Effect of Intracameral Epinephrine and Indocyanine Green Use on Corneal Endothelium during Cataract Surgery

Purpose: To investigate the safety of single and combined use of epinephrine and indocyanine green during cataract surgery by evaluating the effects on corneal endothelial cells. Methods: From January 2017 to October 2021, 121 patients (132 eyes) who underwent cataract surgery were enrolled. Patients were divided into 4 groups: epinephrine (n = 20), indocyanine green (n = 49), epinephrine and indocyanine green combination (n = 12), and control (n = 51). Retrospective medical chart findings and endothelial cell count change data were compared among study groups before and after operation. Results: Endothelial cell count change (oECC) decreased for all groups; however, a significant difference among groups was not observed (p = 0.822). Univariate linear regression showed that oECC was associated with postoperative hexagonality, nuclear sclerosis grade, ultrasound time, and cumulative dissipated energy (beta =-0.216, 0.254, 0.368, 0.351 and p = 0.013, p = 0.003, p < 0.001, p < 0.001). Multivariate linear regression showed that oECC was associated with postoperative hexagonality and ultrasound time (beta =-0.215, 0.367, p = 0.010, p < 0.001). Conclusions: Factors closely associated with postoperative endothelial cell loss were postoperative hexagonality and ultrasound time. No significant damage to the corneal endothelium was observed when epinephrine and indocyanine green were used alone or in combination. Thus, these agents appear safe for use in this context.