Scanning electron microscopy of the endothelial lesion produced by air bubbles during phacoemulsification with various viscoelastics in human

Purpose. To investigate the corneal endothelial lesion by the air bubbles during phacoemulsification (phaco) in human. Methods. Phaco was performed on fresh human eye bank eyes for l min with phaco power 90% and bottle height 80cm with Healon, Healon GV, Viscoat or BSS Plus. Corneas were resected immediately after phaco and fixed in glutaraldehyde. Tissues were processed for scanning EM. Results. Many air bubbles were generated from the phaco tip and touched the corneal endothelium with Healon, Healon GV and BSS Plus groups. The air bubbles were captured in viscoelastic material in Viscoat group. Many circular lesions with loss of endothelial cells were found in the Healon, Healon GV or BSS Plus groups. In the Viscoat group, the endothelial cells were intact with many granules coating them. Conclusions. Human endothelial cells can be disrupted by the air bubbles during phaco. Some viscoelastics protected endothelial damage from the air bubbles while others did not. Further efforts to reduce the bubble generation during phaco procedure are needed to assure complete endothelial cell protection.