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S. C. Hau, A. Scott, C. Bunce, K. Barton; Corneal Endothelial Morphology in Eyes Implanted With Aqueous Shunts. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3957.
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To investigate the relationship between aqueous shunt position within the anterior chamber and changes in corneal endothelial cell morphology in glaucoma patients implanted with aqueous shunt devices (ASD).
Prospective, exploratory analysis of 24 consecutive eyes that underwent ASD implantation by one ophthalmologist (KB) over the period of 2002 - 2004 was undertaken. Anterior segment optical coherence tomography (AS-OCT) (VisanteTM, Carl Zeiss Meditec, Germany) to document the tube position within the eye, SP 2000-P specular microscopy analysed with IMAGEnet 2000 (Topcon, Tokyo, Japan) for peripheral/central corneal endothelial cell density (CED), anterior chamber (AC) flare measurement and peripheral/central ultrasonic pachymetry were performed on all eyes. The position of the tube portion of the ASD was defined by the following parameters: tube length (TL), tube angle to anterior iris surface (TAI), distance from anterior iris surface to tube entry site (IT), distance from tip of tube to cornea (TC), distance from tip to anterior iris surface (TI), and tube angle to posterior cornea surface (TAC). The primary outcome variables were CED and the proximity of the tube to the corneal endothelium.
The median age of the 22 patients (24 eyes) was 59 years (range 16-76), with a median duration post ASD implantation of 41 months (range 24-84). All ASD were positioned in the AC: 11 mid AC, 8 touching or close to the iris, 2 touching or close to cornea, and 3 very short tubes. The correlation coefficient (r) between CED and the tube measurements were: TL -0.218, TAI 0.063, IT -0.514 (p=0.010), TC -0.238, TI -0.017, TAC 0.234 and length of follow-up after surgery (r=-0.395);
Although the weaker negative correlation with the period of time from surgery is a potential confounding factor, the greater negative correlation between CED and entry site distance from anterior iris surface (ie. closer to cornea) than other parameteres, suggests that entry site position close to peripheral cornea, may have an important negative influence on long-term corneal endothelial function. AS-OCT is a promising technique that allows the tube portion of the ASD to be documented accurately. Longitudinal studies are warranted to ascertain whether this association represents a progressive effect on the corneal endothelium with AC-implanted ASD.
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