Investigation of Endothelial Cell Density after PreserFlo Implantation Compared to Contralateral Eyes without PreserFlo Implantation – A Retrospective Analysis

Abstract

Background Loss of corneal endothelial cells after glaucoma surgery can lead to corneal decompensation and reduced vision. This loss may be accelerated by drainage implants like PreserFlo, which allow controlled subconjunctival filtration. In a retrospective analysis, we examined its impact on corneal endothelial cell density (ECD).

Patients and methods Data from medical records for 94 eyes were retrospectively analyzed. This included 47 PreserFlo-operated eyes and 47 contralateral control eyes. Inclusion criteria were open-angle glaucoma, laser trabeculoplasty as the only prior glaucoma surgery, and a contralateral control eye without any previous glaucoma surgeries and without any relevant diseases. Only standalone procedures and pseudophakic eyes were considered. We included 48 eyes at 2 weeks (24 operated, 24 control eyes), 72 at 3 months (36 each), 34 at 1 year (17 each), and 36 at 3 years (18 each).

Results Preoperatively, the 47 eyes that were planned for surgery had a mean ECD of 2141 ± 527 cells/mm², and the 47 control eyes had an ECD of 2114 ± 561 cells/mm². Two weeks postoperatively, ECD decreased by 5.4% in the operated eyes and increased by 1.1% in the control eyes. After 3 months, endothelial cell loss (ECL) was 3.6% (operated) and 1.9% (controls). After 1 year, ECL was 11.7% (operated) and 5.6% (controls); after 3 years it was 7.6% (operated) and 2.9% (controls). No significant differences in ECL dynamics between the operated and control eyes were detected by the analysis of variance.

Conclusion Although there was a trend to accelerated ECL in operated eyes compared to controls, this difference was not significant. Overall, the Preserflo procedure appears safe as regards to its influence on endothelial cell count.

Zusammenfassung

Hintergrund Verlust von kornealen Endothelzellen stellt eine relevante langfristige Komplikation der Glaukom Chirurgie dar, weil sie zur Hornhautdekompensation und Sehreduktion führen kann. Besonders gefährdet dürften die Augen sein, die ein Glaukomimplantat erhalten wie das PreserFlo, welches die Kammerflüssigkeit subkonjunktival ableitet. Wir haben den Effekt auf die Endothelzellendichte (ECD) analysiert.

Patienten und Methoden Insgesamt wurden 94 Augen nachkontrolliert und die Daten retrospektiv via Aktenstudium analysiert; es gab 47 operierte und 47 Kontrollaugen. Inkludiert wurden nur pseudophake Augen mit einem Offenwinkelglaukom, die keine vorausgegangene Glaukomchirurgie außer der selektiven Laser-Trabekuloplastik hatten und ein Kontrollauge ohne vorherige Glaukomeingriffe oder relevanten Erkrankungen hatten. Die postoperative Analyse schloss 48 Augen nach 2 Wochen (24 operierte, 24 Kontrollaugen) ein, 72 Augen nach 3 Monaten (je 36), 34 Augen nach 1 Jahr (je 17) und 36 Augen nach 3 Jahren (je 18).

Ergebnisse Die präoperativen Mittelwerte der ECD von den 47 Patienten waren 2141 ± 527 Zellen/mm² am zu operierenden Auge und 2114 ± 561 Zellen/mm² am kontralateralen Kontrollauge. Es gab einen Rückgang von 5,4% am operierten und eine Zunahme von 1,1% am Kontrollauge nach 2 Wochen. Nach 3 Monaten zeigte sich ein Rückgang von 3,6% (operiertes) vs. 1,9% (Kontrollauge), nach 1 Jahr ein Verlust von 11,7% (operiertes) vs. 5,6% (Kontrollauge) und nach 3 Jahren eine Abnahme von 7,6% (operiertes) vs. 2,9% (Kontrollauge).

Schlussfolgerung Im Vergleich zu den Kontrollaugen gab es in den operierten Augen einen beschleunigten ECD-Verlust, dieser Unterschied ist jedoch nicht signifikant. Die PreserFlo-Implantation scheint sicher zu sein in Bezug auf die Endothelzellengesundheit.

Keywords

glaucoma - cornea - endothelial cells - PreserFlo

Schlüsselwörter

Glaukom - Kornea - Endothelzellen - PreserFlo

Publication History

Received: 16 September 2024

Accepted: 29 November 2024

Article published online:
27 January 2025

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