Comparison of endothelial cell number changes with specular microscopy between the patients who performed vitrectomy surgery and vitrectomy combined facoemulsification

Purpose: Comparison of changes in corneal endothelial cell numbers in patients undergoing phacoemulsification (PHACO) surgery combined with pars plana vitrectomy (PPV) and pars plana vitrectomy with speculer microscope. Methods: The study included 81 patients (81 eyes); 48 eyes who underwent pars plana vitrectomy (group 1) and 33 eyes who underwent phacoemulsification combined with pars plana vitrectomy (group 2). Ophthalmologic examination including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopic and fundoscopic evaluation was performed before and after the operation. All cases were examined preoperatively and postoperatively at 1 and 3 months with non-contact specular microscope (Konan CellChek XL). Endothelial cell density (cells/mm 2), coefficient of variation (%), hexagonality ratio (%) and central corneal thickness (μm) values were recorded. All parameters were statistically compared between groups and p <0.05 values were considered significant. Results: The mean age was 61,10 ± 12,64 (48-73 years) in the pars plana vitrectomy group, in pars plana vitrectomy and phacoemulsification group, 62,45 ± 11,05 (51-73 years), 43.2% of the cases were female and 56.8% were male. At the postoperative 1st and 3rd months corneal endothelial cell density was found to be statistically significantly lower than preoperative values in the group with pars plana vitrectomy (p:0.00). Postoperative 1st and 3rd months corneal endothelial cell density in postoperative phacoemulsification combined with pars plana vitrectomy was statistically significantly lower than preoperative values (p:0.00). Compared with the two groups, postoperative 3 months corneal endothelial cell loss was significantly higher in group with phacoemulsification combined with pars plana vitrectomy than only group with pars plana vitrectomy (p:0.01). In both groups, no significant difference was found in other quantitative specular microscopy data such as CV, HEX, CCT compared to preoperative values in postoperative 1st and 3rd month measurements. Conclusions: Patients undergoing phacoemulsification combined with pars plana vitrectomy have significant corneal endothelial cell loss in the postoperative period compared to patients treated with pars plana vitrectomy alone. Tamponades used in pars plana vitrectomy and the ultrasonic power used in phacoemulsification in resultant thermal energy resulting in damage to the corneal endothelium. Therefore, the combined surgery has a higher risk of corneal decompensation in patients with low corneal endothelial density in the preoperative period. However, due to its advantages, combined surgery can be recommended. In this respect, it is very important to determine the surgical method to be evaluated preoperatively by specular microscopy.