BackgroundCataract surgery induces corneal endothelial cell loss (ECL). This study investigates the relationship between bottle height (BH) and ECL induced due to irrigation and aspiration (I/A) in cataract surgery and quantifies protective effects of intraoperatively used ophthalmic viscoelastic substances.MethodsIntermittent I/A without phacoemulsification was performed in porcine eyes for 10 min with varying BHs of 100 cm (BH100), 125 cm (BH125), 150 cm (BH150) or no treatment (control, no I/A). Additionally, in one group a dispersive ophthalmic viscoelastic substance was injected into the anterior eye chamber before treatment with I/A at a BH of 150 cm (BH150 + V). After exposure of the corneal endothelium to I/A, the corneas were prepared to split corneal buttons on day 0 and cultivated for 15 days. Endothelial cell density (ECD) was analyzed blinded on days 1, 8 and 15.ResultsRelative ECL significantly correlated with irrigation BH (control (n= 13): -9.69 ± 6.03% (average ± standard deviation); BH100 (n= 12): -9.69 ± 4.81%—p= 1.000; BH125 (n= 14): -19.44 ± 7.30% –p< 0.001; BH150 (n= 13): -21.99 ± 6.70%—p< 0.001). I/A-induced ECL was significantly decreased by the injection of ophthalmic viscoelastic, as BH150 + V (n= 14; -10.92 ± 4.09%—p= 1.000) showed a cell loss comparable to the control group.ConclusionsECL is altered by I/A BH and reduced when viscoelastic substances are used.