Original articleEffect of cataract surgery on the corneal endothelium: Modern phacoemulsification compared with extracapsular cataract surgery☆
Section snippets
Materials and methods
The clinical work for this prospective study was conducted in 2 centers (Moorfields Eye Hospital, London and the Oxford Eye Hospital) over a period of 4 years (1994–1998). The randomization procedure, sample size estimation, and methodology have been described in full elsewhere,1 and hence will be described briefly. Approval was obtained from ethics committees at both centers. All consenting patients with age-related cataracts admitted for surgery at these centers were potentially eligible. The
Results
Of the 439 patients who completed the trial and had the final follow-up at 1 year postoperatively, 433 (99%) had complete data on corneal endothelial cell count before surgery and over the 1-year postoperative follow-up period. The profile of these patients is shown in Table 1. The initial preoperative mean cell count for the entire sample was 2481 (standard error [SE]: 18.6), reduced at 1 year postoperatively to 2239 (SE: 23.5). Figure 1 depicts the change in cell count over the follow-up
Demographics and study design
The design of this study had several important strengths. The study design (randomized controlled trial) and the large number of subjects (relative to other studies) recruited with similar numbers in each of the treatment groups lend considerable statistical power to the findings. These factors, in addition to high response rates at follow-up periods, have been noted to be important in such endothelial cell studies comparing cataract surgery techniques, where it is important to identify the
Acknowledgements
The authors are grateful for the input of Moorfields Eye Hospital NHS Trust, The Oxford Eye Hospital NHS Trust, and the Southampton Universities Hospitals Trust. In particular, they thank the ophthalmologists Professor T. Bron, Hung Cheng, L. Ficker, S. Tuft, J. Stevens, E. Craig, T. Gray, R. Aggarwal, A. Steele, R. Daniel, and Sister J. Morrin. The authors also thank K. Buckingham and J. Roberts for advice on economic methods, and Isabel Moldon and Lynda Lindsell, who managed the trial at the
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This study was funded by a project grant from the Medical Research Council, United Kingdom. Allergan, Alcon, and Bausch & Lomb donated intraocular lenses and materials.