Abstract
Purpose :
The corneal endothelium plays an important role in maintaining corneal health and transparency. Glaucoma is a widely prevalent disease which can be managed medically, surgically, and/or with laser treatment, yet the effects of glaucoma treatments on the corneal endothelium is unknown. We performed a retrospective, observational clinical study to describe the characteristics of the corneal endothelium of glaucomatous eyes by specular microscopy. Our goal was to compare the health of the corneal endothelium of glaucomatous eyes treated with various treatment modalities.
Methods :
The central cornea of 121 eyes consisting of normal control and glaucoma-affected eyes were imaged using the Konan NSP-9900 specular microscope. Any eyes with corneal pathology (other than dry eye disease), keratoplasty, or cataract or glaucoma surgery within the past 6 months were excluded. Glaucomatous eyes were divided into those treated by topical medication only, or those who received two or more treatment types: glaucoma drops, laser, or incisional surgery. The Konan CellChek software was used to perform analysis of endothelial cell density (ECD).
Results :
The mean ECD was significantly decreased in glaucomatous eyes compared to normal control eyes (p<0.001). Glaucomatous eyes treated with topical medication had lower average ECD compared to controls. A one-way ANOVA performed comparing the ECD of control, medically treated, and eyes that received 2 or more treatment types showed a statistically significant difference between groups (p<0.0005). Glaucomatous eyes that had undergone 2 or more treatment types (laser, surgery, and medication) had a significantly decreased ECD compared to those which received medication alone (p<0.05).
Conclusions :
Eyes with glaucoma, particularly those receiving 2 or more treatments, have a lower corneal ECD than controls. Lower ECD suggests that corneal endothelial cell loss is associated with glaucoma treatment and/or the disease process itself. Eyes that had undergone multiple treatments had significantly lower ECD than eyes treated with medication alone, indicating that cell loss in the corneal endothelium likely increases with additional glaucoma treatments. Further studies are needed to explore the underlying mechanism for this decrease in corneal endothelial cell density in patients with glaucoma, and to characterize which treatments have the most impact on the health of the corneal endothelium.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.