Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-ku, Seoul, 137-701, Korea.
Graefes Arch Clin Exp Ophthalmol. 2012 Nov;250(11):1673-80. doi: 10.1007/s00417-012-1998-4. Epub 2012 Mar 23.
To compare the change in endothelial cell counts (ECC) after early phacoemulsification and laser peripheral iridotomy (LPI) using sequential argon:yttrium-aluminum-garnet (YAG) laser technique for the treatment of acute primary angle closure (APAC).
This was a retrospective chart review, case-control study; 86 APAC patients were enrolled. Sixteen patients who underwent early phacoemulsification with intraocular lens implantation and 32 patients who underwent LPI were matched by propensity score analysis. All subjects underwent a complete ophthalmic examination, including intraocular pressure (IOP) measurements, optic disc examinations, and gonioscopy. ECC were acquired at the center of the cornea with a noncontact specular microscope before treatment, and at 1, 6, 12, and 24 months following phacoemulsification or LPI.
The mean follow-up was 26.1 ± 4.7 months in the phacoemulsification group and 26.3 ± 4.5 months in the LPI group. After intervention, the changes in anterior chamber depth and Shaffer grading by gonioscopy were significantly different between groups. ECC were not different before treatment; however, after phacoemulsification or LPI at 12 months (2280 ± 320 vs 1993 ± 380 cells/mm(2)) and 24 months (2113 ± 333 vs 1880 ± 422 cells/mm(2)), there was a significant difference between the two groups (P = 0.040 and P = 0.032 respectively). Regression analysis showed that anterior chamber depth at baseline (P = 0.041) and intervention modality (phacoemulsification vs LPI; P < 0.001) were significantly related to the change in ECC.
Early phacoemulsification showed lower endothelial cell loss than did LPI in the treatment of APAC after a 2-year follow-up. In terms of ECC, early phacoemulsification could be a better intervention modality for APAC.
比较急性原发性闭角型青光眼（APAC）采用序贯氩：钇铝石榴石（YAG）激光技术行早期超声乳化白内障吸除术联合激光周边虹膜切开术（LPI）治疗后内皮细胞计数（ECC）的变化。
这是一项回顾性图表分析、病例对照研究；共纳入 86 例 APAC 患者。通过倾向评分分析，将 16 例行早期超声乳化白内障吸除术联合人工晶状体植入术和 32 例行 LPI 的患者进行匹配。所有患者均接受完整的眼科检查，包括眼压（IOP）测量、视盘检查和房角镜检查。在治疗前和超声乳化白内障吸除术或 LPI 后 1、6、12 和 24 个月，使用非接触式共焦显微镜在角膜中央获取 ECC。
超声乳化白内障吸除术组的平均随访时间为 26.1±4.7 个月，LPI 组为 26.3±4.5 个月。干预后，两组间前房深度和房角镜下 Shaffer 分级的变化差异有统计学意义。治疗前 ECC 无差异；然而，在超声乳化白内障吸除术或 LPI 后 12 个月（2280±320 比 1993±380 个细胞/mm²）和 24 个月（2113±333 比 1880±422 个细胞/mm²）时，两组间差异有统计学意义（P=0.040 和 P=0.032）。回归分析显示，基线时前房深度（P=0.041）和干预方式（超声乳化白内障吸除术与 LPI；P<0.001）与 ECC 的变化显著相关。
在 2 年的随访中，与 LPI 相比，早期超声乳化白内障吸除术治疗 APAC 后内皮细胞丢失更少。就 ECC 而言，早期超声乳化白内障吸除术可能是治疗 APAC 的更好干预方式。
