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Editors Selection IGR 7-3

Surgical treatment: Cataract extraction and ACG

Comment by Paul Foster on:

12205 Effects of phacoemulsification and intraocular lens implantation on the corneal endothelium in primary angle-closure glaucoma, Ko Y-C; Liu CJ-L; Chou JC et al., Journal of Medical Ultrasound, 2004; 12: 33-37

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This study by Ko et al. (712) reports an increase in corneal thickness (7 µm, P = 0.034) and a fall in endothelial cell density (16%, P < 0.001) in 24 eyes of 24 patients with primary angle-closure following uncomplicated phaco-emulsification and posterior chamber lens implantation. Mean visual acuity improved, while IOP and the number of medications required fell after surgery. The fall in endothelial cell count was moderately correlated (r = 0.487; p = 0.016) with pre-operative IOP and number of glaucoma medications (r = 0.427; p = 0.038), but not with biometric characteristics.

Endothelial cell loss is a well-recognised corollary of angle-closure. The authors rightly point out that the growing trend for lens extraction in the management of angle-closure requires a clearer understanding of the potential impact of surgery on a compromised endothelium. The authors acknowledge that the number of subjects in their study is too small to allow them to accurately assess which characteristics were the most important in conferring risk of endothelial cell loss. It is very possible that the factors considered are all surrogates markers of disease severity (IOP, number of medications and biometrics). It is therefore understandable that biometrics were not a significant predictor of endothelial cell loss in a statistical model that included IOP and number of medications. Future studies may be able to advance our understanding of this issue with larger numbers, and better characterization of possible sub-groups of disease, specifically those who have and have not experienced previous episodes of corneal oedema from angle-closure.

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