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M Osako, R Asaoka, K Tachibana, T Okano, M Usui; Evaluation of Corneal Endothelial Cell Reduction Rates After Combined Glaucoma and Cataract Surgery and After Glaucoma Surgery Alone . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1080.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:Recently, new surgical procedures such as nonpenetrating trabeculectomy (NPT) and viscocanalostomy have been used in glaucoma surgery to avoid the complications of filtering blebs. In this study, we investigated the corneal endothelial reduction rates after combined cataract and glaucoma surgery using penetrating trabeculectomy (PT) or NPT, and after glaucoma surgery alone. In addition, we evaluated the influence of postoperative complications and usage of mitomycin C (MMC) on the corneal endothelial cell. Methods:A PT combined (cataract and glaucoma) surgery group (46 eyes of 33 patients), a NPT combined surgery group (21 eyes of 16 patients), a PT single (glaucoma) surgery group (25 eyes of 20 patients), and a NPT single surgery group (10 eyes of 7 patients) were studied. Two hundred ninety-seven eyes of 212 patients who had cataract surgery were enrolled as the control group. All cataract surgery was done by phecoemulsification. MMC was used in 42 eyes in the PT combined surgery group, 24 eyes in the PT single surgery group, and all eyes in the NPT combined and single surgery groups. Corneal endothelial cells were measured before surgery and 3 months postoperatively, and endothelial cell reduction rates were calculated. Results:The average endothelial cell reduction rates were 11.112.7% in PT combined surgery group, 9.78.4% in NPT combined surgery group, 11.012.2% in cataract surgery control group, 8.3 16.3% in PT single surgery group, and 2.42.7% in NPT single surgery group. There was no significant difference between PT combined surgery, NPT combined surgery, and cataract surgery; or between PT and NPT single surgery. In the PT combined surgery group, no significant difference in average postoperative reduction rate was found between cases using and not using MMC. In the PT combined surgery and PT single surgery groups, cases complicated with shallow anterior chamber or fibrinous exudations had higher endothelial cell reduction rates compared to those without these complications(p<0.05). Significant correlation was also found between shallow anterior chamber and fibrinous exudations(p<0.05). Conclusion:Surgical procedure for glaucoma does not affect corneal endothelial cell damage in both combined and single surgeries. Complications of shallow anterior chamber and fibrinous exudations are related to corneal endothelial damage.
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