{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:36:27Z","timestamp":1792020987871,"version":"4.4.0"},"reference-count":117,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Identifying pre\/perioperative factors that predict corneal endothelial-cell loss (ECL) after phacoemulsification may reveal ways to reduce ECL. Our literature analysis showed that 37 studies have investigated one or several such factors but all have significant limitations. Therefore, the data of a large randomized controlled trial (PERCEPOLIS) were subjected to post-hoc multivariate analysis determining the ability of nine pre\/perioperative variables to predict ECL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PERCEPOLIS was conducted in 2015\u20132016 to compare two phacoemulsification techniques (subluxation and divide-and-conquer) in terms of 3-month ECL. Non-inferiority between the techniques was found. In the present study, post-hoc univariate and multivariate analyses were conducted to determine associations between ECL and age, sex, cataract density, preoperative endothelial-cell density, phacoemulsification technique, effective phaco time (EPT), and 2-hour central-corneal thickness. The data are presented in the context of a narrative review of the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three-month data were available for 275 patients (94% of the randomized cohort; mean age, 74 years; 58% women). Mean LOCSIII cataract grade was 3.2. Mean EPT was 6 seconds. Mean ECL was 13%. Only an older age (beta = 0.2%, p = 0.049) and higher EPT (beta = 1.2%, p = 0.0002) predicted 3-month ECL. Cataract density was significant on univariate (p = 0.04) but not multivariate analysis. The other variables did not associate with ECL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Older age may amplify ECL due to increased endothelial cell fragility. EPT may promote ECL\n                      <jats:italic>via<\/jats:italic>\n                      cataract density-dependent and -independent mechanisms that should be considered in future phacoemulsification research aiming to reduce ECL. Our literature analysis showed that the average ECL for relatively unselected consecutively-sampled cohorts is 12%.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0298795","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T13:46:16Z","timestamp":1711028776000},"page":"e0298795","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1427-7567","authenticated-orcid":true,"given":"Jean-Marc","family":"Perone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Soline","family":"Luc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinka","family":"Zevering","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Charles","family":"Vermion","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Gan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8381-2607","authenticated-orcid":true,"given":"Christophe","family":"Goetz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"pone.0298795.ref001","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1097\/01.ico.0000214225.98366.83","article-title":"Pseudophakic corneal edema: A review of mechanisms and treatments","volume":"25","author":"R Narayanan","year":"2006","journal-title":"Cornea"},{"key":"pone.0298795.ref002","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1167\/iovs.02-0892","article-title":"Antioxidant protection against corneal damage by free radicals during phacoemulsification","volume":"44","author":"A Rubowitz","year":"2003","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0298795.ref003","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1076\/soph.17.3.110.14783","article-title":"Corneal edema after cataract surgery: Incidence and etiology","volume":"17","author":"DH Yi","year":"2002","journal-title":"Semin Ophthalmol"},{"key":"pone.0298795.ref004","doi-asserted-by":"crossref","first-page":"90","DOI":"10.22336\/rjo.2017.17","article-title":"Pseudophakic bullous keratopathy","volume":"61","author":"S Pricopie","year":"2017","journal-title":"Rom J Ophthalmol"},{"key":"pone.0298795.ref005","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.survophthal.2017.07.004","article-title":"A review of the evidence for in vivo corneal endothelial regeneration","volume":"63","author":"B Van den Bogerd","year":"2018","journal-title":"Surv Ophthalmol"},{"key":"pone.0298795.ref006","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3928\/1081-597X-19930101-08","article-title":"Long-term endothelial cell loss following phacoemulsification: model for evaluating endothelial damage after intraocular surgery","volume":"9","author":"TP Werblin","year":"1993","journal-title":"Refract Corneal Surg"},{"key":"pone.0298795.ref007","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.4103\/ijo.IJO_871_17","article-title":"Corneal edema after phacoemulsification","author":"N Sharma","year":"2017","journal-title":"Indian Journal of Ophthalmology"},{"key":"pone.0298795.ref008","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1016\/j.jcrs.2010.06.060","article-title":"Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification.","volume":"36","author":"A Reuschel","year":"2010","journal-title":"J Cataract Refract Surg"},{"key":"pone.0298795.ref009","first-page":"17","article-title":"2020: the Cataract Challenge","volume":"13","author":"Foster A. 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