Clinical Research Of Corneal Endothelial Cells Affected By Concomitant Strabismus Surgery

Objective: To compare the changes of corneal endothelial cells in patients with concomitant strabismus with the surgical methods of anterior ciliary artery(ACA)dissection and preservation,and to further explore whether ACA preservation has protective value on corneal endothelial cells.For concomitant strabismus patients with corneal endothelial dysfunction caused by congenital development or acquired pathological changes,whether ACA needs to be preserved when undergoing surgical correction of eye position is provided.Methods: A randomized controlled study was conducted to take in 246 eyes of 133 patients with concomitant strabismus who were admitted to Suining Central Hospital from October 2020 to January 2022.The patients were divided into two groups by random number table method: Group A,123 eyes of 66 patients ACA were preserved during operation;ACA were removed in 123 eyes of 67 patients in group B.The corneal endothelial cell density,average size,coefficient of variation,hexagonality and central corneal thickness of 2 groups were examined by Noncontact Specular Microscopy(TOPCON SP-3000P)1d before surgery and 1d after surgery,1wk,2wk and 1mo.The changes of corneal endothelial cells in the two groups were observed before and after surgery,and the changes of corneal endothelial cells in the two groups were observed when ACA was removed or preserved in concomitant strabismus.Results:(1)The postoperative orthotopic rate was 87.88% in the ACA preservation group and 91.04% in the ACA removal group,and without statistical difference between them(P > 0.05).(2)The corneal endothelial cell density,average size,coefficient of variance,and hexagonality did not significantly changed from 1d,to 1mo after operation when only one horizontal rectus muscle was removed from one eye in concomitant strabismus,regardless of whether ACA was preserved(P > 0.05).Central corneal thickness did not change significantly until 1mo after ACA preservation(P > 0.05),while central corneal thickness increased 1 day after ACA dissection(P < 0.05),and returned to the preoperative level after 1wk.(3)There were no significant changes in corneal endothelial cell density and cell area at 1d,1wk,2wk and 1mo after surgery when two horizontal rectus muscles were removed from one eye at the same time,regardless of whether ACA was preserved(P > 0.05).The coefficient of variation of the ACA group increased 1d after surgery compared with that before surgery(P < 0.05).The coefficient of variation of the ACA group continued to increase until 1wk after surgery,and remained stable from 1wk to 1mo after surgery,while there was no significant difference between the ACA group before and after surgery(P > 0.05).The hexagonality in the ACA group decreased 1d after surgery compared with that before surgery(P < 0.05).The hexagonality continued to decrease until1 wk after surgery,and remained stable from 1wk to 1mo after surgery,while there was no significant difference between the ACA group before and after surgery(P > 0.05).From1 wk to 1mo after surgery,the coefficient of variation in the ACA preservation group was lower than that in the ACA dissection group,and the hexagonality was higher than that in the ACA isolation group(P < 0.05).The central corneal thickness of group ACA was significantly higher between 1 day and 1wk after surgery(P < 0.05).The central corneal thickness of ACA group was preserved to the preoperative level 2wk after surgery,while the central corneal thickness of ACA group was higher 1 day after surgery(P < 0.05).Central corneal thickness returned to the preoperative level at 1wk postoperative.Conclusion:(1)In concomitant strabismus surgery,when only one horizontal rectus muscle be recession or resection,there was no significant effect on corneal endothelial cells whether ACA was preserved or not.Postoperative corneal edema was transient in dissection ACA group.(2)ACA preservation in patients with concomitant strabismus requiring simultaneous removal of two horizontal rectors from one eye was less severe than that in patients with dissociated ACA,with less changes in corneal endothelial cells and faster postoperative recovery.ACA preservation can be considered in patients with corneal endothelial dysfunction who requiring eye position correction.