Endothelial cell loss associated with minimally invasive glaucoma surgery

Abstract

Purpose of reviewMinimally invasive glaucoma surgery (MIGS) represents a safer, albeit moderately effective surgical option for intraocular pressure control. However, the CyPass Micro-Stent (Alcon Laboratories) was withdrawn from the market in 2018 as the COMPASS-XT study demonstrated greater cornea endothelial cell (CEC) loss in patients who received the CyPass Micro-Stent with phacoemulsification compared with phacoemulsification alone. This led to the increased attention on MIGS-associated CEC loss and thus, this review will summarise the recent, available evidence on MIGS-associated CEC loss. Recent findingsProspective clinical trials and retrospective observational studies published between 2011 and 2021 reported a wide range of 12 month CEC loss from 'insignificant', and up to 14.6%, for phacoemulsification combined with various MIGS procedures. Recent clinical trials over the same time period reported CEC loss of 12.8-15.2% associated with phacoemulsification alone.

Corneal endothelial safety profile in minimally invasive glaucoma surgery

“…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.…”

“…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…”

Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma

“…It has been reported that the Cypass microstent was effective to sustain IOP reduction over 2 years in POAG 55,56. The Cypass suprachoroidal stent was withdrawn from the market in 2018 due to significant loss of corneal endothelial cells 57…”

“…55,56 The Cypass suprachoroidal stent was withdrawn from the market in 2018 due to significant loss of corneal endothelial cells. 57…”