Materials-Methods: In this prospective and comparative study, participants were categorized into two groups based on cataract severity: Group 1 had dense cataracts and Group 2 had moderate cataracts. The best visual acuity, endothelial cell density (ECD), hexagonality (HEX), coefficient of variation (CV), anterior chamber volume (ACV), central corneal thickness (CCT), and corneal densitometry (CD) were evaluated before and 1 month after phacoemulsification. The mean cumulative dissipated energy (CDE), total fluid aspirated (TFA), and effective phacoemulsification time (EPT) were recorded.

Results: One hundred and three eyes (group 1, 50 eyes; group 2, 53 eyes) were included in the study. CDE, TFA, and EPT were significantly higher in group 1 (p = 0.0001). At postoperative 1 month, mean endothelial cell loss was 46.5% in dense cataracts and 28.6% in moderate cataracts (p<0.0001, 1396±609 cells/mm2 and 1868.7± 551.6 cells/mm2, respectively). The changes in HEX and CCT were significantly greater in dense cataracts after phacoemulsification (p =0.008 and p= 0.0001, respectively). The change in HEX was positively correlated with TFA in group 1 (p = 0.03). Despite these findings, there were no significant differences in the CD values between the two groups.

Conclusion: Dense cataracts undergoing phacoemulsification showed endothelial cell loss and disruptions in HEX. Despite these endothelial changes, CD remained stable postoperatively, suggesting that current phacoemulsification techniques can achieve corneal clarity comparable to that of early stage cataract surgeries in cases with dense cataracts. Keywords : dense cataract, phacoemulsification, cumulative dissipated energy, total fluid aspirated, endothelial cell loss, corneal densitometry, hexagonality