Changes in the Density of Corneal Endothelial Cells in Elderly Diabetic Patients After Combined Phacovitrectomy and Ex-PRESS Glaucoma Implants

Abstract

Background & Objective: Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland. Methods: In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey’s post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant. Results: The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05). Conclusion: Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.

Endothelial Cell Density After XEN Implant Surgery: Short-term Data From the Italian XEN Glaucoma Treatment Registry (XEN-GTR)

“…It was suggested that the reduction of ECD was greater in tube-shunt surgery than in trabeculectomy 17. In addition, Ex-PRESS shunt implantation was associated with a significant reduction in the number of corneal endothelial cells, despite the reduction was found to be lower than that observed after classical trabeculectomy 20,21…”

“…in the number of corneal endothelial cells, despite the reduction was found to be lower than that observed after classical trabeculectomy. 20,21 Minimally invasive glaucoma surgery may offer a safer and less invasive means of lowering intraocular pressure (IOP) than traditional surgery. 22,23 However, it should be noted that the supraciliary CyPass micro-stent has been withdrawn from the market after the results of the COMPASS-XT long-term safety study, which reported a significant ECD reduction in patients undergoing the implantation of the micro-stent in combination with cataract surgery.…”

Dose- and Time-Dependent Cytotoxicity of Carteolol in Corneal Endothelial Cells and the Underlying Mechanisms

“…Since cornea endothelial cells from feline species have no proliferation (Landshman et al, 1987), they are considered similar to HCECs, which thus provide a great model to assess the cytotoxicity of carteolol. Our results showed that 2% clinical carteolol induces a time-dependent reduction in corneal ECD, and increases the average size ratio of endothelial cells in vivo, which can cause deterioration in visual acuity in ophthalmic disease (Lyssek-Boroń et al, 2019). Furthermore, ultrastructural observations showed that FCE cells had shrunk, and this process was accompanied by mitochondrial swelling and cytoplasmic vacuolation after carteolol treatment .…”

Endothelial Cell Density before and after Phacoemulsification in patients with Diabetes Mellitus

“…Our results coincide with theirs. 16,17 Hugod M. et al noted that patients with diabetes had a lengthy recovery period from corneal edoema and significant CED destruction. The mean CED depletion was found to be 6.2% in the diabetic group and 1.4% in the control category after the researchers evaluated 30 patients with type 2 diabetes and 30 healthy subjects.…”