A study of endothelial cell count pre- and post-neodymium-doped yttrium aluminum garnet laser iridotomy in subacute angle closure using specular microscope

Abstract

AIM: The aim of this study was to study the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iridotomy on corneal endothelial cell count in patients with subacute angle closure using specular microscope. MATERIALS AND METHODS: In this prospective study, 50 cases of narrow-angle Grade 1 and Grade 2 (Shaffer gonioscopic grading) visiting the Regional Institute of Ophthalmology, Government Medical College, Amritsar underwent Nd:YAG laser peripheral iridotomy. After obtaining informed written consent, specular microscopy was performed before and after iridotomy at 1 week, 1 month, 3 rd month, and at 6 th -month follow-up visits. Central, nasal, and temporal endothelial cell counts were evaluated through noncontact specular microscopy. RESULTS: The mean participant age was 51.52 ± 7.9 years, and majority of the participants were females (76%). The mean IOP before the laser was 19.25 ± 1.914 mmHg and it varied from 18.50 ± 1.647 to 18.25 ± 1.699 mmHg (day 1, p = 0.06 and at 6 months, p = 0.04) following laser procedure. The mean corneal endothelial cell count at superotemporal site before laser peripheral iridotomy was 2844 ± 260, and this value decreased to 2807 ± 263, 2699 ± 267, 2656 ± 270, and 2591 ± 275 cells/mm 2 at postiridotomy, 1, 3, and 6 months’ follow-up visits, respectively; these differences were statistically significant ( p < 0.05). The mean total energy required to produce iridotomy was 14.88 ± 6.71 mJ, ranging from 5 to 37 mJ. The linear regression analysis indicated no statistical correlation between change in endothelial cell count at the treated site and total mean energy used. No significant difference was found between preiridotomy and postiridotomy corneal thickness at any site. CONCLUSION: This study demonstrated a significant endothelial cell loss at the treated site in 6 months’ follow-up and suggested that Nd:YAG laser iridotomy may pose hazard to the corneal endothelium, although corneal decompensation at the treated site or as a whole was not seen.

Association Between Anterior Chamber Angle and Corneal Endothelial Cell Density in Chronic Angle Closure

“…Many recent studies with the interest on corneal endothelium in patients with angle closure focused on the effect of laser peripheral iridotomy or phacoemulsification. [29][30][31][32][33][34][35] In PACS, LPI does not appear to cause clinically significant corneal endothelial damage over 1, 3, and 6 years after treatment. [29][30][31][32] However, Bansal et al 33 demonstrated a significant endothelial cell loss at the treated site at a 6 monthfollow-up and suggested that Nd:YAG laser iridotomy may pose hazard to the corneal endothelium in patients with subacute angle closure.…”

“… 29–35 In PACS, LPI does not appear to cause clinically significant corneal endothelial damage over 1, 3, and 6 years after treatment. 29–32 However, Bansal et al 33 demonstrated a significant endothelial cell loss at the treated site at a 6 monthfollow-up and suggested that Nd:YAG laser iridotomy may pose hazard to the corneal endothelium in patients with subacute angle closure. Studies have also been conducted to evaluate the effect of phacoemulsification on corneal endothelial cells in acute angle closure.…”

Effect of Hydroxypropylmethylcellulose versus Sodium Hyaluronate on corneal endothelial cell count in patients undergoing cataract surgery by phacoemulsification

“…1 With increased age, endothelial cells decrease in fully developed cornea. 2 Basic physiological function performed by corneal endothelium is allowing leakage of nutrients and solutes from the aqueous humor to superficial layers of the cornea and water is pumped in opposite direction actively i.e. from stroma to the aqueous.…”