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

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/mm²) and 24 months (2113±333 vs 1880±422 cells/mm²), 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.