{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T14:12:06Z","timestamp":1778595126118,"version":"3.51.4"},"reference-count":48,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Corneal endothelial damage remains a key concern following phacoemulsification. This study aimed to quantify early postoperative changes in endothelial cell density metrics after cataract surgery in a Romanian population and to identify preoperative and intraoperative predictors of endothelial cell loss at 1 week and 1 month postoperatively. Methods: We conducted a retrospective observational study of 137 eyes that underwent standard phacoemulsification with intraocular lens implantation at Ocularcare Ophthalmology Hospital in Bucharest, Romania. Preoperative data included age, sex, and biometric parameters: anterior chamber depth (ACD), axial length (AL), and central corneal thickness (CCT). Corneal endothelium was assessed by specular microscopy preoperatively and at 1 week and 1 month postoperatively, with measurements of endothelial cell density (CD), number of analyzed cells (No), average cell size (ACS), minimum and maximum cell size (MinCS, MaxCS), and cell size variability (SD). Intraoperative parameters included average ultrasound energy (AVE) and actual phacoemulsification time (APT). Associations between demographic, biometric, and surgical variables and postoperative endothelial changes were analyzed using univariable and multivariable regression models. Results: In 137 eyes, mean CD decreased from 2401.99 \u00b1 342.57 cells\/mm2 preoperatively to 2144.38 \u00b1 449.92 at 1 week and 2053.15 \u00b1 471.13 at 1 month. CCT increased from 534.64 \u00b1 38.01 \u00b5m to 548.70 \u00b1 41.34 \u00b5m at 1 week and remained higher than baseline at 1 month (545.67 \u00b1 42.91 \u00b5m). Endothelial remodeling was reflected by significant increases in ACS, MaxCS, and SD, while No and MinCS showed no significant change. In adjusted models, lower postoperative CD was independently associated with shallower ACD and lower baseline CD at both timepoints, whereas higher AVE was associated with lower postoperative CD at 1 week but not at 1 month; sex was not independently associated with postoperative CD. Conclusions: In this Romanian cohort, phacoemulsification was associated with significant early endothelial cell loss measurable within the first postoperative month. The magnitude of CD reduction was influenced by both baseline patient ocular characteristics (ACD) and intraoperative phacoemulsification parameters, particularly ultrasound energy (AVE). These findings support the incorporation of preoperative biometric assessment and intraoperative ultrasound minimization strategies to reduce endothelial risk.<\/jats:p>","DOI":"10.3390\/diagnostics16101468","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T12:33:37Z","timestamp":1778589217000},"page":"1468","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endothelial Cell Loss After Phacoemulsification in a Romanian Cohort: Early Outcomes and Associated Risk Factors"],"prefix":"10.3390","volume":"16","author":[{"given":"Aurelian Mihai","family":"Ghi\u021b\u0103","sequence":"first","affiliation":[{"name":"Physiology Department, Carol Davila University of Medicine and Pharmacy, Bd. Eroii Sanitari No. 8, 050474 Bucharest, Romania"},{"name":"Ophthalmology Department, Bucharest University Emergency Hospital, Splaiul Independen\u021bei No. 169, 050474 Bucharest, Romania"},{"name":"Ocularcare Ophthalmology Clinic, Bd. Ion Mihalache No. 128, 012244 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela Adriana","family":"Iliescu","sequence":"additional","affiliation":[{"name":"Physiology Department, Carol Davila University of Medicine and Pharmacy, Bd. Eroii Sanitari No. 8, 050474 Bucharest, Romania"},{"name":"Ocularcare Ophthalmology Clinic, Bd. Ion Mihalache No. 128, 012244 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Larisa Adriana","family":"Ilie","sequence":"additional","affiliation":[{"name":"Ocularcare Ophthalmology Clinic, Bd. Ion Mihalache No. 128, 012244 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Cristina","family":"Ghi\u021b\u0103","sequence":"additional","affiliation":[{"name":"Ocularcare Ophthalmology Clinic, Bd. Ion Mihalache No. 128, 012244 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Sato, T. (2025). Corneal Endothelial Cell Loss in Shallow Anterior Chamber Eyes After Phacoemulsification Using the Eight-Chop Technique. J. Clin. Med., 14.","DOI":"10.20944\/preprints202501.1876.v1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.aopr.2024.08.002","article-title":"Research Progress on the Impact of Cataract Surgery on Corneal Endothelial Cells","volume":"4","author":"Yang","year":"2024","journal-title":"Adv. Ophthalmol. Pract. 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