The effects of prolonged phacoemulsification time on the corneal endothelium.

The question of whether or not phacoemulsification causes significant corneal endothelial damage has been studied in many ways. In this study, we used videotaped specular microscopy and nitroblue tetrazolium (NBT) staining to assess cell damage under conditions in which the two most commonly blamed sources of damage--probe tip trauma and lens fragments--cannot be implicated. After 15 minutes of irrigation, aspiration, and ultrasound in a modified corneal viewing and storage (CVS) chamber, the four test corneas showed less than 5% cell damage as assessed by NBT staining, which was no more than in the control. In one case, an unexpected air bubble on the endothelium caused a loss of endothelial cells. Because small air bubbles are common during phacoemulsification, and because such air bubbles may represent a cause of endothelial cell loss, the endothelial damage caused by air bubbles during phacoemulsification merits further study.