Endothelial Cell Loss After 3.5 mm Temporal Clear Corneal Incision and 3.5 mm Superior Scleral Tunnel Incision

OBJECTIVE: To undertake a comparative study of endothelial cell loss after 3.5 mm temporal clear corneal incisions (tCCI) and 3.5 mm superior scleral tunnel incisions (sSTI). STUDY DESIGN: Besides the site and preparation of the incision all 59 eyes were operated with the same surgical technique and implantation of a flexible silicone intraocular lens (IOL) through a 3.5 mm incision. In group 1 a temporal clear corneal incision and in group 2 a superior scleral tunnel incision were prepared. Endothelial cell density was measured preoperatively and 6 months after surgery with a contact specular microscope (Konan®). The results were compared and statistically analysed. RESULTS: Mean endothelial cell loss was 8.1% in group 1 and 3.0% in group 2. Even though relevant differences were found between the 2 groups, in statistical analysis the significance was ‘borderline’ (P < 0.0964). CONCLUSIONS: Even though CCI is a promising surgical technique with high beneficial influence on surgery and postoperative outcome, an increased central endothelial cell loss may be expected after surgery. Because of this fact, in the opinion of the authors, this technique should be avoided in cases with very hard cataracts and/or in cases with low preoperative endothelial cell density. As shown in the literature, when performing a CCI it is advisable to create the incision at the temporal site and not at the superior site which is close to the central corneal region.