Abstract
BackgroundTo compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD).MethodsThis study prospectively evaluated changes in the CECD in 60 eyes of 60 patients who underwent trabeculectomy and 50 eyes of 45 patients who underwent EX-PRESS device implantation. Baseline patient data recorded included age at surgery, sex, type of glaucoma medications, and lens status. Using a noncontact specular microscope, corneal specular microscopy was performed preoperatively at the central cornea and then at 6, 12, 18 and 24 months after surgery. CECD before and after surgery was compared using a paired t-test.ResultsThere was a significant decrease in the IOP and number of antiglaucoma medications in both groups after the surgery. The mean CECD in the trabeculectomy group was 2505 ± 280 cells/mm2 at baseline, while it was 2398 ± 274 cells/mm2 (P < 0.001), 2349 ± 323 cells/mm2 (P < 0.001), 2293 ± 325 cells/mm2 (P < 0.001), and 2277 ± 385 cells/mm2 (P = 0.003) at 6, 12, 18, and 24 months, respectively. However, the CECD in the EX-PRESS group was 2377 ± 389 cells/mm2 at baseline, while it was 2267 ± 409 cells/mm2 (P = 0.007), 2292 ± 452 cells/mm2 (P = 0.043), 2379 ± 375 cells/mm2 (P = 0.318), and 2317 ± 449 cells/mm2 (P = 0.274) at 6, 12, 18, and 24 months, respectively.ConclusionsAs compared to trabeculectomy, EX-PRESS device implantation appears to be a safer procedure with regard to the endothelial cell loss risk.
Highlights
To compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD)
It has been previously shown that trabeculectomy can damage corneal endothelial cells [10–13], no changes have been observed in the CECD at either 1 or 3 months after EX-PRESS implantation surgery [12]
No significant differences were observed for the patient age, gender, and lens status between the trabeculectomy and EX-PRESS shunt groups
Summary
To compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD). The aim of glaucoma treatments is to slow disease progression while preserving visual functions without changing the patient’s quality of life These treatments are primarily designed to lower the intraocular pressure (IOP), with first approaches utilizing medical therapies with antiglaucomatous drugs. The EX-PRESS drainage device (Alcon Laboratories, Fort Worth, TX) was designed and created as a safer alternative for controlling the IOP [1]. This device, In young adults, the corneal endothelial cell density (CECD) is approximately 3000 cells/mm. It should be noted that this previous study did not Omatsu et al BMC Ophthalmology (2018) 18:243 compare eyes undergoing implantation to a control group of eyes undergoing trabeculectomy
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