Effect of two anterior capsulotomy techniques on the corneal endothelium

We performed a prospective, randomized, clinical study to assess the effect of two anterior capsulotomy techniques on the corneal endothelium. Specular microscopy was done preoperatively and postoperatively in 57 patients having manual extracapsular cataract surgery with a can-opener capsulotomy or with a retained anterior capsule flap. The mean percentage of cell loss following the can-opener capsulotomy was 0.43 (P = .22). There was no statistically significant alteration in endothelial morphology after surgery. The cell loss with a retained anterior capsule flap was zero. However, there was a statistically significant difference in polymegathism (P = .024) and pleomorphism (P = .045) after surgery. A comparison of the two techniques showed no statistically significant difference in cell loss or in pleomorphism. The statistically significant difference in polymegathism (P = .01) was not clinically significant. Our findings indicate that, when carefully performed, both methods of anterior capsulotomy for manual extracapsular cataract surgery are safe for the corneal endothelium.