Güvenç Umay, Akkaya Züleyha Yalnız, Burcu Ayşe
Department of Ophthalmology, Ankara Training and Research Hospital, Ankara, Turkiye.
Korean J Ophthalmol. 2025 Aug;39(4):312-322. doi: 10.3341/kjo.2025.0027. Epub 2025 Jun 16.
Pseudophakic corneal edema (PCE) remains a significant postoperative challenge despite advancements in cataract surgery, often delaying visual recovery and affecting refractive outcomes. This study investigates the relationship between keratometric and pachymetric changes during PCE resolution, evaluates factors influencing this process, and examines the efficacy of coenzyme Q10 (CoQ10) as an adjunct therapy.
A retrospective study was conducted on 88 patients aged 50 years and older who developed PCE after uneventful phacoemulsification. Corneal assessments were performed using Pentacam HR, focusing on keratometric and pachymetric changes. Patients were monitored weekly until PCE resolution, defined as a return of central corneal thickness within ±30 μm of preoperative values. Patients received standard postoperative treatment, with a subset also receiving CoQ10 as an adjunct therapy.
Postoperative visual acuity improved significantly (p < 0.001). Despite pachymetric normalization, persistent keratometric changes were observed, particularly a steepening of posterior curvature (p < 0.001) and increased anterior asphericity (p = 0.047). CoQ10-treated patients exhibited faster edema resolution (p = 0.019), greater reduction in corneal thickness (p = 0.003), and improved transparency. Higher cumulative dissipated energy correlated with increased edema severity (r = 0.419, p < 0.001) and higher cumulative dissipated energy was linked to slower recovery times. Patients with diabetes had a prolonged recovery period compared to nondiabetic patients (p = 0.018), though pachymetric recovery rates were similar. The pachymetric progression index was unreliable in edematous corneas.
While visual acuity and pachymetry improved in all patients, persistent topographic changes suggest incomplete structural normalization. Preliminary findings indicate that adjunctive CoQ10 use may support more efficient corneal edema resolution, as evidenced by faster recovery and favorable structural changes. Further prospective studies are warranted to confirm these observations.
尽管白内障手术取得了进展，但人工晶状体性角膜水肿（PCE）仍然是一个重大的术后挑战，常常延迟视力恢复并影响屈光结果。本研究调查了PCE消退过程中角膜曲率和角膜厚度变化之间的关系，评估影响这一过程的因素，并检验辅酶Q10（CoQ10）作为辅助治疗的疗效。
对88例50岁及以上在超声乳化白内障吸除术后发生PCE的患者进行了一项回顾性研究。使用Pentacam HR进行角膜评估，重点关注角膜曲率和角膜厚度变化。每周对患者进行监测，直至PCE消退，PCE消退定义为中央角膜厚度恢复到术前值±30μm范围内。患者接受标准的术后治疗，其中一部分患者还接受CoQ10作为辅助治疗。
术后视力显著提高（p < 0.001）。尽管角膜厚度恢复正常，但仍观察到持续的角膜曲率变化，特别是后表面曲率变陡（p < 0.001）和前表面非球面性增加（p = 0.047）。接受CoQ10治疗的患者水肿消退更快（p = 0.019），角膜厚度减少更明显（p = 0.003），透明度提高。更高的累积耗散能量与水肿严重程度增加相关（r = 0.419，p < 0.001），且更高的累积耗散能量与恢复时间延长有关。与非糖尿病患者相比，糖尿病患者的恢复期延长（p = 0.018），尽管角膜厚度恢复率相似。角膜厚度进展指数在水肿角膜中不可靠。
虽然所有患者的视力和角膜厚度均有所改善，但持续的地形图变化表明结构未完全恢复正常。初步研究结果表明，辅助使用CoQ10可能有助于更有效地消退角膜水肿，更快的恢复和有利的结构变化证明了这一点。需要进一步的前瞻性研究来证实这些观察结果。
