Study reveals risk factors for endothelial cell loss after B
This study examines risk factors for corneal endothelial cell density (ECD) loss after Baerveldt glaucoma implant insertion.

This prospective cohort study included 72 patients (72 eyes) with glaucoma. Central corneal endothelial cell density, peripheral corneal endothelial cell density, anterior chamber flare, tube insertion entry site position, anterior segment OCT tube parameters, and clinical parameters were evaluated after Baerveldt glaucoma implant insertion. Primary outcomes were central and peripheral endothelial cell density loss at 5 years. Secondary outcomes included prognostic factors for endothelial cell density loss: tube insertion entry site position relative to Schwalbe’s line (SL); anterior segment OCT tube parameters; anterior chamber flare and clinical factors including IOP. Tube insertion entry site positions were defined as all of the entry sites behind SL (tube insertion position 1), less than 50% of entry site anterior to SL (tube insertion position 2), more than 50% but less than 100% of entry site anterior to SL (tube insertion position 3; TIP3), and all of the entry site in front of SL (tube insertion position 4; TIP4).

Sixty-four patients completed the study. The mean percentages of central and peripheral endothelial cell density loss at 5 years were 36.8% and 50.1%, respectively. On univariate analysis at 5 years, a lower central endothelial cell density was associated with TIP3. Tube angle-to-anterior iris distance, tube length, and TIP3 were associated with lower peripheral endothelial cell density at 5 years.

Multiple regression analysis revealed TIP3 to be associated with both lower central endothelial cell density and peripheral endothelial cell density. A short tube length was associated with lower peripheral endothelial cell density. The fastest rate of cell loss was associated with TIP3 for central endothelial cell density and TIP4 for peripheral endothelial cell density. Anterior chamber implant insertion was associated with endothelial cell density loss greatest close to the tube. Tube insertion in the vicinity of or anterior to SL, and short tube length were associated with significant endothelial cell density loss with time.

Placement of glaucoma drainage devices is common and resulting corneal decompensation has been reported. While some endothelial cell density loss occurs with all tube shunts over time, this study provides guidance on risk factors for endothelial cell density loss as well as tube insertion landmarks, position, and length to minimize endothelial cell density loss.

Source:https://www.aao.org/editors-choice/study-reveals-risk-factors-endothelial-cell-loss-a
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