Changes of corneal endothelial cell density after EX-PRESS® Glaucoma shunt implantation: 2-year follow-up study.

Abstract

Purpose: To evaluate effects of the EX-PRESS ® glaucoma filtering device on the corneal endothelial cell density (ECD) in eyes with open angle glaucoma (OAG).Designs: A prospective, non-comparative study. Methods: We prospectively evaluated the changes in the ECD, hexagonality, and coefficient of variation (CV) in 20 eyes of 19 patients who had an implantation of the EX-PRESS ® . The type of glaucoma was exfoliation glaucoma in 6 eyes, uveitic glaucoma in 5 eyes, secondary glaucoma following vitrectomy in 4 eyes, primary OAG in 3 eyes, and neovascularization glaucoma in 2 eyes. Corneal specular microscopy was performed at the central cornea before, 1, and 2 years after the EX-PRESS ® implantation. Results: The mean ECD was 2008 cells/mm 2 before the surgery, 1956 cells/mm 2 at 1 year, and 1846 cells/mm 2 at 2 years after the surgery which represent a decrease of 5.0% at 1 year and a further decrease of 9.4% at 2 years. The decrease in the ECD from baseline to 1 year was not statistically significant, however the decreases from the baseline to 2 years (P<.0001) and from 1 year to 2 years (P=.0001) were significant. There was a significant change in the CV between the baseline and 1 year (P=0.03), and the change between baseline and 2 years was close to a statistically significant difference (P=0.07). There was no significant change in hexagonality during the 2 years. Two eyes with low preoperative ECD had a marked decrease in the ECD at 2 years. Conclusions: There is a slow decrease in the ECD after the EX-PRESS ® implantation.

Corneal Endothelial Cell insult by Chronically Elevated Intraocular Pressure in Primary Open Angle Glaucoma: A Cross-sectional Study

“…This study revealed early affection of CV% and HEX% but not CEC density, which may be affected in the interval period of chronic IOP elevation before the diagnosis of glaucoma has been made. Yu ZY et al reported that elevated IOP cause destruction of the HEX% and the damage of the cells causes further deformation and loss, but he didn't correlate these changes of corneal endothelial cells to RNFL thickness nor macular GCC thickness 24 Morphological changes of corneal endothelial cell detected in early glaucoma with controlled IOP could be attributed only to IOP changes as eyes with previous surgical and LASER procedures-known to affect corneal endothelium in other studies were excluded [25][26][27] . The effect of topical antiglaucoma medication on corneal endothelium is negligible according to Kwou-Yeung Wu et al, 20 .…”

Corneal endothelium, retinal nerve fiber layer, ganglion cell complex, and perimetry measurements in normal eyes and those with primary open-angle glaucoma

“…Morphological changes in CECs detected in early glaucoma with controlled IOP could be attributed only to IOP changes, as eyes with previous surgical and laser procedures known to affect corneal endothelium [ 26 , 27 ] were excluded from our analyses. The effect of topical antiglaucoma medication on corneal endothelium is negligible according to Wu et al [ 20 ].…”

Progression of Corneal Endothelial Insult by Chronic Elevation of intraocular Pressure: A prospective Observational Comparative Study Among Primary Open Angle Glaucoma Patients

“…This study revealed early affection of CV% and HEX% but not CEC density, which occurred in the interval period of chronic IOP elevation before the diagnosis of glaucoma has been made. Yu ZY et al reported that elevated IOP cause destruction of the HEX% and the damage of the cells causes further deformation and loss, but he didn't correlate these changes of corneal endothelial cells to PRNFL thickness nor macular GCC thickness 23 Morphological changes detected in early glaucoma with controlled IOP could be attributed only to IOP changes as eyes with previous surgical and LASER procedures-known to affect corneal endothelium in other studies were excluded [24][25][26] . The effect of topical antiglaucoma medication on corneal endothelium is negligible according to Kwou-Yeung Wu et al, 19 .…”