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Category: Volume 08 Issue 03 March 2020
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Title: Implications of Glaucoma Management on Corneal Endothelial Cell Density - Two Edged Sword

Authors: Dr Preeti Rawat, Dr Varun Upadhyay , Dr V Bhaisare, Dr S. Walia, Dr Neetu Kori

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.23

Abstract

   

Purpose: To study the effect of glaucoma management on corneal endothelial cell density.

Method: Our study included 112 eyes of 65 diagnosed cases of glaucoma of same age group who underwent visual acuity test, IOP measurement, Gonioscopy, Fundus examination and specular microscopy analysis. Exclusion criteria included history of corneal disease, diabetes mellitus, any ocular inflammation, trauma or surgery other than peripheral iridectomy.

Observations and Results:  Patients who underwent PI or Trabeculectomy were found to have significantly lower cell density (2080 +263 cells/mm2)than those without any surgical or laser intervention (2474 + 362 cells/mm2) (p=0.000). Although statistically insignificant, but patients on 3 or 4 anti glaucoma medications were having lower cell density than those on 1 or 2 medication.

Conclusion: In our study it is evident that cell density is lower in glaucoma patients than those without glaucoma. This may be proposed to direct damage from high IOP, post trabeculectomy or iridectomy cell loss, medication toxicity or combination of these. So while achieving target pressure benefit- risk ratio of endothelial cell density decompensation should be mandatorily considered.

Keywords: Glaucoma, Endothelial cell density, laser PI, Trabeculectomy.

References

  1. Edelhauser HF. The balance between corneal transparency and edema: the Proctor Lecture. Invest Ophthalmol Vis Sci.2006;47:1754e67.
  2. Aldrich BT, Schlotzer-Schrehardt U, Skeie JM, et al. Mitochondrial and morphologic alterations in native humancorneal endothelial cells associated with diabetes mellitus. Invest Ophthalmol Vis Sci. 2017;58:2130e8
  3. Janson BJ, Alward WL, Kwon YH, et al. Glaucoma-associated corneal endothelial cell damage: a review. Surv Ophthalmol 2018; 63: 500–506.
  4. Jonas JB, Aung T, Bourne RR, et al. Glaucoma. Lancet.2017; 390:2183e93
  5. Arnavielle S, Lafontaine PO, Bidot S, et al. Corneal endothelialcell changes after trabeculectomy and deep sclerectomy.J Glaucoma. 2007;16:324e8
  6. Anshu A, Price MO, Price FW. Descemet’s strippingendothelial keratoplasty: long-term graft survival and riskfactors for failure in eyes with pre-existing glaucoma. Ophthalmology. 2012;119:1982e7
  7. Gagnon MM, Boisjoly HM, Brunette I, et al. Cornealendothelial cell density in glaucoma. Cornea. 1997;16:314e8.
  8. Baratz KH, Nau CB, Winter EJ, et al. Effects of glaucoma medications on    corneal endothelium, keratocytes, and subbasal nerves among participants in the ocular hypertension treatment study. Cornea. 2006;25:1046e52.
  9. Kim MS, Kim KN, Kim CS. Changes in corneal endothelial cell after Ahmed glaucoma valve implantation and trabeculectomy: 1-year follow-up. Korean J Ophthalmol.2016;30:416e25.

Corresponding Author

Dr Varun Upadhyay

PG Resident, Dept of Ophthalmology, MGM medical college Indore MP 452001 INDIA