Abstract
Background/objectives
To investigate changes in corneal endothelial cell density (CECD) after initial Ex-PRESS surgery in Japanese patients with open-angle glaucoma (OAG) followed-up for 36 months.
Subjects/methods
Corneal specular microscopy was used to examine preoperative and postoperative (3, 6, 12, 24 and 36 months) CECD and CECD changes were analysed. Kaplan–Meier survival curve was used to examine CECD maintained at 95% level, and Cox proportional hazards model was used to detect the risk factors for CECD loss. Intraocular pressure (IOP) changes during the course were also examined.
Results
A total of 79 eyes of 79 patients (standalone surgery, 24 cases; combined cataract surgery, 55 cases) were investigated. Preoperative CECD (mean ± SD) was 2521 ± 305 cells/mm² and 2429 ± 366 (P = 0.003, adjusted for Bonferroni correction), 2462 ± 332 (P = 0.002), 2457 ± 317 (P < 0.001), 2433 ± 333 (P < 0.001), and 2387 ± 352 (P < 0.001) at 3, 6, 12, 24 and 36 months, respectively. The decrease rate was calculated as 1.8%/year. Further, 95% maintenance CECD at 36 months was 50.0% (95% confidence interval, 37.1–63.0%). Both univariate and multivariate Cox proportional hazard models showed that a low preoperative CECD was a significant risk factor for CECD loss. Baseline IOP of 19.3 ± 5.8 mmHg decreased at all measurement points (P < 0.001) after surgery.
Conclusion
CECD after initial Ex-PRESS surgery in 36 months might not be clinically problematic. However, longer-term follow-up is necessary, and regular CECD measurement should be performed, especially in patients with low CECD.
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Acknowledgements
The authors would like to thank Enago (www.enago.jp) for the English language review.
Funding
Supported in part by the GRANT 18K16945 from the Ministry of Education, Culture, Sports, Science and Technology of Japan (R.S.). The funding organization had no role in the design or conduct of this research.
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Study conception and design: MA and SS; Acquisition of data: YA, RS, TF, MH, SS and MA; Analysis of interpretation of data: YA, RS and MA; Drafting of the manuscript: YA, RS and MA; Critical revision: MH, SS and MA.
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Aoyama, Y., Sakata, R., Fujishiro, T. et al. Changes in corneal endothelial cell density after initial Ex-PRESS drainage device implantation and its relating factors over 3 years. Eye 37, 69–74 (2023). https://doi.org/10.1038/s41433-021-01888-1
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DOI: https://doi.org/10.1038/s41433-021-01888-1
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