Materials and Methods: In this prospective, randomized controlled clinical study, 120 participants presenting with cataracts were divided into six equal groups (nuclear opacity 1 to 6; NO1, NO2, NO3, NO4, NO5, NO6) according to Lens opacity classification system (LOCS) III. Total ultrasound time (UST), phaco time (PT), torsion time (TT), percent of total equivalent phaco power at position 3 (3PTEFG%), cumulative energy use (CDE), and balanced salt solution (BSS) volume measurements were recorded. Postoperative clear corneal incision (CCI) morphology by anterior segment OCT and endothelial cell loss (ECL) were evaluated.

Results: Intraoperative UST, PT, TT, CDE, and 3PTEFG% and BSS data showed statistically significant differences in each group (P<0.001). At the postoperative 3rd month, ECL was higher in high-density cataracts as 9.1% in the NO1 group and 53.4% in the NO6 group, and there was a statistically significant difference between all groups (P<0.001). Descemet?s membrane detachment on postoperative day 1 was statistically significantly higher in the high-density cataract groups (P:0.028).

Conclusion: As the density of nuclear cataracts increases, the energy used, the amount of BSS volume, and corneal damage increase. While damage occurred in all layers in CCI morphology, Descemet?s membrane was found to be the structure most affected by the increase in nuclear density in the postoperative early period. Keywords : Clear corneal incision morphology, Endothelial cell loss, Torsional phacoemulsification