Corneal endothelial cell loss after trabeculectomy and phacoemulsification in one or two steps: a prospective study

Abstract

Objective The objective of this study was to analyse the results of the surgical treatment of coexisting cataract and glaucoma and its effects on corneal endothelial cell density (CECD). Methods We include two longitudinal prospective studies: one randomised that included 40 eyes with open angle glaucoma that received one- (n = 20) or two-step (n = 20) phacotrabeculectomy and another that included 20 eyes that received phacoemulsification. We assess the impact of surgery on different clinical variables and in particular in CECD using Confoscan 4™ confocal microscopy and semiautomatic counting methods. Results Phacoemulsification and phacotrabeculectomy, but not trabeculectomy, increase significantly best-corrected visual acuity and anterior chamber depth and trabeculectomy and one- or two-step phacotrabeculectomy decreased similarly the intraocular pressure. We document percentages of endothelial cell loss of 3.1%, 17.9%, 31.6% and 42.6% after trabeculectomy, phacoemulsification and one- or two-step phacotrabeculectomy, respectively. The coefficient of variation did not increase significantly after surgery but the percentage of hexagonality decreased significantly after phacoemulsification and after two-step phacotrabeculectomy. Conclusions Trabeculectomy, phacoemulsification and phacotrabeculectomy are surgical techniques that cause morphological changes and decrease the densities of the corneal endothelial cells. Trabeculectomy produces lesser endothelial cell loss than phacoemulsification, and phacoemulsification lesser cell loss than phacotrabeculectomy. Two-step phacotrabeculectomy (trabeculectomy followed 3 months later by phacoemulsification) causes more cell loss than one-step phacotrabeculectomy, and this could be due to the cumulative effects of two separate surgical traumas or to a negative conditioning lesion effect of the first surgery. For the treatment of coexisting glaucoma and cataract, one-step phacotrabeculectomy is the treatment of choice.

Evaluation of pre-operative and post-operative endothelial cell counts in single-site versus twin-site phacoemulsification trabeculectomy: A Prospective, randomized study

“…Hence, there is a significantally lower loss of corneal endothelial cells in twin site phacotrabeculectomy as compared to single site. In the present study, the visual acuity after a follow up period of 3 months improved both in single site and twin site to values being 50.82% in single site and 62.97% in twin site surgeries and IOP was reduced to an average of 11.81±1.13 at a follow up period of 3 months [10] . A prospective randomized controlled trial in 2008 by Buys YM et al, noted no statistically significant difference in post-operative IOP between two types of surgeries.…”

Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation

“…Such incisional intraocular surgeries are associated with endothelial cell loss and increased risk of graft decompensation. 26 Additionally, the use of antimetabolite, especially 5-fluorouracil (5-FU), and tube-endothelium touch are additional possible causes of corneal graft failure. Graft survival in post-keratopathy glaucomatous patients undergoing tube shunt surgeries ranges from 60% to 88%, while after GDDs the graft failure occurred in 35-74% of the patients at 2 years of follow-up.…”

Small incision lenticule extraction and femtosecond-assisted laser in situ keratomileusis in patients with deep corneal opacity: case series

“…We speculate that the traumatic history by spectacles of case 1 or severe firecracker wound and subsequent intraocular surgeries of case 4 contributed to preoperative endothelial cell loss (ECL). ECL can result from inherited, inflammatory, traumatic, immunological, intraocular manipulation, and infectious etiologies [12][13][14] . Mechanical injury in infants caused significant ECL with a higher annual decrease compared to the fellow eye [15] .…”