A comparison of the effects of phacoemulsification and nucleus expression on endothelial cell density.

A series of patients undergoing extracapsular cataract extraction by phacoemulsification (1,126) or nucleus expression (632) were studied to evaluate the relative effects of emulsification time, irrigating volume, and surgical technique on endothelial cell density. The collective data revealed a higher cell loss with phacoemulsification (15%) than with nucleus expression (12%). Patients over 69.5 years appeared to be more vulnerable to the effects of phacoemulsification than those below 69.5 years. Although the data were subjected to combinations and permutations of age, sex, time, and volume, no direct correlation between emulsification time and/or irrigating volume and endothelial cell loss was shown. When data sets for individual surgeons were analyzed, the most striking difference was between the endothelial effect of anterior chamber phacoemulsification (26% average reduction) and that of posterior chamber phacoemulsification (13% average reduction).