Effect of Intracameral Air Injection on Corneal Endothelial Cell Loss After Phacoemulsification for Cataracts of LOCS III Nuclear Grade 4 or Higher: A Randomised Clinical Trial.
Rui Feng, Ruijue Peng, Shiyan Chen et al.
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In 30 seconds
This prospective randomised clinical trial assessed intracameral air injection during phacoemulsification in patients with LOCS III nuclear grade 4 or higher cataracts. Eighty eyes from 80 patients were allocated equally to air injection or conventional surgery. Endothelial cell loss was lower with air injection at both follow-ups: at 1 month, mean loss was 8.15% (SD 3.84%) versus 15.97% (SD 6.11%) (difference, -7.82%; 95% CI, -10.10% to -5.55%; p < 0.001). The air group also had a smaller increase in central corneal thickness at 1 week.
Key findings
- At 1 week, endothelial cell loss was 6.90% (SD 3.23%) with air injection versus 12.81% (SD 6.32%) with conventional surgery (p < 0.001).
- At 1 month, endothelial cell loss was 8.15% (SD 3.84%) versus 15.97% (SD 6.11%), respectively (p < 0.001).
- The increase in central corneal thickness was smaller with air injection at 1 week (p = 0.02).
- At 1 month, follow-up was completed for 34 eyes (85.0%) in the air group and 35 eyes (87.5%) in the control group.
Why it matters
Corneal endothelial cell loss is an important postoperative outcome, particularly in eyes undergoing surgery for dense cataracts. In this randomised trial, intracameral air injection was associated with less endothelial cell loss at both measured time points and a smaller early increase in corneal thickness. These findings add evidence about a potential intraoperative approach to protecting the cornea in this cataract population.
What to keep in mind
The trial was conducted at a single hospital, and only 69 of 80 randomised eyes completed the 1-month follow-up. Follow-up was limited to 1 month.