The effect of phacoemulsification on corneal endothelial cells in patients with chronic kidney disease on dialysis: A prospective comparative study

Background: Phacoemulsification in patients with chronic kidney disease (CKD) may be challenging because of pre-existing corneal endothelial abnormalities, including pleomorphism and polymegathism. Thus, a careful intraoperative technique is necessary. Aim: This study aimed to evaluate the implications of uneventful phacoemulsification on the endothelial cells in CKD patients. Setting: The study was carried out in the Ophthalmology Departments of both Sohag and Assiut University Hospitals. Methods: In this prospective comparative study, 50 patients with CKD on dialysis who underwent uneventful phacoemulsification were compared with 50 age-matched controls without systemic disease. Corneal endothelial parameters were assessed using specular microscopy preoperatively and followed up for 6 months postoperatively. Results: Both groups were matched regarding age, sex, grade of nuclear cataract, uncorrected visual acuity, best corrected visual acuity, anterior chamber depth, cumulative dissipated energy, estimated fluid and corneal parameters (endothelial cell density [ECD], coefficient variation, hexagonality, and central corneal thickness), with no significant difference. Postoperatively, a significant progressive decrease in ECD in both groups was noticed, although the decrease was more significant in the CKD group. After 6 months, a mean difference of 471 ± 71 cells/mm2 in the CKD group and 268 ± 63 cells/mm2 in the control group was observed; other corneal parameters showed varying changes postoperatively. Conclusion: The CKD patients on dialysis experience a higher incidence of corneal endothelial cell loss after uneventful phacoemulsification compared with the control group. Therefore, a more careful preoperative evaluation and a more careful intraoperative technique are required. Contribution: The article highlights strategies to optimise visual outcomes following cataract surgery in CKD patients.