Effects of phacoemulsification and intraocular lens implantation on the corneal endothelium in primary angle-closure glaucoma

Background: Phacoemulsification and intraocular lens implantation (P-IOL) is an option for intraocular pressure (IOP) control for primary angle-closure glaucoma (PACG). This study examined the effects of P-IOL on the corneal endothelium in eyes with PACG. Patients and methods: Ultrasound biometry and pachymetry, as well as specular microscopy, were performed preoperatively and 3 months after surgery in 24 eyes with PACG that underwent P-IOL. The postoperative changes in central corneal endothelial density and central corneal thickness (CCT) were evaluated. The correlations between postoperative endothelial changes and both preoperative IOP control and biometric features were analyzed. Results: After surgery, corneal endothelial cell density decreased significantly (p < 0.001), with a mean cell loss of 15.7%, and mean CCT increased by 7 μm (p = 0.034). A greater postoperative corneal endothelial loss was correlated with a higher preoperative mean IOP and more glaucoma medications (correlation coefficients = 0.487 and 0.427, p = 0.016 and 0.038, respectively). The corneal endothelial changes did not correlate with preoperative biometric features including anterior chamber depth, lens thickness, and axial length. Conclusion: Significant corneal endothelial cell loss after P-IOL in PACG patients suggests that corneal endothelium status should be carefully evaluated before performing this surgery in these patients, especially those with poor preoperative IOP control.