Phacopower modulation and the risk for postoperative corneal decompensation: a randomized clinical trial.

M. Doors, T.T. Berendschot, W. Touwslager, C.A. Webers, R.M. Nuijts*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Web of Science)


IMPORTANCE In compromised corneas, eg, patients with Fuchs endothelial (FED), it is of utmost importance to use a phacotechnique that is the traumatic to the corneal endothelium. Furthermore, preoperative patient is crucial, because unexpected corneal decompensation leads to patients. OBJECTIVE To compare corneal thickness and corneal volume torsional and longitudinal phacoemulsification in patients with Fuchs dystrophy (FED) and determine risk factors of postoperative corneal decompensation. DESIGN, SETTING, AND PARTICIPANTS Prospective randomized trial of all patients diagnosed with FED and planning to undergo for visually significant cataract at a university medical center from 2008 to May 2010. INTERVENTION Fifty-two eyes with FED and visually cataract underwent torsional (n = 26) or longitudinal (n = 26) phacoemulsification. Patients were evaluated preoperatively and 1 day, 1 month, 3 months, and 6 months postoperatively. Visits included best spectacle-corrected visual acuity, anterior segment optical coherence evaluating central corneal thickness (CCT) and peripheral corneal (PCT), and Scheimpflug imaging calculating corneal volume (CV). took place according to stage of FED, nucleus density grade, and age. Intraoperatively, ultrasonography time and cumulative dissipated energy recorded. MAIN OUTCOMES AND MEASURES Central corneal thickness, PCT, and RESULTS Ultrasonography time and cumulative dissipated energy were lower in the torsional group for harder nucleus density grades compared longitudinal group (P = .009 and P = .002, respectively). Peripheral thickness at the 6-o'clock position, CCT, and CV were significantly the torsional group 1 day postoperatively (P = .002; P = .03; and P = respectively). Changes in PCT at the 12-o'clock position and best spectacle-corrected visual acuity were not significantly different groups (P > .05). Preoperative CCT was the only significant predictor corneal decompensation postoperatively (P < .001). Preoperative CCT microm corresponded to an odds ratio of 1, meaning no increased risk of developing corneal decompensation. For each 10-microm increase in CCT, the odds of developing corneal decompensation increased 1.7 times. CONCLUSIONS AND RELEVANCE Torsional phacoemulsification effectively ultrasonography time and cumulative dissipated energy compared with phacoemulsification in patients with FED. However, there were only differences in corneal thickness and CV changes at 1 day postoperatively of the torsional group. Central corneal thickness more than 620 microm, by noncontact pachymetry, leads to an increased risk for corneal after phacoemulsification in patients with FED. TRIAL REGISTRATION Identifier: NCT00781027.
Original languageEnglish
Pages (from-to)1443-1450
Number of pages8
JournalJAMA Ophthalmology
Issue number11
Publication statusPublished - Nov 2013



Cite this