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ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1533950
Impact of Preoperative Intraocular Pressure on Corneal Endothelial Cell Loss after Phacoemulsification in Acute Primary Angle-Closure Glaucoma with Cataract
Provisionally accepted
Jiaqi Shen 1
Xin Liu 1,2
Mingyue Lin 1
Yuting Shao 1 Guozheng Niu 1
Shen Qu 1 Yunli Niu 1
Zhou Qi 3
Li Zhang 1*
Yanlong Bi 1*- 1 Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- 2 Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
- 3 School of Medicine, Tongji University, Shanghai, Shanghai Municipality, China
Purpose: To assess corneal endothelial cell loss (ECL) following phacoemulsification and intraocular lens implantation (Phaco+IOL) in eyes with acute primary angle-closure glaucoma (APACG) and cataracts under different preoperative intraocular pressure (IOP) levels.Methods: This non-randomized controlled trial included 75 eyes from 75 patients with APACG and cataracts who underwent Phaco+IOL. All patients received pharmacotherapy and anterior chamber paracentesis before surgery and were grouped according to preoperative IOP: high-IOP group (IOP ≥ 25 mmHg) and IOP-controlled group (IOP < 25 mmHg). IOP, visual outcome, endothelial cell density (ECD), hexagonality (HEX), coefficient of variation (CV) and central corneal thickness (CCT) were evaluated up to 3 months postoperatively. Baseline ECD, HEX, and CV parameters were measured in the contralateral eyes of all patients as a reference and compared with the postoperative results.Results: The average IOP decreased from 43.2±4.8 mmHg to 16.5±5.8 mmHg (P<0.001) in the high-IOP group and from 18.3±4.3 mmHg to 14.3±3.2 mmHg (P<0.001) in the IOP-controlled group on the first postoperative day. The changes in IOP were more significant in the high-IOP group (P<0.001). The ECD at 3 months was 1705.2±503.8 cells/mm2 in the high-IOP group and 2091.8±330.1 cells/mm2 in the IOP-controlled group (P<0.001). The ECL rates at 3 months were 35.0% (high-IOP group) and 17.4% (IOP-controlled group) (P<0.001). The postoperative changes in HEX and CV at 3 months were more significant in the high-IOP group (P<0.001; P=0.003). Both groups produced comparable improvements in visual acuity and IOP. Conclusions: Uncontrolled high IOP (≥ 25 mmHg) before phacoemulsification in patients with APACG and cataract is associated with a higher rate of ECL. The rapid and substantial reduction of IOP during surgery may exacerbate corneal endothelial cell loss.
Keywords: Acute primary angle-closure glaucoma, Phacoemulsification, Ocular Hypertension, Corneal endothelial cells loss, Endothelial cell density
Received: 25 Nov 2024; Accepted: 17 Mar 2025.
Copyright: © 2025 Shen, Liu, Lin, Shao, Niu, Qu, Niu, Qi, Zhang and Bi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Li Zhang, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
Yanlong Bi, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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