急性闭角型青光眼高眼压状态下行白内障摘除对角膜内皮细胞的影响

目的：观察急性闭角型青光眼高眼压状态下行白内障摘除联合人工晶状体植入对角膜内皮细胞的 影响。方法：回顾性系列病例研究。选择2018年1月至2021年8月在同济大学附属同济医院眼科就 诊的急性闭角型青光眼发作且药物保守治疗及前房穿刺不能稳定控制眼压患者41例（55眼），眼压 （47.3±4.8）mmHg（1 mmHg=0.133 kPa），同时伴不同程度晶状体混浊。所有患者行白内障摘除联合 人工晶状体植入及房角分离术。术前及术后3个月内行常规眼科检查，并获取角膜内皮相关指标， 包括角膜内皮细胞密度（ECD）、中央角膜厚度（CCT）及变异系数（CV）等。手术前后各指标差值比 较采用配对t检验或Wilcoxon符号秩和检验。结果：术后第1天眼压为（16.7±3.7）mmHg，其中4眼 眼压仍高（ 24.9±2.2）mmHg]需药物控制，其余患眼眼压在正常范围内；术后3个月眼压为（15.7±3.1） mmHg，与术前相比差异有统计学意义（t=36.48, P<0.001）。术后ECD（1 023±344）个/mm2]明显 较术前 （2 062±300）个/mm2]下降（t=-22.75, P<0.001）。术后CV（33.5%±6.8%）明显较术前CV （22.7%±2.6%）增大（t=13.62, P<0.001）。手术前后患眼最佳矫正视力明显改善（Z=-4.94, P<0.001）。 所有患者均未发生术中或术后并发症。结论：急性闭角型青光眼高眼压状态下行白内障摘除联合人 工晶状体植入可快速有效控制眼压，但角膜内皮细胞损伤明显。

Effect of Cataract Extraction under High Intraocular Pressure on Corneal Endothelium Cell in Acute Angle Closure Glaucoma

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.