Comparison of the Contact Lens-Shell Vs the Soft-Shell Technique for Corneal Endothelial Protection during Phacoemulsification in High-Risk Cataracts

Dinesh N Maru*

Purpose: To compare the efficacy of the contact lens-shell technique (CST) and the conventional soft-shell technique (SST) in reducing corneal endothelial cell loss during phacoemulsification in eyes with high-risk cataracts.

Setting: Single private eye care centre, Anand, Gujarat, India.

Design: Prospective, randomized comparative study.

Methods: Forty eyes with high-risk cataracts, including mature cataracts, hard cataracts, small pupils, or shallow anterior chambers, were randomized to undergo phacoemulsification using either the CST (20 eyes) or SST (20 eyes). The CST employed an Etafilcon A hydrogel bandage contact lens as a temporary mechanical endothelial protector, whereas the SST used dispersive and cohesive ophthalmic viscosurgical devices. Uncorrected and corrected distance visual acuity, intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density (ECD), and endothelial cell loss (ECL) were evaluated during postoperative follow-up.

Results: Postoperative visual acuity and central corneal thickness were comparable between the two groups at all follow-up visits (P>.05). On postoperative day 1, mean IOP was significantly lower in the CST group than in the SST group (13.2 ± 2.92 vs 16.06 ± 6.32 mmHg; P=.02). At 1 month, the CST group demonstrated significantly lower endothelial cell loss than the SST group (3.0% ± 5.3% vs 8.8% ± 12.8%; P=.03), despite a longer effective phacoemulsification time.

Conclusion: The contact lens-shell technique was associated with significantly lower endothelial cell loss than the soft-shell technique during phacoemulsification in high-risk cataracts while providing comparable visual and anatomical outcomes. Larger studies with longer follow-up are warranted to confirm these findings.

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Published on: Sep 16, 2026 Pages: 42-47

Full Text PDF Full Text HTML DOI: 10.17352/2455-1414.000115
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