Determinants of Corneal Endothelial Cell Loss After Trabeculectomy With Mitomycin C

Abstract

Purpose: To investigate factors associated with decreased corneal endothelial cell density (ECD) after trabeculectomy with mitomycin C (MMC). Methods: Retrospective review of consecutive glaucoma cases who underwent trabeculectomy with MMC. The types of glaucoma included were primary open-angle glaucoma, exfoliation glaucoma (XFG), neovascular glaucoma, and uveitic glaucoma (UG). The postoperative ECD changes compared with the preoperative ECD and risk factors for ECD decrease were analyzed using mixed-effects models. Results: In total, 162 eyes of 136 patients were included in this study. Postoperative ECD measurements were performed 3.7±1.8 times (mean±SD) during a median follow-up period of 34 months. The mean intraocular pressure decreased from 25.3±9.6 to 9.2±2.3 mm Hg postoperatively. The marginal mean (SE) ECD decrease at 24 months was 9.3% (1.3%) in all cases. The marginal mean ECD decrease at 24 months was 18.2% (3.1%) and 20.6% (4.7%) in eyes with XFG and UG, respectively, which was significantly greater than 4.8% (1.8%) in eyes with primary open-angle glaucoma (P<0.001, each), after accounting for the variability in the number and timepoint of ECD measurements. Multivariate mixed-effects model analyses showed that type of glaucoma (XFG and UG) and older age were significantly associated with larger ECD decrease, and preoperative factors (oral carbonic anhydrase inhibitor and vitrectomy) and postoperative choroidal detachment were significantly associated with a declining trend of ECD over time. Conclusions: The type of glaucoma (XFG, UG) and older age were risk factors for larger ECD decrease after trabeculectomy with MMC.

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

“…At present, the most common aetiology of corneal oedema is cataract surgery [6]. Filtering glaucoma surgery causes less cell loss than cataract surgery [7][8][9][10][11][12][13][14][15][16], but it may also cause significant cell loss, especially if combined with cataract surgery [12,14,17,18].…”

<p>Effects of Baerveldt Glaucoma Implant Surgery on Corneal Endothelial Cells of Patients with No History of Trabeculectomy</p>

“…The mean of ECD decreases at an average rate of approx. 0.6% per year for normal adults, whereas in patients underwent trabeculectomy were about 10% per year 9–11. The reasons rapid corneal endothelial cell loss due to trabeculectomy were toxic effects of mitomycin-C (MMC) or peripheral iridotomy 12,13.…”

Prospective study of corneal endothelial cell loss after trabeculectomy

“…The percentage of corneal endothelial cell density (ECD) loss after trabeculectomy ranged from 3.2% to 18.2% (Kim et al, 2016; Lee et al 2017; Arimura et al 2018; Hirooka et al, 2019). Furthermore, previous studies reported that the risk factors for corneal ECD loss after trabeculectomy are mitomycin C, older age, uveitic glaucoma and exfoliation glaucoma (Zarei et al 2015; Hirooka et al, 2019; Higashide et al; 2019). The present study aimed to evaluate the long‐term changes in corneal ECD loss after trabeculectomy and identify the risk factors for corneal ECD loss.…”