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Romeo Altafini, Simonetta Morselli; Comparison between Endhotelial Cell Loss After MICS Phaco with ExPress Implant and MICS Phaco Safe-Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4794. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate corneal endothelial cell loss after phaco with ExPress implant compared to phaco trabeculectomy
Forty eyes of forty patients affected by cataract and open angle glaucoma were randomized to Micro incision cataract surgery (MICS) phaco with Express P50 implant under scleral flap (group 1) or MICS safe-phacotrabeculectomy (group 2) after informed consent. All patients were operated by two-site surgery. There were no statistically significant differences in age, sex, anterior chamber depth and axial length. Non contact corneal specular microscopy (Tomey 3000 tm) was performed in all eyes before and 1st, 3rd , 6th months after surgery. Endothelial cell density (CCD), coefficient of variation in cell size (CV) and percentage of hexagram cells (HEX) between the two groups were considered before and after surgery. Mean endothelial cell count was measured in the central corneal area and in the superior area close to Express implant and close to trabeculectomy site. One-way analysis of variance (ANOVA) was used to analyze endothelial cell loss differences between two groups.
The mean preoperative endothelial cell density in group 1 (ECD) was 2144 cells/mm(2) ± 267 (SD) and was 2203 ± 269 cells/mm(2) in the group 2 (P=.431). The mean postoperatively endothelial cell loss was 8.8% at the 1st month, 10.5% at 3rd month and 12,6 % at 6th month in group 1 and 8% at 1st month, 10,2% at 3rd month and 12,3 % at 6th month in the group 2. The differences were not statistically significant between the two groups (P >.05). The superior area, close to ExPress implant and close to trabeculectomy site, showed the higher decrease in endothelial cell density. Endothelial cell loss was 18.5% in the group 1 and 18,2% in the group 2 after six months. The percentage of hexagonal cells and coefficient of variation in cell size were not different between the two groups preoperatively or postoperatively. The difference was not statistically significant
Our results suggest that endothelial cell loss is due to surgical trauma even in central and superior area in both group. In our study the implant of P50 Express is safe and effective as mini-trabeculectomy and there were no statistically significant endothelial cell loss after Express P50 implanted.
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