Using continuous intraoperative optical coherence tomography to classify swirling lens fragments during cataract surgery and to predict their impact on corneal endothelial cell damage

PURPOSE: To quantify and classify swirling lens fragments during cataract surgery and record their impact on the corneal endothelium using continuous intraoperative optical coherence tomography (OCT). SETTING: Vienna Institute for Ocular Surgery, Hanusch Hospital, Vienna, Austria. DESIGN: Prospective case series. METHODS: Patients scheduled for cataract surgery without other ophthalmologic comorbidities were included. During surgery, continuous OCT recordings were performed to measure and score swirling lens fragments that came into contact with the corneal endothelium. Endothelial cell density (ECD) was measured preoperatively and 1 month postoperatively. In addition, the central corneal thickness and aqueous flare were measured preoperatively and 1 hour, 1 day, and 1 month postoperatively. RESULTS: Continuous intraoperative OCT video recordings showed 104 swirling lens fragments in 40 eyes that came into contact with the corneal endothelium. A mean of 2.6 lens fragments (range 0 to 6) that came into contact were observed per eye. Small fragments and fragments touching the center of the endothelium had a significantly greater effect on postoperative ECD than other fragment parameters. The predictive power of the fragment score on ECD was found to be moderate (r(2) = 0.6). CONCLUSIONS: Small swirling lens fragments touching the center of the corneal endothelium had a significant influence on ECD. With the newly developed fragment score, it was possible to predict the operative endothelial cell loss. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.