Acute Angle-closure Glaucoma, Phacoemulsification Corneal Endothelial Cells Damage And Related Impact Factors

Objective To study the quantitative morphometric changes of the corneal endothelial cells after phacoemulsification on acute angle-closure glaucoma (AACG) and to analyze the correlated factors of these changes aimed to investigate the effect of phacoemulsification on the corneal endothelium of acute angle closure glaucoma.Methods Collected the clinical data of people who suffering acute angle-closure glaucoma and then accepted phacoemulsification enrolled hospital during 2009 Mar to 2010 Jun. After the regular follow-up, patients were asked to come hospital on 3m,6m, 12m postoperative, checked the vision, intraocular pressure and the change of endothelial cells. Compare the differences in endothelium between the bilateral eyes preoperative and analysis the correlated factors of those changes. Compare the changes of corneal endothelial cells density between pre-and postoperative, calculate the loss rate of endothelial cells density and analyse the related factors.Results 58 cases (63 eyes) patients who suffered acute angle-closure glaucoma and accepted phacoemulsification completed the follow-up. The total follow-up is 12m. Compared with preoperative, the acute attacked eyes are significantly decreased in cell density(F=18.51, P=0.000) and the loss rate was 14.1%. The endothelium loss rate of the eyes is higher that high intraocular pressure time lasts for a longer time (F=6.593, P= 0.016), the endothelium density of the eyes suffered paracentesis of anterior chamber is lower but it is not significant (F=0.145, P=0.705).The corneal endothelial cell density is decreased significantly postoperatively (P= 0.000), and the loss rate is 31.51%,23.5% 31.92% at 3m,6m,12m postoperative respectively. It is significantly decreased in percentage of hexagonal cells(P=0.042)but increased in average cellular area (P=0.047) at 3m postoperatively compared with preoperative. Endothelium loss rate is negatively correlated with axial length(r=-0.293, P=0.014) and anterior chamber depth(r=-0.312, P=0.01),and it is positively correlated with lens thickness(r=0.329, P=0.007), ultrasound time(r=0.427, P=0.001)and cumulative dissipated energy(r=0.396, P=0.003).Anterior chamber depth is positively correlated with axial length(r=0.336, P=0.006) and negatively related with lens thickness(r=-0.387, P=0.002).ConclusionThis study investigates the injury of acute angle-closure glaucoma that accepted phacomulsification on endothelium and analyses the correlated factors. We conclude that the density of endothelium is decrease significantly and the lose rate is 14.1% which related with the lasts time of high intraocular pressure. The endothelium lose rate is 23.5%,31.51%,31.92% at 3m,6m,12m postoperatively respectively compared with preoperative, but the differences among the lose rates are not significant. The lose rate are negatively correlated with axial length and anterior chamber depth while are positively correlated with lens thickness, ultrasound time and cumulative dissipated energy.