Introduction:To analyze the effects of PRE-SERFLO on corneal endothelial cell density (ECD). Methods: Forty-six eyes that underwent PRE-SERFLO implantation were followed up for 12 months. Specular microscopy was performed preoperatively and at 1, 3, 6, and 12 months postoperatively to measure central ECD and mean monthly reduction (MMR). Anterior segment optical coherence tomography (AS-OCT) was applied to measure the tube-endothelium (TE \ 200 lm, 201-500 lm, [ 500 lm) distance. The relationship between TE distance and ECD was analyzed with a linear mixed-effects model. Results: Central ECD decreased significantly at 1 year (7.4%, p = 0.04), with an MMR of -15 ± 25 cells/mm 2 . Regarding TE distance groups, there was an 18% ECD reduction in the \ 200 lm group vs. 1% in the [ 500 lm group (p = 0.08). Endothelial cell loss was related to TE distance (mean 482.9 ± 238 lm), with a higher rate at 1 month in comparison to 12 months for the same tube position in the anterior chamber (-174.8 ± 65.2 cells/mm 2 at 1 month vs. 30.2 ± 11.3 cells/mm 2 at 12 months, p \ 0.01). From month 6, tubes located [ 600 lm from the endothelium showed EC loss close to zero. Conclusions: The PRESERFLO implant is associated with a loss of EC from the immediate postoperative period that continues over time at lower rates. A shorter TE distance appears to cause more severe ECD loss.
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