From the Department of Ophthalmology, Manisa Celal Bayar University, Manisa, Turkey (Mayali, Kurt, Ilker); Department of Ophthalmology, Karsiyaka Eye Hospital, Izmir, Turkey (Baser).
J Cataract Refract Surg. 2021 May 1;47(5):612-617. doi: 10.1097/j.jcrs.0000000000000493.
To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells.
Department of Ophthalmology, Celal Bayar University, Manisa, Turkey.
Prospective randomized controlled trial.
Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE.
This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 μm at postoperative 1 month in both groups (P = .296).
PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve.
比较使用前房维持器（ACM）的超声乳化白内障吸除术（PE）与使用眼科黏弹剂（OVD）的常规 PE 对角膜内皮细胞的影响。
土耳其马尼萨 Celal Bayar 大学眼科系。
前瞻性随机对照试验。
OVD 组（n = 50）行常规 PE，ACM 组（n = 50）行 ACM 辅助下的 PE。术前及术后 1 个月、3 个月和 6 个月，采用角膜内皮镜测量内皮细胞密度（ECD）、变异系数（CV）、六边形细胞比例（HEX）和非接触式中央角膜厚度（CCT）。
本研究共纳入 100 只眼（97 例患者）行 PE。OVD 组的平均年龄为 64.7 ± 10.6 岁，ACM 组为 64.0 ± 12.6 岁（P >.05）。两组术前 ECD、CV、HEX 和 CCT 或总 PE 时间均无显著差异（P >.05）。术后 1 个月、3 个月和 6 个月，ACM 组的 ECD 明显低于 OVD 组（P =.002、P =.002 和 P =.001）。同样，与术前相比，ACM 组在所有术后时间点的 ECD 损失均更大（P =.003、P =.001 和 P =.001）。两组术后 CV 增加，HEX 降低（P >.05）。两组术后 1 个月 CCT 均有短暂的 10 μm 以内的增加（P =.296）。
与常规 PE 相比，ACM 辅助的 PE 导致角膜 ECD 丢失更多。对于角膜内皮储备有限的患者，PE 时不应使用 ACM。
