Toxic endothelial cell destruction of the cornea after routine extracapsular cataract surgery
A. C. Breebaart, R. M. Nuyts, E. Pels, H. F. Edelhauser and F. D. Verbraak
Department of Ophthalmology, University of Amsterdam, The Netherlands.
Eighteen patients developed an acute corneal decompensation following
normal intraocular surgery (cataract extraction in 17 patients),
characterized by star-shaped endothelial folds, a twofold increase in
corneal thickness, and a visual acuity of counting fingers during several
postoperative days. In some cases, there was an additional iritis and
transient hypotony. There was no effect of topical and/or subconjunctival
corticosteroids on the course of the decompensation. Endothelial
morphometric analysis showed a mean endothelial cell loss of 72%.
Endothelial wound healing, as determined by coefficient of variation and
percentage hexagonals, stabilized 6 months postoperatively. We coined the
term toxic endothelial cell destruction for this syndrome. Epidemiological
evaluation revealed the toxic endothelial cell destruction syndrome to be
linked with the 10-fold increase of a detergent solution in the ultrasonic
bath for cleaning the surgical instruments.
