Impact of surgeon experience on corneal endothelial changes after cataract surgery.

Abstract

Purpose: To compare endothelial corneal cell changes following cataract surgery performed by phacoemulsification with intraocular lens implantation, conducted by surgeons with varying levels of experience.

Methods: Two hundred and eighty-three eyes diagnosed with cataract were included. Lens opacity was classified into three categories (I, II, and III). Surgeons were categorized into four experience levels (1, 2, 3, and 4), based on years of practice and lifetime surgeries performed. Corneal endothelial characteristics were assessed using non-contact specular microscopy, with measurements taken before surgery and 30-60 days post-surgery.

Results: Preand postoperative endothelial analysis showed no significant differences between surgeon levels regarding visual acuity achieved, corneal thickness, and endothelial hexagonality. However, the central endothelial cell density index showed a significantly greater reduction among level 1 surgeons (p=0.026). Grade II cataracts exhibited significant variations in the central endothelial cell density (p=0.011) and average cell size, with level 1 surgeons showing the largest increases (p=0.024).

Conclusions: The analysis revealed significant differences in visual acuity and endothelial indices between surgeon experience levels, with less experienced surgeons showing greater variations and poorer performance. Clinical protocols should consider these data to establish safer training protocols.