Efficacy of topical glycerin in the management of post-phacoemulsification corneal edema and striations

Palash Barua; Nazmun Nahar; Kaniz Ahmed Shahnaz

doi:10.18203/2320-6012.ijrms20264157

Authors

Palash Barua Department of Ophthalmology, Medical College for Women and Hospital, Dhaka, Bangladesh
Nazmun Nahar Department of Ophthalmology, Medical College for Women and Hospital, Dhaka, Bangladesh
Kaniz Ahmed Shahnaz Department of Ophthalmology, Medical College for Women and Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20264157

Keywords:

Corneal clarity, Corneal edema, Descemet's membrane striations, Phacoemulsification, Topical glycerin

Abstract

Background: Corneal edema and Descemet’s membrane striations are common early complications after phacoemulsification that may delay visual recovery. As hypertonic saline/NaCl may have limited or delayed effects in marked postoperative corneal edema, topical glycerin may serve as a useful hyperosmotic alternative. This study assessed the effectiveness of topical glycerin in post-phacoemulsification corneal edema and striations.

Methods: This prospective observational study was conducted at Medical College for Women and Hospital, Dhaka, Bangladesh and Maleka Eye Hospital, Faridpur, Bangladesh, from January 2024 to February 2026. Sixty patients with corneal edema and Descemet’s membrane striations on postoperative day 1 after phacoemulsification with posterior chamber intraocular lens implantation received topical glycerin and were followed on days 7 and 21. Visual acuity, corneal clarity and the severity of corneal edema and striations were assessed. Data were analyzed using SPSS version 26.

Results: Most patients were aged 60–69 years (41.7%). At baseline, moderate corneal edema and moderate Descemet’s membrane striations were present in 51.7% and 48.3% of patients, respectively. Progressive improvement occurred during follow-up. By day 21, complete resolution was achieved in 63.3% of patients, while 73.3% attained normal to mildly impaired visual acuity (6/6–6/12). Overall, 83.3% responded positively. Diabetes mellitus (p=0.041), grade IV cataract, prolonged surgical time, high phaco energy exposure and severe baseline edema or striations were significantly associated with delayed or incomplete response.

Conclusions: Topical glycerin effectively improved postoperative corneal edema and Descemet’s membrane striations after phacoemulsification, with most patients achieving good recovery within 2 weeks.

References

Yamazoe K, Yamaguchi T, Hotta K, Satake Y, Konomi K, Den S, et al. Outcomes of cataract surgery in eyes with a low corneal endothelial cell density. J Cat Refract Surg. 2011;37(12):2130-6.

Leal Jr SM, Rodino KG, Fowler WC, Gilligan PH. Practical guidance for clinical microbiology laboratories: diagnosis of ocular infections. Clin Microbiol Rev. 2021;34(3):10-128.

Yang Y, Chai H, Ding Z, Tang C, Liang Y, Li Y, et al. Meta-analysis of corneal endothelial changes after phacoemulsification in diabetic and non-diabetic patients. BMC Ophthalmol. 2023;23(1):174.

Bhattacharyya N, Chai N, Hafford-Tear NJ, Sadan AN, Szabo A, Zarouchlioti C, et al. Deciphering novel TCF4-driven mechanisms underlying a common triplet repeat expansion-mediated disease. PLoS Genetics. 2024;20(5):1011230.

Kausar A, Farooq S, Akhter W, Akhtar N. Transient corneal edema after phacoemulsification. J Coll Physicians Surg Pak. 2015;25(7):505-9.

Ziomek J, Oszczędłowski P, Chorągiewicz T, Dolar-Szczasny J, Słoka A, Denysiuk O, et al. Postoperative management of the patient’s post-surgical corneal edema. Ophthalmol J. 2025;10:145-50.

Fang CE, Mathew RG, Khaw PT, Henein C. Corneal endothelial cell density loss after glaucoma surgery alone or in combination with cataract surgery: a systematic review and meta-analysis. Ophthalmology. 2022;129(8):841-55.

