Cataract extraction and the corneal endothelium.

We examined and photographed the central corneal endothelium of 16 patients with the clinical specular microscope before and at intervals after cataract extraction. No detectable loss of the endothelial cells occurred in 75% of the patients, including 12 routine intracapsular cryoextractions and four phacoemulsifications of soft cataracts in young adults. Only one of the four cases of significant endothelial cell loss occurred in a normal cornea without demonstrable operative or postoperative complications. Two of the four corneas that lost central endothelial cells at cataract extraction continued to lose more cells during the ensuing weeks. A significant increase in central endothelial cell density was demonstrated in one patient. The four corneas with endothelial cell loss also had a significantly higher mean increase in corneal thickness postoperatively, although this was transient. All 16 corneas remained clear during the period of observation (maximum, 14 weeks), and long-term studies are needed to measure the chronic effects of the endothelial damage.