Corneal Endothelial Cell Loss in Patients After Minimally Invasive Glaucoma Surgery: Current Perspectives

Obuchowska, Iwona; Konopińska, Joanna

doi:10.2147/opth.s359305

Cited by 8 publications

(9 citation statements)

References 68 publications

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“…ECL = endothelial cell loss; Phaco = phacoemulsification points highlighted by the authors of those original publications. 32,33 Given that corneal endothelial cells do not regenerate, any ECL incurred is additive over the lifetime of the patient. The results of this study indicate that iStent inject exhibited the highest endothelial safety both in surgical trauma and long-term placement, contributing least additional ECL vs control.…”

Section: Discussionmentioning

confidence: 99%

“…The endothelial outcomes reported in the present paper are more comprehensive than what was summarized in the systematic reviews of Obuchowska et al and Seah et al, since the current analysis incorporates all published endothelial end points from the 3 pivotal trials rather than only the end points highlighted by the authors of those original publications. 32,33…”

Section: Discussionmentioning

confidence: 99%

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Corneal endothelial safety profile in minimally invasive glaucoma surgery

Ahmed,

Sheybani,

De Francesco

et al. 2024

J Cataract Refract Surg

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Purpose: To compare 5-year corneal endothelial safety of 3 micro-invasive glaucoma surgery devices (iStent inject, Hydrus Microstent, CyPass Micro-Stent). Setting: U.S. multicenter trials. Design: Post hoc 5-year analysis from prospective randomized single-masked pivotal trials. Methods: Mild to moderate open-angle glaucoma subjects received a MIGS implant with phacoemulsification (implant+phaco) or phaco alone (control). Five-year endpoints comparing the implant and control groups included proportion of eyes with significant endothelial cell loss (ECL) (>30% or ≥30% vs. baseline) and mean endothelial cell density (ECD). Results: Comparable proportions of eyes in the iStent inject+phaco and control groups had significant 60-month ECL (9.4% vs. 6.3%, respectively, diff: 3.2%, 95% CI: (-5.0%, 11.3%), P=0.77). Hydrus (20.8% vs. 10.6%, diff: 10.2%, 95% CI: (3.2%, 17.2%), P=0.01) and CyPass (27.2% vs. 10.0%, diff: 17.2%, 95% CI: (5.6%, 28.7%), P=0.02) had more eyes with ECL vs. controls (iStent inject 1.49X, Hydrus 1.96X, CyPass 2.72X vs. controls). Mean ECD over 60 months for iStent inject was indistinguishable vs. control, while greater ECL was observed primarily 3 months postoperative (Hydrus) or accelerated after 2 years (CyPass). No iStent inject or Hydrus subjects developed persistent corneal edema, while 7 CyPass-implanted eyes developed ECL-related complications. Conclusions: Through 5 years postoperative, there were no differences in proportion of eyes with significant ECL or mean ECD between the iStent inject and control groups. There was greater 5-year ECL and lower ECD in the Hydrus and CyPass groups versus controls. The Hydrus ECL rate mirrored control after 3 months; the CyPass ECL rate accelerated vs. control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Corneal endothelial safety profile in minimally invasive glaucoma surgery

Ahmed,

Sheybani,

De Francesco

et al. 2024

J Cataract Refract Surg

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“…Trabeculectomy, tube shunt surgery and MIGS are associated with CECL. Obuchowska and Konopińska assumed that increased CECL may result from the chronic presence of a titanium foreign body in the trabecular meshwork, which is rich in phagocytic and antigen-presenting cells; extensive manipulation within the anterior chamber during implantation; and postoperative contact between the blood and endothelium 90. Olgun et al indicated that XEN gel stent (Allergan, Belfast, Ireland) resulted in a 2.1% reduction in the endothelial cell density at 3 months after surgery 91.…”

Section: Discussionmentioning

confidence: 99%

Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis

et al. 2023

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ObjectiveTo compare the efficacy and safety of tube shunt implantation with trabeculectomy in the treatment of patients with glaucoma.MethodsA systematic literature search was performed for studies comparing tube with trabeculectomy in patients with glaucoma (final search date: 27 February 2022). Comparisons between tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified success rate (QSR) and adverse events (AEs).ResultsForty-nine studies were included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (–5.35, 8.02), p=0.69; Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (–3.07, 3.31), p=0.94). The IOP outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=−7.51 (–10.68, –4.35), p<0.00001), but the QSR was higher. No significant difference was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes (IOPR%: MD=−7.87 (–13.55, –2.18), p=0.007), while the success rate was similar. Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, diplopia/strabismus and tube erosion. The incidence of AEs was similar for the XEN and trabeculectomy procedures.ConclusionCompared with trabeculectomy, both Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve sufficient reductions in IOP outcomes similar to those of trabeculectomy.PROSPERO registration numberCRD42021257852.

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“… 19 Prospective studies have shown that iStent inject implantation combined with phacoemulsification has a minimal effect on corneal endothelial cell loss (CECL). 15 , 20 , 21 In the iStent inject pivotal trial, Samuelson et al reported CECL percentages of −13.1% and −12.3% in eyes receiving phacoemulsification-alone and phacoemulsification-iStent inject surgery, respectively, with a comparable CECL >30% observed in both groups at 24 months (10.4% vs 9.5%). 15 Likewise, Gillman et al analyzed 54 eyes with mild to moderate open angle glaucoma and found similar CECL percentages in phacoemulsification-alone (−14.4%) and phacoemulsification-iStent inject eyes (−14.6%) at 12 months.…”

Section: Istent Injectmentioning

confidence: 99%

Spotlight on Schlemm’s Canal MicroStent Injection in Patients with Glaucoma

Wagner,

Ang,

Checo

et al. 2023

OPTH

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Minimally invasive glaucoma surgery (MIGS) has revolutionized glaucoma care with its favorable safety profile and ability to delay or minimize the need for traditional, bleb-based procedures. Microstent device implantation is a type of angle-based MIGS, which reduces intraocular pressure (IOP) through bypass of the juxtacanalicular trabecular meshwork (TM) and facilitation of aqueous outflow into the Schlemm’s canal. Although there are limited microstent devices on the market, multiple studies have evaluated the safety and efficacy of iStent ® (Glaukos Corp.), iStent Inject ® (Glaukos Corp.), and Hydrus ® Microstent (Alcon) in the treatment of mild-to-moderate open-angle glaucoma, with and without concurrent phacoemulsification. This review attempts to provide a comprehensive evaluation of injectable angle-based microstent MIGS devices in the treatment of glaucoma.

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Corneal Endothelial Cell Loss in Patients After Minimally Invasive Glaucoma Surgery: Current Perspectives

Cited by 8 publications

References 68 publications

Corneal endothelial safety profile in minimally invasive glaucoma surgery

Corneal endothelial safety profile in minimally invasive glaucoma surgery

Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis

Spotlight on Schlemm’s Canal MicroStent Injection in Patients with Glaucoma

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