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A comparison of corneal endothelial cell changes after 1-site and 2-site phacotrabeculectomy
Nader Nassiri1, Nariman Nassiri, Mohammad Rahnavardi
1Department of Ophthalmology, Imam Hossein Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. drnassirin@sbmu.ac.ir
Purpose:
To compare the corneal endothelial cell (CEC) changes that occurred after phacotrabeculectomy performed at 1 or 2 sites.
Design:
A historical cohort study.
Methods:
The records of patients who had 1-site (n = 61) or 2-site (n = 52) limbus-based phacotrabeculectomy over a 4-year period (2002-2005) at 1 eye surgery center (Vanak Eye Surgery Center, Tehran, Iran) by a single surgeon were reviewed, and postoperative CEC indices were measured. Preoperative CEC indices, performed for a then-ongoing trial, were compared with postoperative measurements of the last follow-ups. The main outcome measure was endothelial cell count.
Results:
The median follow-up time was 12 months (range 9-24 months). There was no difference between the operations in improving visual acuity, lowering intraocular pressure, and decreasing the number of antiglaucoma medications required. However, 2-site surgery was associated with significantly more expansion in the CEC area (P < 0.001). On multivariate analysis, longer follow-up, 2-site surgery, and grade 4 cataract density were independently associated with more CEC loss, and longer follow-up, 2-site surgery, and steroid-induced glaucoma were associated with CEC area expansion. Postoperative complications were not markedly different between the 2 groups.
Conclusions:
In both groups, the longer the follow-up time was, the higher the CEC loss and the CEC area expansion were. One-site surgery seems to cause less CEC damage than the 2-site operation during the median follow-up time of 1 year.