Corneal Endothelial Cell Loss After Mitomycin C-augmented Trabeculectomy

Abstract

Purpose To determine the effect on the corneal endothelium of mitomycin C (MMC)-augmented trabeculectomy 3 and 12 months after surgery. Patients and Methods In a prospective, observational clinical study, 14 eyes of 14 patients with well-established open angle glaucoma were followed for 12 months after MMC-augmented trabeculectomy. We measured the endothelial cell density, the variation in mean cell size, the percentage of hexagonal cells, and the central corneal thickness at baseline and 3 and 12 months postoperatively. Results The mean endothelial cell density was 2525 [standard deviation (SD) 457] cells/mm² before surgery and 2332 (SD 643) cells/mm² and 2283 (SD 597) cells/mm² at 3 and 12 months after surgery, respectively, representing a cell loss of 9.5% (P=0.052) and 10.0% (P=0.027). The cell loss from 3 to 12 months was nonsignificant (P=0.40). After 12 months of follow-up, the variation in mean cell size and the percentage of hexagonal cells had not yet stabilized around the preoperative values. Conclusions Our results show that significant cell loss occurs during or immediately after MMC-augmented trabeculectomy. However, no progressive cell loss was observed from 3 to 12 months, demonstrating that MMC has no prolonged toxic effect on the corneal endothelium. From 3 to12 months after MMC-augmented trabeculectomy, active endothelial adaptations were taking place.