Long-term changes in endothelial cell counts after early phacoemulsification versus laser peripheral iridotomy using sequential argon:YAG laser technique in acute primary angle closure

Graefes Arch Clin Exp Ophthalmol. 2012 Nov;250(11):1673-80. doi: 10.1007/s00417-012-1998-4. Epub 2012 Mar 23.


Objective: To compare the change in endothelial cell counts (ECC) after early phacoemulsification and laser peripheral iridotomy (LPI) using sequential argon:yttrium-aluminum-garnet (YAG) laser technique for the treatment of acute primary angle closure (APAC).

Methods: This was a retrospective chart review, case-control study; 86 APAC patients were enrolled. Sixteen patients who underwent early phacoemulsification with intraocular lens implantation and 32 patients who underwent LPI were matched by propensity score analysis. All subjects underwent a complete ophthalmic examination, including intraocular pressure (IOP) measurements, optic disc examinations, and gonioscopy. ECC were acquired at the center of the cornea with a noncontact specular microscope before treatment, and at 1, 6, 12, and 24 months following phacoemulsification or LPI.

Results: The mean follow-up was 26.1 ± 4.7 months in the phacoemulsification group and 26.3 ± 4.5 months in the LPI group. After intervention, the changes in anterior chamber depth and Shaffer grading by gonioscopy were significantly different between groups. ECC were not different before treatment; however, after phacoemulsification or LPI at 12 months (2280 ± 320 vs 1993 ± 380 cells/mm(2)) and 24 months (2113 ± 333 vs 1880 ± 422 cells/mm(2)), there was a significant difference between the two groups (P = 0.040 and P = 0.032 respectively). Regression analysis showed that anterior chamber depth at baseline (P = 0.041) and intervention modality (phacoemulsification vs LPI; P < 0.001) were significantly related to the change in ECC.

Conclusions: Early phacoemulsification showed lower endothelial cell loss than did LPI in the treatment of APAC after a 2-year follow-up. In terms of ECC, early phacoemulsification could be a better intervention modality for APAC.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Case-Control Studies
  • Cell Count
  • Corneal Endothelial Cell Loss / prevention & control*
  • Endothelium, Corneal / pathology*
  • Female
  • Follow-Up Studies
  • Glaucoma, Angle-Closure / physiopathology
  • Glaucoma, Angle-Closure / surgery*
  • Gonioscopy
  • Humans
  • Intraocular Pressure / physiology
  • Iridectomy*
  • Iris / surgery
  • Lasers, Solid-State / therapeutic use*
  • Lens Implantation, Intraocular*
  • Male
  • Middle Aged
  • Phacoemulsification*
  • Retrospective Studies
  • Tonometry, Ocular
  • Treatment Outcome
  • Visual Acuity / physiology