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Yuko Maruyama, Kazuhiko Mori, Morio Ueno, Yoko Ikeda, Kazuichi Maruyama, Shigeru Kinoshita; Corneal Endothelial Cell Density and Filtration Surgery in Patients with Posner-Schlossman Syndrome. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4763.
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© ARVO (1962-2015); The Authors (2016-present)
In some cases of Posner-Schlossman syndrome (PSS), corneal endothelial cell (CEC) density in the afflicted eye was lower than that of the healthy eye. Trabeculectomy (TLE) is necessary for controlling intraocular pressure (IOP) that cannot be managed with drug medications. The purpose of this present study was to analyze the correlation between percentage of CEC reduction and necessity of TLE in patients with PSS.
This study involved 19 eyes of 19 glaucoma patients (10 females, 9 males; mean age: 51.5±20.7 years; mean follow-up: 2.6±1.6 years) diagnosed as PSS at the glaucoma and uveitis clinic of Kyoto Prefectural University of Medicine, Kyoto, Japan. PSS was diagnosed based on having recurrent unilateral episodes of elevated intraocular pressure, mild anterior chamber inflammation with a few keratic precipitates and excluding other uveitic diseases. We retrospectively investigated the patient data of CEC density measured by specular microscopy. CEC reduction rate in the afflicted eye was defined as follows: (healthy-eye CEC density - afflicted-eye CEC density) / healthy-eye CEC density x 100 (%). The cases were divided into 2 groups in relation to mean CEC reduction rate (CEC_RR high or CEC_RR low group), and the rate of patients who required TLE were then compared in these 2 groups. The frequency of events, such as IOP elevation or inflammatory attack, between 1-year pre- and postoperative periods in the cases that required filtering surgery was also compared.
Of the 19 patients, there were 9 cases of CEC_RR high (CEC reduction > 23.3%) and 10 cases of CEC_RR low (CEC reduction < 23.3%). Seven cases (78%) required TLE in the CEC_RR high group, while only 1 case (10%) in the CEC_RR low group (p=0.0055, Fisher’s exact test). The frequency of inflammatory events was reduced to 0.2±0.1 times/year in the period of the following surgery, while 4.9±0.5 times/year in the period of preceding surgery (p<0.0001, Student’s t-test).
The findings of this study show that the cases of high corneal endothelial cell reduction rate tend to be drug resistant and require trabeculectomy.
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