Effect of hypothermic perfusion on phacoemulsification in eyes with hard nuclear cataract: randomized trial

J Cataract Refract Surg. 2019 Dec;45(12):1717-1724. doi: 10.1016/j.jcrs.2019.07.029.


Purpose: To evaluate the effectiveness and safety of hypothermic perfusion in the phacoemulsification of hard nuclear cataract.

Setting: Tertiary opthalmology center, China.

Design: Laboratory study and prospective randomized clinical trial.

Methods: Rabbits and patients with hard nuclear cataract underwent phacoemulsification with perfusion temperatures at 4°C or 24°C. Anterior segment optical coherence tomography (AS-OCT), corneal endothelial cell count (ECC), and cornea sections were observed before the rabbits' operation and 1 day and 7 days postoperatively. AS-OCT, corneal ECC, and anterior chamber (AC) inflammation were observed before the patients' operation and 1 day, 7 days, and 30 days postoperatively.

Results: The study comprised 40 rabbits and 80 patients. In the animal models, the mean central corneal thickness (CCT) in the 4°C group (370.4 μm ± 45.5 [SD]) was thinner than in the 24°C group (496.7 ± 121.5 μm) 1 day postoperatively (P < .001). The mean AC inflammation reaction grade in the 4°C group (1.1 ± 0.9) was lower than in the 24°C group (2.2 ± 0.8) (P = .0333). In clinical trials, the mean CCT and incisional corneal thicknesses in the 4°C group (600.7 ± 51.8 μm and 859.2 ± 177.8 μm, respectively) were thinner than in the 24°C group (655.3 ± 85.0 μm and 955.9 ± 196.7 μm, respectively) (P < .001). The endothelial cell density (P = .036) and hexagonality (P = .001) were higher in the 4°C group. The mean AC inflammation reaction grade in the 4°C group (0.6 ± 0.6) was lower than in the 24°C group (1.3 ± 1.0) 1 day postoperatively (P = .004).

Conclusions: Hypothermic perfusion in phacoemulsification of hard nuclear cataract is safe and it can effectively protect corneal endothelium, decrease corneal edema, and reduce AC inflammation in the early postoperative stage.

Publication types

  • Randomized Controlled Trial, Veterinary
  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Animals
  • Cataract / diagnosis
  • Cataract / therapy*
  • Disease Models, Animal
  • Endothelium, Corneal / pathology
  • Female
  • Hypothermia, Induced / methods*
  • Lens Implantation, Intraocular
  • Male
  • Perfusion / methods*
  • Phacoemulsification / methods*
  • Prospective Studies
  • Rabbits
  • Tomography, Optical Coherence / methods

Supplementary concepts

  • Cataract, zonular