Monitoring for continuing endothelial cell loss with cataract extraction and intraocular lens implantation.

For a period of three years, more than 2,700 endothelial cell density measurements were performed in over 1,000 patients undergoing cataract extraction with and without intraocular lens implantation. We concluded the following from the data: (1) Significant cell loss occurred with all surgical procedures, averaging between 11.6% and 25.6%, depending on type of procedure and implant used; anterior chamber phacoemulsification without intraocular lens implantation caused the most cell loss. (2) Patients with Medallion suture implants produced by one of two manufacturers studied demonstrated statistically significant cell loss during the first (15.6% additional cells lost) and second (22.9% additional cells lost) postoperative years following the initial cell loss due to surgery. This evidence for continuing cell loss with the Medallion suture lens correlated with the clinical observation of an increasing incidence of late bullous keratopathy in these patients. (3) No other surgical procedure or implant type, including Choyce and Shearing implants and Medallion style lenses from another manufacturer, demonstrated any evidence of continuing endothelial cell loss following the initial loss due to surgery.