Changes in corneal endothelial cell density after initial Ex-PRESS drainage device implantation and its relating factors over 3 years
Changes in corneal endothelial cell density after initial Ex-PRESS drainage device implantation and its relating factors over 3 years
复制标题
首次Ex-PRESS引流装置植入后3年角膜内皮细胞密度变化及相关因素
DOI：
10.1038/s41433-021-01888-1
复制
发表时间：
2022
期刊：
影响因子：
3.9
通讯作者：
Aihara Makoto
中科院分区：
文献类型：
--
作者：
Aoyama Yurika;Sakata Rei;Fujishiro Takashi;Honjo Megumi;Shirato Shiroaki;Aihara Makoto
背景/目的研究日本开角型青光眼（OAG）患者初次Ex-PRESS手术后随访36个月的角膜内皮细胞密度（CECD）变化。 受试者/方法采用角膜镜面显微镜检查术前和术后（3、6、12、24和36个月）CECD并分析CECD变化。采用Kaplan-Meier生存曲线检验CECD维持在95%水平，采用Cox比例风险模型检测CECD丧失的危险因素。还检查了病程中眼压（IOP）的变化。结果共调查79例患者79只眼（单独手术24例；联合白内障手术55例）。术前CECD（平均值±±SD）为2521±±305个细胞/mm²和2429±±366（P=±0.003，根据Bonferroni校正进行调整）、2462±±332（P=±0.002）、2457±±317 (P< 0.001)、2433 ± 333 (P< 0.001) 和 2387 ± 352 (P< 0.001) 分别为 3、6、12、24 和 36 个月。计算下降率为1.8%/年。此外，36 个月时的 95% 维持 CECD 为 50.0%（95% 置信区间，37.1-63.0%）。单变量和多变量 Cox 比例风险模型均表明，术前 CECD 较低是 CECD 丢失的重要危险因素。术后所有测量点的基线 IOP 均下降至 19.3±5.8mmHg (P<0.001)。 结论 初次 Ex-PRESS 手术 36 个月后的 CECD 可能不会出现临床问题。然而，长期随访是必要的，并且应定期进行CECD测量，特别是对于CECD低的患者。
Background/objectivesTo 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/methodsCorneal 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.ResultsA 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.ConclusionCECD 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.