Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medykow 1, 42-200 Sosnowiec, Poland.
Katowice School of Technology, The University of Science and Art in Katowice, Katowice, Poland.
Curr Pharm Biotechnol. 2019;20(12):1037-1043. doi: 10.2174/1389201020666190808154341.
BACKGROUND & OBJECTIVE: Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland.
In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey's post-hoc test in order to determine the differences in the density of ECD cells/mm2 between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant.
The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm2 and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm2 were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex- PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm2 density turned out to be statistically significant (r = +0.521381; p < 0.05).
Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.
角膜内皮细胞（ECD）的再生潜能有限，而糖尿病患者的这种潜能进一步受损。本回顾性研究纳入了 2013 年至 2017 年期间在波兰索斯诺维茨的圣芭芭拉医院接受 23 号穿刺玻璃体切除术联合白内障手术（Phaco-Vitrectomy）和进一步的 Ex-PRESS 分流植入术的 27 名患者，患者年龄 58.1±13.6 岁，其中 16 名为女性，11 名为男性。
在我们的研究中，我们区分了 4 个时期：初始期、Phaco-Vitrectomy 后和油膏取出后、以及 Ex-PRESS 分流植入后的 3 个月和 12 个月。统计分析的显著性水平为 p<0.05。它包括方差分析（ANOVA）和 Tukey 事后检验，以确定观察期内 ECD 细胞密度的差异。还进行了配对样本 t-Student 检验，以确定 PPV 前后和 Ex-PRESS 分流前后视力值的差异是否具有统计学意义。
ECD 细胞的初始计数为 2381.1±249 个细胞/mm2，降至 1872.8±350.7 个细胞/mm2，最终在终点降至 1677.9±327 个细胞/mm2。ECD 细胞密度的差异在各个时期均具有统计学意义：PPV 后与 ECD 细胞初始数量相比（p = 0.000138）；Ex-PRESS 分流前 3 个月与 ECD 细胞初始数量相比（p = 0.000138）；Ex-PRESS 分流后 12 个月与 ECD 细胞初始数量相比（p = 0000138）。分析视力变化，我们观察到 Ex-PRESS 分流前后和 PPV 前后均有恶化（p = 0.007944）。相反，相关性分析表明存在统计学上显著的中度正相关。Ex-PRESS 分流后视力与 ECD 细胞密度之间的关系具有统计学意义（r = +0.521381；p < 0.05）。
无论观察期和糖尿病并发症的眼科治疗选择如何，我们都观察到 ECD 细胞数量减少和视力恶化。因此，向患者提供有关拟议程序的完整信息并考虑风险-效益平衡是合理的。
