Abstract:Objective: To investigate the effect of cataract extraction under high intraocular pressure on corneal endothelial cells in acute angle closure glaucoma patients. Methods: This retrospective case series study was conducted with 41 patients (55 eyes) with acute angle closure glaucoma and cataract from January 2018 to August 2021 in the Ophthalmology of Tongji Hospital Affiliated to Tongji University. Preoperative mean intraocular pressure was (47.3±4.8)mmHg (1 mmHg=0.133 kPa). Both pharmacotherapy and anterior chamber paracentesis can’t reduce the intraocular pressure, and all patients subsequently underwent cataract extraction combined with intraocular lens implantation and goniosynechialysis. Routine ophthalmic examination and corneal endothelium parameters including endothelial cell density, central corneal thickness and coefficient of variation were examined in all patients before surgery and during the three-month followup period. For the difference before and after surgery, either a paired t test or a Wilcoxon rank sum test was applied. Results: The average intraocular pressure (IOP) was (16.7±3.7)mmHg at 1 day after the operation, 4 eyes still needed medication to control the IOP[(24.9±2.2) mmHg], while the IOP in the other eyes stabilized in a normal range. IOP of all the affected eyes stabilized in (15.7±3.1)mmHg at 3 months after the operation, and the difference was statistically significant compared with preoperative IOP (t=36.48, P<0.001). Postoperative ECD [(1 023±345 )each/mm2 ] significantly declined compared with preoperative ECD[(2 063±300) each/mm2 ] (t=-22.75, P<0.001). Postoperative CV (33.5%±6.8%) was significantly increased compared with preoperative CV (t=13.62, P<0.001).There was a significant improvement in postoperative BCVA (Z=-4.94, P<0.001). No intraoperative or postoperative complications occurred in all patients. Conclusion: Cataract extraction combined with intraocular lens implantation in acute angle closure glaucoma under high intraocular pressure can control the IOP effectively, but significantly damage the corneal endothelial cells.
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