Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 11;23(1):211.
doi: 10.1186/s12886-023-02954-w.

Effect of elevated irrigation bottle height during cataract surgery on corneal endothelial cells in porcine eyes

Daniel A Wenzel  1   2 , Constanze Schultheiss  3 , Vasyl Druchkiv  4 , Olaf J C Hellwinkel  5 , Martin S Spitzer  4 , Maximilian Schultheiss  4 , Maria Casagrande #  4 , Nils Alexander Steinhorst #  4
Affiliations

Effect of elevated irrigation bottle height during cataract surgery on corneal endothelial cells in porcine eyes

Daniel A Wenzel et al. BMC Ophthalmol. .

Abstract

Background: Cataract surgery induces corneal endothelial cell loss (ECL). This study investigates the relationship between bottle height (BH) and ECL induced due to irrigation and aspiration (I/A) in cataract surgery and quantifies protective effects of intraoperatively used ophthalmic viscoelastic substances.

Methods: Intermittent I/A without phacoemulsification was performed in porcine eyes for 10 min with varying BHs of 100 cm (BH100), 125 cm (BH125), 150 cm (BH150) or no treatment (control, no I/A). Additionally, in one group a dispersive ophthalmic viscoelastic substance was injected into the anterior eye chamber before treatment with I/A at a BH of 150 cm (BH150 + V). After exposure of the corneal endothelium to I/A, the corneas were prepared to split corneal buttons on day 0 and cultivated for 15 days. Endothelial cell density (ECD) was analyzed blinded on days 1, 8 and 15.

Results: Relative ECL significantly correlated with irrigation BH (control (n = 13): -9.69 ± 6.03% (average ± standard deviation); BH100 (n = 12): -9.69 ± 4.81%-p = 1.000; BH125 (n = 14): -19.44 ± 7.30% - p < 0.001; BH150 (n = 13): -21.99 ± 6.70%-p < 0.001). I/A-induced ECL was significantly decreased by the injection of ophthalmic viscoelastic, as BH150 + V (n = 14; -10.92 ± 4.09%-p = 1.000) showed a cell loss comparable to the control group.

Conclusions: ECL is altered by I/A BH and reduced when viscoelastic substances are used.

Keywords: Aspiration; Bottle height; Cataract; Cataract surgery; Corneal endothelium; Irrigation; Phacoemulsification.

PubMed Disclaimer

Conflict of interest statement

None of the authors has a (non-)financial or proprietary interest in this study to declare.

Figures

Fig. 1
Fig. 1
Schematic illustration of the experimental setup – five groups were compared in terms of I/A-induced corneal endothelial cell damage. Bottle height (BH) was varied between groups between 100 to 150 cm (BH100, BH125, BH150). Viscoelastic was used in one group to determine protective capabilities (BH150 + V)
Fig. 2
Fig. 2
Box plots with whiskers providing endothelial cell densities of all groups on day 1 and on day 15. All groups showed significant endothelial cell losses after two weeks of cultivation. ECL was higher in BH125 and BH150 compared to the control group, BH100 and BH150 + V (also compare Fig. 3). Levels of significance: **p ≤ 0.01, ***p ≤ 0.001
Fig. 3
Fig. 3
The relative endothelial cell loss (ECL) 15 days after irrigation/aspiration at different bottle heights is shown. See Table 1 for descriptive data. Data depicted as mean ± SD. Level of high significance at ***p < 0.001
Fig. 4
Fig. 4
Representative photographs of corneal endothelial cells – Endothelial cells were photographed on day 1 (unstained) and day 15 (stained with trypan blue and alizarin red S). Significant endothelial cell decline was observed in BH125 and BH150 compared to control, whereas BH100 and BH150 + V did not. Enlargement of endothelial cells and damaged areas are clearly visible in BH125 and BH150. Scale bar corresponds to 100 µm
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bourne RRA, Minassian DC, Dart JKG, Rosen P, Kaushal S, Wingate N. Effect of cataract surgery on the corneal endothelium modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology. 2004;111(4):679–685. doi: 10.1016/j.ophtha.2003.07.015. - DOI - PubMed
    1. Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology. 1994;101(6):1014–1023. doi: 10.1016/S0161-6420(94)31224-3. - DOI - PubMed
    1. Gogate P, Ambardekar P, Kulkarni S, Deshpande R, Joshi S, Deshpande M. Comparison of endothelial cell loss after cataract surgery: phacoemulsification versus manual small-incision cataract surgery. Six-week results of a randomized control trial. J Cataract Refract Surg. 2010;36(2):247–53. doi: 10.1016/j.jcrs.2009.09.023. - DOI - PubMed
    1. Olson LE, Marshall J, Rice NSC, Andrews R. Effects of ultrasound on the corneal endothelium: I The acute lesion. Br J Ophthalmol. 1978;62(3):145–154. doi: 10.1136/bjo.62.3.145. - DOI - PMC - PubMed
    1. Takahashi H. Corneal Endothelium and Phacoemulsification. Cornea. 2016;35(Suppl 1):S3–S7. doi: 10.1097/ICO.0000000000000990. - DOI - PubMed