急性闭角型青光眼前房穿刺对角膜内皮细胞的影响

目的观察急性闭角型青光眼急性发作期行前房穿刺所致眼压波动对角膜内皮细胞密度(ECD)的影响。方法回顾性分析同济大学附属同济医院2018年11月至2019年11月闭角型青光眼急性发作期者30例(30只眼)的临床资料。所有患者分为两组,其中15例药物无法控制眼压而行前房穿刺(穿刺组);另15例经降眼压药物控制眼压(药物组)。两组患者眼压降至正常后均行晶状体超声乳化人工晶状体植入术联合前房角分离术。术后随访3个月,观察两组最佳矫正视力(BCVA)、ECD、角膜厚度和并发症。结果术后3个月,穿刺组ECD为(1166.6±309.95)个/mm^2,较药物组ECD(2034.7±261.23)个/mm^2明显减少(t=-5.46,P<0.05)。术后BCVA及角膜厚度均具有统计学差异(t=3.21,-4.01;P<0.05)。结论闭角型青光眼急性发作期间,反复前房穿刺可导致角膜内皮细胞大量丢失。

The effect of paracentesis of anterior chamber on corneal endothelial cells in patients with acute attack of angle-closure glaucoma

Objective To observe the effect of intraocular pressure(IOP)fluctuations induced by paracentesis of anterior chamber on the corneal endothelial cell density(ECD)in patients with acute attack of angle-closure glaucoma.Methods The clinical data of 30 eyes of 30 patients of acute episodes of angle-closure glaucoma were analyzed from Nov.2018 to Nov.2019 in Tongji Hospital Affiliated to Tongji University were analyzed retrospectively.They were divided into two groups,15 cases underwent paracentesis of anterior chamber to control intraocular pressure as the paracentesis group,and 15 cases received IOP-lowering drugs as the drug group.Both groups received phacoemulsification and intraocular lens implantation combined with goniosynechialysis after IOP was reduced to normal.The best corrected visual acuity(BCVA),ECD,corneal thickness and complications were observed.The follow-up time was 3 months.Results At 3 months after surgery,the ECD in the puncture group was(1166.6±309.95)cells/mm^2,which was less than the(2034.7±261.23)cells/mm^2 in the drug group(t=-5.46,P<0.01).The difference of postoperative BCVA(t=3.21,P<0.05)and the corneal thickness(t=-4.01,P<0.05)were statistically significant.Conclusion The rapid fluctuation of IOP caused by repeated anterior chamber paracentesis may lead to the obvious loss of ECD during acute angle-closure glaucoma.