Long-term corneal endothelial cell loss after cataract surgery. Results of a randomized controlled trial. Oxford Cataract Treatment and Evaluation Team (OCTET)

Three hundred thirty-three eyes were randomly assigned to three treatments for cataract: group A, intracapsular extraction plus contact lens; group B, intracapsular extraction plus Federov implant (Federov I lenses were made by Rayners Ltd, United Kingdom, based on a design by Professor Fyodorov); and group C, extracapsular extraction plus iridocapsular implant. Endothelial cell loss estimated at one and six months and yearly up to four years showed significantly greater loss in the two implant groups from one year onward. Continuing loss slowed down after the third year, except for the intracapsular extraction plus implant group, in which cell loss appeared complication related. Of operative factors, use of alpha-chymotrypsin significantly reduced cell loss, and pseudophakos contact increased cell loss. Postoperative complications associated with significantly greater cell loss were hypopyon, uveitis, subluxation, shallow anterior chamber, and cystoid macular edema. To date, five and four cases of bullous keratopathy were derived from implant groups B and C, respectively.