1. Endothelial cell loss after cataract surgery P.Bruttini MD,G.Acerbi MD,L.Vitale MD, M.Sironi. CLINICA S.CARLO PADERNO DUGNANO THE AUTHORS REPORT NO CONFLICT OF INTEREST IN THIS WORK XXX ESCRS CONGRESS MILAN, 8-12 SEPTEMBER 2012

2. THE CURRENT SURGICAL TECHNIQUES TO TREAT CATARACT ARE ASSOCIATED WITH. ENDOTHELIAL CELL LOSS. IN CERTAIN CASES THIS CAN BE A SIGNIFICANT ISSUE.

3. MANY PRESURGICAL AND INTRAOPERATIVE FACTORS COULD INFLUENCE CELLULAR LOSS, WHOSE SINGULAR RELEVANCE CAN SELDOM BE DETERMINED.

4. WE WANTED TO COMPARE THE CELLULAR LOSS WITH A MEASURABLE PARAMETER: CDE

5. CDE (CUMULATIVE DISSIPATED ENERGY) REFLECTS HOW MUCH ENERGY HAS BEEN EXPENDED TO COMPLETE PHACO WHAT IS CDE?

6. Phaco Display with CDE WE CAN EASILY READ THE FINAL CDE QUOTA ON PHACO DISPLAY ALCON INFINITY

7. 2011: we had 1086 cataract patients that underwent surgery 2011: we had 1086 cataract patients that underwent surgery Materials and Methods

8. WE FOCUSED ON THE NUMERICAL DATA OF ENDOTHELIAL CELL DENSITY Materials and Methods

9. Each patient was subjected to a pre-surgical endothelial count with an endothelial microscope Materials and Methods SP02 (CSO)

10. Materials and Methods INCLUSION CRITERIA Post surgery count was taken only for patients coming from our centre

11. Materials and Methods EXCLUSION CRITERIA PATIENTS WITH A PRE-EXISTING ENDOTHELIAL PATHOLOGY WERE EXCLUDED 988 REMAINING PATIENTS

12. 2 Techniques for 2 surgeons PHACO - CHOP (463 patients) Average CDE 6.2 DIVIDE AND CONQUER (525 patients) Average CDE 36.0

13. Average CDE 988 patients

14. 2 Techniques for 2 surgeons Both were made with ALCON INFINITY Vision System

15. IN OUR STUDY WE SELECTED 146 PATIENTS (ABOUT 14,5% OF ALL POPULATION) 61 Phaco Chop 85 Divide and Conquer

16. Patients were divided in 3 groups Group 1 LOWEST CDE LEVELS ( 48 cases : CDE 0.0 -6.13) 98% chop 2% divide and conquer Group 3 HIGHEST CDE LEVELS ( 58 cases:CDE 33.18 - 100.3 ) 3% chop 97% divide and conquer Group 2 : CONTROL (40 cases : CDE 6.13- 33.18) 30% chop 70% divide and conquer

17. RESULTS

18. AVERAGE CELL LOSS IN EACH CDE GROUP 146 PATIENTS

19. after cataract surgery can be very significant, and Endothelial cell loss after cataract surgery can be very significant, and lead to corneal edema CDE SHOULD BE CONSIDERED AS AN IMPORTANT INTRAOPERATIVE PARAMETER (AND VERY EASY TO RECORD!!!)

20. THERE IS JUST A MODERATE CORRELATION BETWEEN CDE AND ENDOTHELIAL CELL LOSS CORRELATION INDEX (0.5325) IS SIGNIFICANTLY DIFFERENT FROM 0 BUT THE RATIO IS NOT A LINEAR ONE. In our 146 cases:

21. OUR STATISTIC ANALYSIS DOES NOT ALLOW US TO CATEGORICALLY STATE THAT THERE IS A DANGEROUS UPPER CDE LEVEL BEYOND WHICH CORNEAL EDEMA APPEARS

22. TAKE HOME MESSAGE CDE IS USEFUL CDE IS USEFUL BUT WE CANNOT STRESS THE IMPORTANCE OF THIS PARAMETER!

23. Thank you