Authors' objectives: The corneal endothelium is a single-cell layer that lines the posterior surface of the cornea. It is involved in keeping the cornea clear. Any injury to this layer results in a decrease of the number of cells, and cataract surgery too inevitably induces a ‑ limited ‑ decrease in the number of corneal endothelial cells. Although advances in cataract surgery have made it possible to limit endothelial cell injury, there are several conditions in which endothelial cell loss can negatively impact the post-operative visual outcome due to the loss of corneal transparency. Corneal endothelial cell counting through specular microscopy is a diagnostic procedure which allows the ophthalmologist to examine the structure of the cornea to identify any diseases or follow up postoperative processes. It can for instance be performed before deciding to proceed with a cataract operation. The number of endothelial cell countings before a cataract surgery has considerably increased over the past few years in Belgium. This study consists of a systematic review of the literature on the clinical and cost-effectiveness impacts of corneal endothelial cell counting before cataract surgery. A description of the organisational and financial aspects of the use of endothelial cell counting in Belgium – and in a selection of neighbouring countries – will be provided. Based on the findings, the recommendations of this study should help policymakers to optimise the use and reimbursement of endothelial cell counting in the setting of cataract surgery.

Authors' results and conclusions: In Belgium, specular microscopy is a widely available diagnostic tool for ophthalmologists. Although it is not recommended by international guidelines, except in infrequent situations, its application in Belgium is much higher than in other European countries explored in our analysis. Although well established in the Belgian clinical practice, likely driven by the intention to improve the quality of corneal disease screening, and overall surgical management, its widespread use is not supported by scientific evidence, as demonstrated in our systematic reviews of the literature. Additionally, it cannot be denied that these practices are associated with notable and increasing expenditure. Consequently, it is challenging to justify the extensive use of this test. Therefore, if its continued application is intended, it will be necessary to conduct further studies to substantiate its contribution in cataract surgery.

Authors' identified further research: Considering the very good visual outcomes and the rarity of corneal complications after surgery, further research should not only examine potential complications, but also explore, through well-designed studies, the value that specular microscopy could have on the management of the surgery and on different outcomes such as long-term visual acuity or refractive results, for instance.

Project Status: Completed

URL for project: https://kce.fgov.be/en/publications/all-reports/the-use-of-endothelial-cell-count-in-the-preoperative-evaluation-of-cataract-surgery

Year Published: 2024

URL for published report: https://doi.org/10.57598/R390C

URL for additional information: https://kce.fgov.be/en/publications/all-reports/the-use-of-endothelial-cell-count-in-the-preoperative-evaluation-of-cataract-surgery

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Belgium

DOI: 10.57598/R390C

Organisation Name: Belgian Health Care Knowledge Centre

Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85

Contact Name: info@kce.fgov.be

Contact Email: info@kce.fgov.be

Copyright: <p>Belgian Health Care Knowledge Centre (KCE)</p>