Zhao M, Sun Q, Oatts J, Hu G, Ge L, Zhu B, et al. Changes in intraocular pressure and angle structure after dilation in primary angle-closure suspects with visually significant cataract. Ophthalmology. 2021;128(1):39-47.

Agrawal S, Gupta S, Gupta N, Vanathi M, Tandon R. Efficacy of hypertonic saline in treatment of corneal edema: A randomized crossover trial. Medical Journal Armed Forces India. 2024;80(5):522-7.

Surico PL, Parmar UP, Sun CC, Lanzetta P. Sustainability in cataract and refractive surgery: current challenges and future perspectives. J Ophthalmol. 2025;20(1):4632626.

Kaur M, Bhai N, Titiyal JS. Risk factors for complications during phacoemulsification cataract surgery. Expert Rev Ophthalmol. 2020;15(5):303-12.

Bourne RR, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al. Magnitude, temporal trends and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Global Health. 2017;5(9):888-97.

Khanna RC, Marmamula S, Krishnaiah S, Giridhar P, Chakrabarti S, Rao GN. Changing trends in the prevalence of blindness and visual impairment in a rural district of India: systematic observations over a decade. Indian J Ophthalmol. 2012;1;60(5):492-7.

Mencucci R, Ponchietti C, Virgili G, Giansanti F, Menchini U. Corneal endothelial damage after cataract surgery: microincision versus standard technique. J Cataract Refract Surg. 2006;32(8):1351-4.

Kaur G, Khurana AK, Chawla U, Dahiya M. A comparative study of divide and conquer, stop and chop and phaco chop techniques of nucleotomy in phacoemulsification. Indian J Clin Exp Ophthalmol. 2021;7(3):471-6.

Perone JM, Boiche M, Lhuillier L, Ameloot F, Premy S, Jeancolas AL, et al. Correlation between postoperative central corneal thickness and endothelial damage after cataract surgery by phacoemulsification. Cornea. 2018;37(5):587-90.

Mayer WJ, Klaproth OK, Hengerer FH, Kohnen T. Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery. American J Ophthalmol. 2014;157(2):426-32.

Zhao H, He Y, Ren YR, Chen BH. Corneal alteration and pathogenesis in diabetes mellitus. Int J Ophthalmology. 2019;12(12):1939.

Hugod M, Storr-Paulsen A, Norregaard JC, Nicolini J, Larsen AB, Thulesen J. Corneal endothelial cell changes associated with cataract surgery in patients with type 2 diabetes mellitus. Cornea. 2011;30(7):749-53.

Gao Y, Yang N, Wei L, Yan Y, Li L. Relationship between postoperative oxidative stress levels and corneal endothelial cell loss after phacoemulsification in diabetic patients with cataract. Clin Ophth. 2024;31:3957-65.

Zander DB, Böhringer D, Fritz M, Grewing V, Maier PC, Lapp T, et al. Hyperosmolar eye drops for diurnal corneal edema in Fuchs’ endothelial dystrophy: a double-masked, randomized controlled trial. Ophthalmology. 2021;128(11):1527-33.

Zhou Q, Yang L, Wang Q, Li Y, Wei C, Xie L. Mechanistic investigations of diabetic ocular surface diseases. Front Endocrinol. 2022;13:1079541.

Sekhon AS, He B, Iovieno A, Yeung SN. Pathophysiology of corneal endothelial cell loss in dry eye disease and other inflammatory ocular disorders. Ocular Immunol Inflammation. 202;31(1):21-31.

Gonzalez-Cortes JH, Martinez-Pacheco VA, Gonzalez-Cantu JE, Bilgic A, De Ribot FM, Sudhalkar A, et al. Current treatments and innovations in diabetic retinopathy and diabetic macular edema. Pharmaceutics. 2022;15(1):122.