Effects of extracapsular implant techniques on endothelial density.

A comparison of surgical techniques with phacoemulsification showed that changing from anterior to posterior chamber emulsification afforded a drop in endothelial cell loss from 24.6% to 12.5%. Implantation of a Shearing posterior chamber lens instead of a Binkhorst two-loop iridocapsular lens did not decrease the cell loss using anterior chamber emulsification. Cell loss was approximately 25% in both groups. The addition of sodium hyaluronate (Healon) to the procedure of posterior chamber emulsification and implantation of a Shearing lens did not raise or lower the cell loss noted when using air alone. However, with the technique described whereby most of the sodium hyaluronate is irrigated from the eye at the end of the procedure, there was no increase in intraocular pressure postoperatively and no untoward effects. Posterior chamber emulsification seems mandatory, and though sodium hyaluronate did not improve cell loss, its use as a precaution seems to be completely safe when correct procedures are followed.