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Juan Dios, Maybee Delgado, Vania Castro; Corneal Endothelial Cells Loss After Trabeculectomy For Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4748.
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© ARVO (1962-2015); The Authors (2016-present)
To study corneal endothelial cells changes after trabeculectomy with mitomycin C, performed for uncontrolled glaucoma and determine risk factors associated to adverse results.
Prospective, observational evaluation of changes in density and shape of the corneal endothelial cells in 59 eyes of 53 patients, who underwent trabeculectomy, in an academic center, during a one-year period. Intracameral anesthesia was not used, hyaluronic acid was injected to the anterior chamber to maintain it formed, and removed it during the surgery. Central corneal endothelial cells were studied with specular microscopy at baseline and 1, 7, 15, 30, 60 and 120 days after surgery. Intraocular pressure (IOP), lens status, and presence of complications were analyzed. Statistical significance was evaluated with the Mann Whitney U test.
Mean endothelial cell density (ECD) decreased 464 cells/mm2 (17.86%) 30 days post surgery compared to baseline; and 563 cells/mm2 (21.67%) at 120 days, these changes were statistically significant (p <0.001). Patients who achieved Total Success (IOP <18 mm Hg postoperatively) showed no significant decrease (17.01%) of ECD, in contrast to those with Partial Success or Failure (26.08% and 29.4%; p <0.001). Greater ECD reduction was observed in patients with post-surgery hyphema or flat anterior chamber, compared with patients without complications (-1059 vs. -456 cells/mm2; p <0.001). ECD was also reduced in pseudophakic patients compared to those without prior cataract surgery (-571 vs. -405 cells/mm2; p <0.001). Coefficient of variation (CoV) was statistically significant increased in nearly all patients, independent of the IOP value, complications and lens status.
Statistically significant ECD loss was observed in eyes after trabeculectomy with mitomycin C for glaucoma. The severity of this loss was associated with post-surgical time, poorly controlled IOP after trabeculectomy, post-operative complications (such as flat anterior chamber), and prior cataract surgery. CoV was statistically increased in nearly all patients without risk factor associated. Our data supports the consideration of risk factors for corneal damage in deciding surgical management for glaucoma, trying to avoid surgical complications.
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