Corneal Endothelial Changes Following Phacoemulsification In Pseudoexfoliation Syndrome: A Prospective Study

Abstract

Background: Pseudoexfoliation syndrome (PXF) is an age-related fibrillopathy associated with corneal endothelial vulnerability, increasing the risk of cell loss during phacoemulsification. This study evaluates corneal endothelial changes following phacoemulsification in PXF patients.

Methods: A prospective interventional study was conducted at R.L. Jalappa Hospital, Kolar, India, involving 25 cataract patients associated with PXF undergoing phacoemulsification. Preoperative and postoperative (Day 1, Week 1, Month 1, Month 3) assessments of ECD, pleomorphism, polymegathism, and CCT were performed using specular microscopy and ultrasound pachymetry respectively. Paired t-tests analysed changes, with significance set at p<0.05.

Results: Mean preoperative ECD was 2057.6±259.5 cells/mm², decreasing significantly to 1785.8±270.4 cells/mm² by 3^rd month (13.2% loss, p<0.001). Pleomorphism declined from 55.2±2.6% to 51.4±2.7% (p<0.001), while polymegathism increased from 34.3±2.7% to 38.5±2.6% (p<0.001). CCT increased significantly on Day 1 (551.8±11.4 µm vs. 526.4±11.1 µm preoperatively, p<0.001) but normalized by 3^rd month (526.4±11.1 µm, p>0.05). No significant intraoperative complications were reported.

Conclusion: Phacoemulsification in PXF patients results in significant corneal endothelial changes indicating persistent stress. Transient CCT elevation resolved by 3 months, suggesting partial functional recovery. Preoperative specular microscopy and intraoperative protective strategies are crucial to minimize endothelial damage and optimize visual outcomes.