Department of Ophthalmology, Graduate of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Yotsuya Shirato Eye Clinic, Tokyo, Japan.
Eye (Lond). 2023 Jan;37(1):69-74. doi: 10.1038/s41433-021-01888-1. Epub 2022 Jan 10.
BACKGROUND/OBJECTIVES: To 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/METHODS: Corneal 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.
A 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.
CECD 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.
背景/目的：本研究旨在调查在接受初始 Ex-PRESS 手术治疗的日本开角型青光眼（OAG）患者中，36 个月内角膜内皮细胞密度（CECD）的变化。
对象/方法：使用角膜共焦显微镜检查术前和术后（3、6、12、24 和 36 个月）的 CECD，并分析 CECD 的变化。采用 Kaplan-Meier 生存曲线分析 CECD 维持在 95%水平的情况，采用 Cox 比例风险模型检测 CECD 丢失的风险因素。还检查了研究过程中眼压（IOP）的变化。
共纳入 79 例 79 只眼患者（单纯手术 24 例，联合白内障手术 55 例）。术前 CECD（平均值±标准差）为 2521±305 个细胞/mm²和 2429±366（P=0.003，经 Bonferroni 校正调整），2462±332（P=0.002），2457±317（P<0.001），2433±333（P<0.001）和 2387±352（P<0.001），分别在术后 3、6、12、24 和 36 个月时测量。每年的下降率为 1.8%。此外，36 个月时 95%的 CECD 维持率为 50.0%（95%置信区间，37.1-63.0%）。单因素和多因素 Cox 比例风险模型均显示，术前 CECD 低是 CECD 丢失的显著危险因素。术后所有测量点的基础 IOP（19.3±5.8）mmHg 均下降（P<0.001）。
初始 Ex-PRESS 手术后 36 个月的 CECD 可能不会产生临床问题。然而，需要进行更长期的随访，并且应定期进行 CECD 测量，尤其是在 CECD 较低的患者中。
