Corneal endothelial protection during manual small-incision cataract surgery: A narrative review

• Published in: Indian journal of ophthalmology Vol. 70; no. 11; pp. 3791 - 3796
• Main Authors: Singh, Mamta, Mishra, Deepak, Sinha, Bibhuti, Anand, Abhishek, Singhal, Shubha
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.11.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Analysis; Blindness; Care and treatment; Cataract; cataract blindness burden; Cataract Extraction - adverse effects; Cataract Extraction - methods; Cataracts; Cornea; corneal endothelium; Developing countries; Endothelial Cells; Endothelium; Endothelium, Corneal; Eye surgery; Free radicals; Humans; LDCs; Lenses, Intraocular; manual small-incision cataract surgery; ocular viscoelastic devices; Phacoemulsification - methods; Review; Surgery; Surgical Wound; Trauma; Viscoelasticity; India; Cataract blindness burden; corneal endothelium; ocular viscoelastic devices; manual small-incision cataract surgery
• ISSN: 0301-4738; 1998-3689
• DOI: 10.4103/ijo.IJO_1048_22

Cataract causes bilateral blindness in 20 million people globally, the vast majority of whom live in developing countries. Manual small-incision cataract surgery (MSICS) has emerged as an efficient and economical alternative to phacoemulsification, giving comparable results in terms of final visual gain. One of the important determinants of postoperative visual gain is the status of the corneal endothelium. Multiple factors such as corneal distortion, irrigation solution turbulence, mechanical trauma by instruments, nuclear fragments, intraocular lens contact, and free oxygen radicals, all have been implicated in causing corneal damage during cataract surgery. MSICS with posterior chamber intraocular lens implantation has been reported to cause an endothelial cell loss of 15.83%, which is comparable with other modes of cataract surgery like extracapsular cataract extraction and phacoemulsification. Thorough preoperative assessment of endothelial status and taking necessary steps for endothelial protection during surgery can decrease the endothelial cell loss and overall burden of pseudophakic bullous keratopathy. In addition to surgical techniques, the type of irrigating solutions, ocular viscoelastic devices, intracameral dyes, and drugs all affect the endothelial cell status. This review presents a summary of available literature on the protection of endothelial cells during different steps of MSICS. This is especially relevant for developing countries where large-scale MSICS cataract surgeries are performed to decrease the cataract blindness burden.