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A. N. Tan, T. T. J. M. Berendschot, J. de Brabander, C. A. B. Webers, P. M. de Witte, R. M. M. A. Nuijts, J. S. A. G. Schouten, H. J. M. Beckers; Corneal Endothelial Cell Loss After Trabeculectomy or Baerveldt Glaucoma Drainage Device Implantation in Relation With Tube Position. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4442.
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The purpose of this study was to prospectively study central and peripheral endothelial cell density (ECD) loss in patients who underwent Baerveldt (BV) glaucoma drainage device (GDD) surgery or trabeculectomy with Mitomycin C (TE+MMC). Additionally, we studied the ECD in the quadrant closest to the BV-tube or TE filtering bleb, and evaluated the relationship between the tube-endothelium distance and ECD loss.
Thirty-one BV eyes, 34 TE eyes and 40 fellow eyes were included. All surgery was performed in the University Eye Hospital Maastricht, from 2008 onwards. Adult patients were included if they underwent BV-GDD surgery or primary TE+MMC. Patients needing revision of the BV-GDD or re-TE were excluded from further analysis. ECD was measured 3 times centrally and 3 times in the 4 peripheral quadrants with Konan specular microscope Noncon ROBO Pachy SP-9000. Additionally, Visante Optical Coherence Tomography (Carl Zeiss Meditec, Inc) images were made in the BV eyes to determine the tube-endothelium distance.Patients were evaluated pre-operatively and 3, 6 and 12 months post-operatively. Statistical analyses were performed using linear mixed model analyses in SPSS.
Patients from the BV group did have a significant lower ECD pre-operatively when compared to the TE+MMC group (p<0,001). The mean central ECD loss was 7,4% a year in BV eyes (p<0,001) and 4,2% in TE eyes (p<0,001). Fellow eyes had an ECD loss of 0,7% a year (p=0,31). In the peripheral quadrant closest to the BV-tube or the TE filtering bleb there was no significant more ECD loss. There was no statistically significant relationship between the tube-endothelium distance and the ECD loss. In the BV-eyes, there was significant more ECD loss than in the fellow eyes (p=0,008).
ECD loss is a matter of concern in patients needing BV-GDD surgery, ECD loss being almost twice as high when compared to (primary) TE+MMC patients. The ECD loss in the quadrant closest to the BV tube or TE filtering bleb did not statistically differ from the other quadrants. After one year of follow-up, we found no relationship between the tube-endothelium distance and the level of ECD loss.
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