Prospective cohort study of corneal endothelial cell loss after Baerveldt glaucoma implantation.
Prospective cohort study of corneal endothelial cell loss after Baerveldt glaucoma implantation.
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DOI：
10.1371/journal.pone.0201342
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Inatani M
中科院分区：
文献类型：
--
作者：
Iwasaki K;Arimura S;Takihara Y;Takamura Y;Inatani M
评价Baerveldt青光眼植入术后角膜内皮细胞损失。我们前瞻性地评估了59例（59只眼）接受Baerveldt青光眼植入术的患者角膜内皮细胞密度（ECD）的变化。其中前房置管45眼，睫状体平坦部置管14眼。主要结局指标是Baerveldt青光眼植入后角膜ECD的变化。次要结局指标包括角膜ECD和光学相干断层扫描图像的管参数（管-角膜距离和管-角膜角度）之间的关系以及角膜ECD丢失的预后因素。术后12个月，角膜ECD显著降低9.2%（P = 0.001）。在前房Baerveldt青光眼植入组中，插管象限的角膜ECD在3个月时显著下降9.6%（P = <0.001），6个月时下降10.7%（P = <0.001），12个月时下降13.1%（P = <0.001）。术后6个月（损失7.2%; P = 0.012）和术后12个月（损失12.1%; P = 0.001），中心角膜ECD显著降低。仅在术后12个月时，对侧象限的角膜ECD显著降低（损失10.3%; P = 0.004）。在平坦部Baerveldt青光眼植入组中，在任何术后随访访视时，均未发现任何角膜区域的角膜ECD明显丧失。插管-角膜角度与插管象限的角膜ECD丢失率呈负相关; r =-0.55（P = 0.0013）。在多变量分析中，剥脱性青光眼和较窄的管-角膜角是严重角膜ECD丢失的重要预后因素（分别为P = 0.0068和P = 0.046）。前房Baerveldt青光眼植入导致角膜内皮细胞损失。角膜内皮细胞损失开始于插管象限。剥脱性青光眼和较窄的管-角膜角与角膜内皮细胞的严重损失有关。
To evaluate corneal endothelial cell loss after Baerveldt glaucoma implantation. We prospectively evaluated changes in endothelial cell density (ECD) in the cornea of 59 patients (59 eyes) who underwent Baerveldt glaucoma implantation. Tubes were inserted into the anterior chamber in 45 eyes and pars plana in 14 eyes. The primary outcome measure was the change in corneal ECD after Baerveldt glaucoma implantation. Secondary outcome measures included relationships between corneal ECD and optical coherence tomography images of tube parameters (tube–cornea distance and tube–cornea angle) and prognostic factors for corneal ECD loss. Corneal ECD decreased significantly by 9.2% at 12 months after surgery (P = 0.001). In the anterior chamber Baerveldt glaucoma implantation group, corneal ECD at the tube insertion quadrant decreased significantly by 9.6% at 3 months (P = <0.001), 10.7% at 6 months (P = <0.001), and 13.1% at 12 months (P = <0.001). Corneal ECD at the center decreased significantly at 6 months after surgery (7.2% loss; P = 0.012) and at 12 months after surgery (12.1% loss; P = 0.001). Corneal ECD at the contralateral quadrant decreased significantly at 12 months after surgery only (10.3% loss; P = 0.004). In the pars plana Baerveldt glaucoma implantation group, no significant loss of corneal ECD was found in any corneal areas at any post-surgery follow-up visits. Tube-cornea angle was negatively correlated with the rate of corneal ECD loss at the tube insertion quadrant; r = −0.55 (P = 0.0013). In multivariable analyses, exfoliation glaucoma and narrower tube–cornea angle were significant prognostic factors for severe corneal ECD loss (P = 0.0068 and P = 0.046, respectively). Anterior chamber Baerveldt glaucoma implantation causes corneal endothelial cell loss. Corneal endothelial cell loss starts at the tube insertion quadrant. Exfoliation glaucoma and narrower tube-corneal angle are associated with severe loss of corneal endothelial cells.
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