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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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LETTER TO THE EDITOR
Year : 2012  |  Volume : 19  |  Issue : 2  |  Page : 269-270  

Corneal endothelial cell density following cataract surgery in eyes with previous blunt trauma


1 Department of Ophthalmology, University College of Medical Sciences and G. T. B. Hospital, Delhi, India
2 Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India

Date of Web Publication21-Apr-2012

Correspondence Address:
Ved Prakash Gupta
275, Ground Floor, Gagan Vihar, Delhi - 110 051
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-9233.95272

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How to cite this article:
Gupta VP, Gupta P, Gupta R. Corneal endothelial cell density following cataract surgery in eyes with previous blunt trauma. Middle East Afr J Ophthalmol 2012;19:269-70

How to cite this URL:
Gupta VP, Gupta P, Gupta R. Corneal endothelial cell density following cataract surgery in eyes with previous blunt trauma. Middle East Afr J Ophthalmol [serial online] 2012 [cited 2020 Feb 23];19:269-70. Available from: http://www.meajo.org/text.asp?2012/19/2/269/95272

Sir,

We read the article by Yeniad B, Corum I, Ozgun C [1] with keen interest. We did note some discrepancies in the numbers of subject reported in the text and the figures. In particular we draw attention to the text that states the study population consists of 31 subjects in the traumatic cataract group and 30 healthy subjects with senile cataract in the control group. However, [Figure 1] presents only 21 patients in the traumatic cataract group and 20 subjects in the control group. Similarly in [Figure 2] the article describes the distribution of corneal endothelial cell density in 61 healthy eyes (30 eyes in the control group and 31 contralateral eyes in the traumatic cataract group); however, the figure presents 40 eyes. The authors need to address the discrepancies between the text and figures.

Furthermore, Yeniad and colleagues [1] indicate that the control group comprised of healthy subjects with senile cataract. The mean age of the patients in traumatic cataract group (48 years) was significantly younger than the mean age of senile cataract group (55 years). However, the authors did not report the mean ages of the two traumatic cataract subgroups. According to [Figure 1] there were 6 patients below 31 years in the traumatic cataract group without age-matched controls. Yeniad and colleagues [1] should include age-matched patients in the control group rather than only senile cataract patients. Corneal endothelial cell density (ECD) differs with age. Age and ECD show a negative correlation with endothelial cells decreasing by 0.1% for every year of life. [2],[3] In the Discussion, Yeniad and colleagues state that 10 out of 12 patients in the complicated surgery subgroup had one or more coexisting clinical findings such as iridodonesis, phacodonesis and zonular rupture. However, these additional clinical findings are not reported in the Materials and Methods or in the Results.

Yeniad and colleagues [1] did not report the hardness of nucleus or the technique of nucleotomy. In addition to the several factors that Yeniad and colleagues [1] mention, endothelial cell loss depends on the technique used to remove nuclear material, nucleus hardness, ultrasound power, the type of phacoemulsification unit, age of the patient and the presence of corneal disease. [4],[5] Endothelial cell loss after cataract surgery ranges from 4 to 25%. [4] For example, one study reported no difference in endothelial cell loss after phacoemulsification (10%) and extracapsular cataract extraction (ECCE) (10%). [5] The phacoemulsification group actually had a higher rate of cell loss in hard cataracts (18.9% vs. 11.8%). [5] The factors associated with greater cell loss in the study included hard cataract, age, capsule break and vitreous loss. [5] Yeniad and colleagues [1] report a 16.7% decrease in ECD in the complicated surgery group which appears reasonable. Median endothelial cell loss of 14% has been reported 12 months after combined pars plana phacofragmentation, vitrectomy, and Artisan lens implantation in the management of traumatic subluxated cataracts in adults. [6]

Yeniad and colleagues [1] conclude that patients with cataract due to blunt trauma had a decreased endothelial cell count, which was significantly aggravated by cataract surgery. However, blunt trauma does not appear to play any role in decreased ECD after cataract surgery because ECD decreased significantly after cataract surgery even in the control group. Moreover, the difference in the decrease in ECD between the two groups was not significant.

 
   References Top

1.Yeniad B, Corum I, Ozgun C. The effects of blunt trauma and cataract surgery on corneal endothelial cell density. Middle East Afr J Ophthalmol 2010;17:354-8.  Back to cited text no. 1
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2.Cavanagh HD, Petroll WM, Alizadeh H, He YG, McCulley JP, Jester JV. Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease. Ophthalmology 1993;100:1444-54.  Back to cited text no. 2
    
3.Guthoff RF, Stave J. In vivo micromorphology of the cornea: Confocal microscopy principles and clinical applications. Cornea 2006;25:127-31.  Back to cited text no. 3
    
4.Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology 1994;101:1014-22.  Back to cited text no. 4
    
5.Bourne RR, Minassian DC, Dart JK, Rosen P, Kaushal S, Wingate N. Effect of cataract surgery on the corneal endothelium: Modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology 2004;111:679-85.  Back to cited text no. 5
    
6.Kodjikian L, Beby F, Spire M, Gambrelle J, Hubert I, Burillon C, et al. Combined pars plana phacofragmentation, vitrectomy, and Artisan lens implantation for traumatic subluxated cataracts. Retina 2006;26:909-16.  Back to cited text no. 6
    




 

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