Comparison of endothelial cell density by specular photomicroscopy of the right and left eyes after single eye surgery shows a similar reduction in endothelial cell density to that recorded between pre- and postoperative photographs in the operated eye. A review of 43 single-eye cataract extractions, with and without placement of a prepupillary intraocular lens, confirms that the major cause of endothelial cell loss is operative trauma to the endothelium. In our experience a cataract extraction with lens implantation but without endothelial contact produces no greater reduction in cell density than the cataract extraction alone.
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