Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2019; 7(5): 642-649
Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.642
Perioperative topical ascorbic acid for the prevention of phacoemulsification-related corneal endothelial damage: Two case reports and review of literature
Chia-Yi Lee, Hung-Ta Chen, Yi-Jen Hsueh, Hung-Chi Chen, Chieh-Cheng Huang, Yaa-Jyuhn James Meir, Chao-Min Cheng, Wei-Chi Wu
Chia-Yi Lee, Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 50093, Taiwan
Chia-Yi Lee, Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan 71241, Taiwan
Hung-Ta Chen, Department of Internal Medicine, Taipei City Hospital- Heping Branch, Taipei 10341, Taiwan
Yi-Jen Hsueh, Hung-Chi Chen, Wei-Chi Wu, Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 20012, Taiwan
Yi-Jen Hsueh, Hung-Chi Chen, Chieh-Cheng Huang, Chao-Min Cheng, Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 20012, Taiwan
Hung-Chi Chen, Wei-Chi Wu, Department of Medicine, College of Medicine Chang Gung University, Taoyuan 33305, Taiwan
Chieh-Cheng Huang, Chao-Min Cheng, Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30010, Taiwan
Yaa-Jyuhn James Meir, Department of Biomedical Sciences, College of Medicine Chang Gung University, Taoyuan 33305, Taiwan
Author contributions: Lee CY and Chen HT contributed equally to this work. All authors gave approval of the final version.
Supported by the Chang Gung Memorial Hospital, No. CMRPG3F1471~2 and No. CMRPG3G0031~3; the Ministry of Science and Technology No. MOST 106-2314-B-182A-042-34 and No. MOST 107-2314-B-182A-088-MY3.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2013), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hung-Chi Chen, MD, PhD, Attending Ophthalmologist, Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
Telephone: +886-3-3281200 Fax: +886-3-3287798
Received: November 17, 2018
Peer-review started: November 19, 2018
First decision: December 29, 2018
Revised: January 16, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: March 6, 2019

The current case report describes successful phacoemulsification with the aid of perioperative topical ascorbic acid (AA) in two patients with corneal endothelial disorders to prevent postoperative corneal endothelial decompensation.


Two eyes of two patients underwent phacoemulsification with pre-existing corneal endothelial disorders including Fuchs corneal endothelial dystrophy (Patient 1) and endotheliitis (Patient 2). Topical AA was applied to both patients at least one month before and after with a frequency of four times per day. After the surgery, both eyes improved best-corrected visual acuity (BCVA) and there was limited human corneal endothelial cell loss without signs of corneal endothelial decompensation, such as deteriorated BCVA or persistent corneal edema during the follow-up of at least two years.


Perioperative administration of topical AA may be an alternative therapy to the triple procedure in patients expecting to undergo cataract surgery.

Keywords: Ascorbic acid, Fuchs corneal endothelial dystrophy, Endotheliitis, Human corneal endothelial cell, Phacoemulsification, Case report

Core tip: Perioperative topical ascorbic acid (AA) was instilled in two patients with low corneal endothelial cell density who were scheduled for cataract surgery. After the surgery, both patients showed improved visual acuity without corneal decompensation. Perioperative topical AA is promising for prevention of corneal endothelial dysfunction in high-risk patients undergoing phacoemulsification; it may be considered as an alternative therapy.