title: 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.
abstract: 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.
authors.affiliation: Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-ku, Seoul, 137-701, Korea.
authors.forename: Hae-Young Lopilly
authors.initials: HY
authors.lastname: Park
authors.forename: Na Young
authors.initials: NY
authors.lastname: Lee
authors.forename: Chan Kee
authors.initials: CK
authors.lastname: Park
authors.forename: Man Soo
authors.initials: MS
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D016022:Case-Control Studies; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000517:prevention & control*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D032801:Iridectomy; D007498:Iris / Q000601:surgery; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology