Tan Annelie N, Webers Carroll A B, Berendschot Tos T J M, de Brabander John, de Witte Pauline M, Nuijts Rudy M M A, Schouten Johannes S A G, Beckers Henny J M
Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands.
Maastricht University Medical Center, University Eye Clinic Maastricht, Maastricht, The Netherlands.
Acta Ophthalmol. 2017 Feb;95(1):91-96. doi: 10.1111/aos.13161. Epub 2016 Aug 6.
To investigate central and peripheral corneal endothelial cell density (ECD) in relation to Baerveldt (BV) glaucoma drainage device (GDD) tube corneal (TC) distance.
Prospective study of all patients scheduled for glaucoma tube surgery with 36 months follow-up. A BV GDD was inserted into the anterior chamber (AC). Anterior segment optical coherence tomography (AS-OCT) scans were made to determine the TC distance. Central and peripheral ECD was measured, preoperatively and at 3, 6, 12, 24 and 36 months postoperatively.
Fifty-three eyes were included [primary open-angle glaucoma, (n = 13); secondary glaucoma, (n = 30); and primary angle-closure glaucoma, (n = 10)]. Central ECD significantly decreased during follow-up, with a mean decrease of 4.54% per year (p < 0.001), and 6.57% in the peripheral quadrant closest to the BV GDD tube (PQC, p < 0.001). In the PQC, a yearly decrease of 1.57% was shown after transiridial tube placement versus 7.43% after placement 'free' into the AC (p = 0.006). Endothelial cell (EC) loss was related to TC distance (mean 1.69 mm), with a central loss of 6.20% and 7.25% in the PQC per year with shorter TC distances, versus a central loss of 4.11% and 5.77% in the PQC per year with longer TC distances (outside mean ± 2SD, p < 0.001). A difference in EC loss by glaucoma subtype was not identified.
The TC distance is of significant influence on corneal ECD, a shorter TC distance causing more severe EC loss, especially in the PQC. Transiridial placement of the BV GDD tube seems safer than placement 'free' into the AC.
研究中央和周边角膜内皮细胞密度（ECD）与Baerveldt（BV）青光眼引流装置（GDD）管角膜（TC）距离之间的关系。
对所有计划接受青光眼引流管手术的患者进行前瞻性研究，并随访36个月。将BV GDD植入前房（AC）。进行眼前节光学相干断层扫描（AS-OCT）以确定TC距离。在术前以及术后3、6、12、24和36个月测量中央和周边ECD。
纳入53只眼[原发性开角型青光眼，（n = 13）；继发性青光眼，（n = 30）；原发性闭角型青光眼，（n = 10）]。随访期间中央ECD显著下降，平均每年下降4.54%（p < 0.001），在最靠近BV GDD管的周边象限（PQC）下降6.57%（p < 0.001）。在PQC中，经虹膜植入引流管后每年下降1.57%，而“自由”植入AC后为7.43%（p = 0.006）。内皮细胞（EC）损失与TC距离（平均1.69 mm）有关，TC距离较短时，中央每年损失6.20%，PQC每年损失7.25%，而TC距离较长时（超出平均±2SD），中央每年损失4.11%，PQC每年损失5.77%（p < 0.001）。未发现青光眼亚型之间EC损失存在差异。
TC距离对角膜ECD有显著影响，TC距离越短，EC损失越严重，尤其是在PQC。BV GDD管经虹膜植入似乎比“自由”植入AC更安全。
