Loss of Corneal Endothelial Cells during Glaucoma Surgery

Abstract

As known, there are changes in the biomechanical properties of the fibrous tunic in glaucoma. This is also due to the imbalance between the formation and loss of collagen fibers. The cornea is a highly sensitive tunic of the eyeball, endothelium is one of the target organs in the formation of pathological changes in primary open-angle glaucoma, and endothelial dysfunction, according to many authors, plays a significant role in its pathogenesis. The unintended consequences of glaucoma surgery lead to a progressive loss of corneal endothelial cells, which can lead to corneal decompensation. In the proposed literature review, we analyzed more than 30 publications by authors representing the results of multicenter studies of the pathological effects of antiglaucoma operations on the corneal endothelium in patients with various types of uncompensated glaucoma. The analysis of both classic fistulizing type operations and modern, so-called micro-invasive techniques (MIGS), including the use of various drains and devices, is presented. Thus, the smallest decrease in the density of endothelial cells was noted during deep sclerectomy and trabeculectomy. The use of mitomycin C in glaucoma surgery significantly improving the prognosis, but increases the loss of endothelial cells in both high and low concentrations. The highest rates of loss of corneal endothelial cells are noted during using valves and shunts. Ex-PRESS shunt implantation is associated with a significant loss of corneal endothelial cell density in the immediate area to the drainage tube, and therefore, shunt implantation should not be considered as an option for eyes with corneal dysfunction. In addition, the authors prove that the drainage device changes its position in the anterior chamber, especially when performing massage and self-massage of filtration bleb, which leads to a greater loss of density of corneal endothelial cells.