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Kazuyuki Hirooka, Eri Nitta, Kaori Ukegawa, Shino Sato, Yoshiaki Kiuchi; Long-term effect of trabeculectomy on corneal endothelial cell loss. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3747.
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© ARVO (1962-2015); The Authors (2016-present)
While the changes that occur in the corneal endothelial cell density (CECD) up to 12 months after trabeculectomy have been investigated in several studies, long-term continuous loss of CECD has not yet to be examined. We performed a prospective, observational clinical study to learn long-term changes in CECD after trabeculectomy.
This study followed 115 eyes of 115 patients for at least 2 years after trabeculectomy. The central cornea was examined by corneal specular microscopy prior to and at every 6 months after the surgery. Survival analysis of patients who exhibited a 20% or less reduction of the postoperative CECD compared to preoperative levels was assessed using the Kaplan-Meier survival curve. The seven possible risk factors for CECD reduction that were observed included age, gender, CECD before surgery, combined with cataract surgery, postoperative shallow anterior chamber, postoperative mean intraocular pressure (IOP), and type of glaucoma. These seven parameters were selected by a univariate analysis and then used for the Cox proportional hazards model analysis.
The mean follow-up period was 32.0±8.1 months. At baseline, the mean CECD was 2405±370 cells/mm2, while at 6, 12, 18, 24, 30, 36 and 42 months after surgery, the mean CECD was 2320±373 cells/mm2 (P < 0.001), 2270±408 cells/mm2 (P < 0.001), 2291±403 cells/mm2 (P < 0.001), 2260±454 cells/mm2 (P < 0.001), 2283±484 cells/mm2 (P = 0.008), 2205±505 cells/mm2 (P < 0.001) and 2125±582 cells/mm2 (P < 0.001), respectively. At 12, 24, and 36 months after surgery, the results of the Kaplan-Meier survival analysis of the 20% loss of CECD from baseline were 95%, 92%, and 85%, respectively. Uveitic glaucoma was significant prognostic factor for decreasing CECD (P = 0.01).
CECD significantly and continuously decreased after trabeculectomy. This suggests that not only the IOP but also the CECD needs to be carefully examined in glaucoma patients, especially uveitic glaucoma patients, after trabeculectomy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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