Managing Pseudophakic Corneal Edema: Structural Changes and Preliminary Observations on Coenzyme Q10 Use.

Purpose: Pseudophakic corneal edema (PCE) remains a significant postoperative challenge despite advancements in cataract surgery, often delaying visual recovery and affecting refractive outcomes. This study investigates the relationship between keratometric and pachymetric changes during PCE resolution, evaluates factors influencing this process, and examines the efficacy of Coenzyme Q10 (CoQ10) as an adjunct therapy.

Methods: A retrospective study was conducted on 88 patients aged 50 and above who developed PCE after uneventful phacoemulsification. Corneal assessments were performed using Pentacam HR, focusing on keratometric and pachymetric changes. Patients were monitored weekly until PCE resolution, defined as a return of central corneal thickness within ±30 microns of preoperative values. Patients received standard postoperative treatment, with a subset also receiving CoQ10 as an adjunct therapy.

Results: Postoperative visual acuity(VA) improved significantly (p < 0.001). Despite pachymetric normalization, persistent keratometric changes were observed, particularly a steepening of posterior curvature (p<0.001) and increased anterior asphericity (p = 0.047). CoQ10-treated patients exhibited faster edema resolution (p = 0.019), greater reduction in corneal thickness (p = 0.003), and improved transparency. Higher cumulative dissipated energy (CDE) correlated with increased edema severity (r = 0.419, p<0.001) and higher CDE was linked to slower recovery times. Diabetic patients had a prolonged recovery period compared to non-diabetics (p = 0.018), though pachymetric recovery rates were similar.. The Pachymetric Progression Index (PPI) was unreliable in edematous corneas.

Conclusions: While VA and pachymetry improved in all patients, persistent topographic changes suggest incomplete structural normalization. Preliminary findings indicate that adjunctive CoQ10 use may support more efficient corneal edema resolution, as evidenced by faster recovery and favorable structural changes. Further prospective studies are warranted to confirm these observations.