To evaluate the short-term clinical outcome of cataract surgery using torsional mode phacoemulsification for patients with low endothelial cell density.

Fifty-seven eyes of 52 patients who underwent torsional phacoemulsification and intraocular lens insertion were included in the present study. Patients were divided into groups according to endothelial cell density (ECD). The control group was comprised of patients with more than 2500/mm² of ECD and was compared with the low ECD group (LECD) comprised of patients with less than 1600/mm² of ECD. The LECD group was further divided into a very low ECD group (VLECD) comprised of patients with less than 1000/mm² of ECD, and a PK-VLECD group comprised of patients with less than 1000/mm² of ECD after penetrating keratoplasty. Measurement of ECD, cell-size variation coefficient, hexagonality, and central corneal thickness were performed preoperatively and 1 month after surgery.

The only one patient who had undergone penetrating keratoplasty with remaining low endothelial density and grade 4 nuclear sclerosis developed overt corneal edema after cataract surgery. No statistically significant differences in the change of endothelial cell characteristics and central corneal thickness before and after surgery were observed between the control and LECD group and between the VLECD and PK-VLECD group.

Even in patients with low ECD, torsional phacoemulsification appears to have a similar effect on the short-term change of endothelial cells, suggesting cataract surgery can be conducted with a staged approach when the density of nucleus is moderate or less dense.