|Year : 1991 | Volume
| Issue : 1 | Page : 25-27
Corneal endothelial changes following pars plana lensectomy
JI Goyal, Anita Panda, SK Angra
Dr. Rajendra Prasad Center for Ophthalmic Sciences, All Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India
J I Goyal
Department of Ophthalmology, JIPMER, Pondicherry-605006
Source of Support: None, Conflict of Interest: None
The corneal endothelial status was studied in 40 eyes of patients with congenital cataract before and 3 months after surgery. Twenty eyes of patients who underwent pars plana lensectomy revealed a mean endothelial cell loss of 8% (SD +/- .76) while the remaining 20 eyes which were operated by needling aspiration had a endothelial cell loss of 10% (SD +/- .89). The difference between the two groups was not statistically significant.
|How to cite this article:|
Goyal J I, Panda A, Angra S K. Corneal endothelial changes following pars plana lensectomy. Indian J Ophthalmol 1991;39:25-7
| Introduction|| |
Congenital cataract is a colossal problem constituting 15°6 of childhood blindness. Major amount of visual loss in congenital cataract is due to stimulus deprivation amblyopia , The conventional surgical procedure like needling and aspiration suffers from the draw back of after cataract formation which blurs the retinal image leading to amblyopia. Today lensectomy is preferred to aspiration for congenital cataract because it result in a clear pupillary aperture in the critical first 18 months of life during which the deleterious effects of defocussed image on the developing visual system is maximum. The decision to remove the lens from a child's eye is affected by a relatively high risk of post operative complications. Amongst the other ocular risks, damage to the corneal endothelium with the advent of specular microscopy is getting more and more attention. Very little is discussed about the damage to the corneal endothelium following congenital cataract surgery and pars plana lensectomy in literature.
This study reports the endothelial cell loss in pars plana lensectomy and compares it with the conventional needling and aspiration procedure.
| Material and methods|| |
Forty eyes of 30 patients with congenital cataract were studied. The age group of the patients varied from six months to 8 years. The cases were divided into two groups. The age of patients in each group matched approximately. Group I consisted of 20 eyes of sixteen patients where pars plana lensectomy was performed. Group II consisted of 20 eyes of fourteen patients where needling and aspiration was carried out. Patients with any other local or systemic anomalies were excluded from the study. Pre-operative and three months postoperative endothelial counts were measured on a contact type specular microscope in each case. For irrigation ringer lactate with adrenaline was used in both types of surgeries. For needling the capsulotomy was done with a 26 gauge needle where as the same was carried out by Ziegler's knife in pars plan a lensectomy. 2% methylcellulose (Visilon) was used to keep the anterior chamber formed in conventional needling and aspiration procedure
| Results|| |
The age, sex, pre and post operative endothelial cell counts are shown in [Table - 1][Table - 2] for Group I and Group II cases respectively. Out of 30 patients, 1 0 were of bilateral and 20 were of unilateral congenital cataract. Seventeen of them were males and 13 were females. Mean endothelial cell loss in group I (pars plana lensectomy) was 8% (SD± 76) where as it was 10% (SD± .89) in cases of needling and aspiration. The difference was statistically not significant.
| Discussion|| |
It is well known that any cataract surgery causes a decrease in endothelial cell density . Baum and associates reported that human endothelial cells can grow if the donor age is below 20 Years . If that was true then congenital and majority of the traumatic cataracts which fall into that age group should not have lowered endothelial counts after cataract surgery. This was contradicted by Olsen (1981) who studied endothelial status after-lens aspiration in young patients, and by the present study (cell loss 8-10%) where it has been found that endothelial layer in young patients does not involve cell proliferation to the extent of complete restoration of cell density. At present the bulk of evidence from specular microscopy indicates that mitotic division presumably plays a minor role as compared to cell spreading .
In our study post operative endothelial specular microscopy was carried out at the end of 3 months because it has been reported that the decrease in central endothelial counts following surgery is retorted to be minimal after 3 months (Gelin et al 1979) .
During aspiration the endothelium is irrigated with large fluid volumes and more manipulation occurs in the anterior chamber in conventional surgery as compared to pars plana lensectomy. Thus one might expect to see more endothelial cell loss in needling aspiration as compared to pars plana lensectomy procedure. The difference in the change in the endothelial cell count in both the study groups was not statistically significant. This could be attributed to the use of 2% Visilon during conventional needling aspiration procedure which is known to prevent mechanical damage to the endothelium to a greater extent.
The mean endothelial cell loss caused at the end of three month was 8% (SD±.76) and 10% (SD±.89) in Group I and Group II respectively. The lower rate of cell loss in congenital cataract surgery may be due to the small limbal incision and there may be a partial proliferation of the corneal endothelium. Thus it is concluded that there is no significant difference in the endothelial cell loss between pars plana lensectomy and the conventional needling and aspiration procedure.
| Summary|| |
Corneal endothelial cell count before and 3 months after surgery is compared in 20 eyes of congenital cataract patients who underwent pars plana lensectomy and 20 congenital cataract eyes who were operated by the conventional needling aspiration procedure.
| References|| |
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[Table - 1], [Table - 2]