≥70 years old），anterior chamber depth（＜2.9 mm，≥2.9 mm），effective phacoemulsification time（＜10 s，≥10 s）and perfusion time（＜180 s，≥180 s）of the observation group and the control group were（21 cases，42 cases）and（20 cases，17 cases），（39 cases，24 cases）and（8 cases，29 cases），（34 cases，29 cases）and（30 cases，7 cases）and（34 cases，29 cases）and（31 cases，6 cases），respectively，accounting for（33.33%，66.67%）and（54.05%，45.95%）and（61.90%，29 cases），respectively.38.10%）and（21.62%，78.38%），（53.97%，46.03%）and（81.08%，18.92%）and（53.97%，46.03%）and（83.78%，16.22%）.The difference between the two groups was statistically significant（χ²=4.14，15.19，7.44，9.11；P＜0.05）.The gender（male，female），diabetes mellitus（yes，no）of the observation group and the control group were（33 cases，30 cases）and（20 cases，17 cases），（27 cases，36 cases）and（13 cases，24 cases），respectively，accounting for（52.38%，47.62%）and（54.05%，45.95%），（42.86%，57.14%）and（35.14%，64.86%）.There was no significant difference between the two groups（χ²=0.03，0.58；P＞0.05）.The effects of age，gender，diabetes mellitus and perfusion time on corneal endothelial cell injury in patients with hard nucleus cataract after phacoemulsification were not statistically significant（χ²=1.46，0.27，0.35，1.21；P＞0.05）.The depth of the anterior chamber was a protective factor for corneal endothelial cell damage in patients with hard nuclear cataracts after phacoemulsification（OR=0.07，95%CI：0.01 to0.29）.The effective phacoemulsification time was a risk factor for corneal endothelial cell injury in patients with hard nuclear cataract after phacoemulsification surgery（OR=1.23，95%CI：1.01 to 1.54），and its impact is statistically significant（χ²=-3.46，2.00；P＜0.05）.There was no linear correlation between age，anterior chamber depth，effective phacoemulsification time，and corneal endothelial cell reduction at one month after surgery in the observation group（r=0.01，0.15，0.14；P＞0.05）.There was no linear correlation between age，anterior chamber depth，effective phacoemulsification time，and corneal endothelial cell reduction at one month after surgery in the control group（r=0.27，0.22，0.02；P＞0.05）.

Conclusions

Age，anterior chamber depth，effective phacoemulsification time and perfusion time are all risk factors for corneal endothelial damage after phacoemulsification surgery.Among them，anterior chamber depth and effective phacoemulsification time are the most important risk factors.If the anterior chamber depth is less than 2.9 mm，patients with hard nuclear cataracts should pay more attention to protecting corneal endothelial cells during surgery and try to shorten the effective phacoemulsification time.

Key words: Hard-nucleus cataract, Phacoemulsification surgery, Corneal endothelial cell, Risk factor