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Corneal complications of glaucoma surgery
1Glaucoma Service, Moorfields Eye Hospital, London, UK.
Current Opinion in Ophthalmology
|February 26, 2009
Summary
Glaucoma surgery can harm the cornea, especially with aqueous shunts. Further studies are needed to understand factors causing corneal endothelial cell loss after these procedures.
Area of Science:
- Ophthalmology
- Corneal Science
- Glaucoma Surgery
Background:
- Glaucoma surgery frequently impacts corneal health, ranging from minor endothelial cell loss to severe decompensation.
- Pre-existing corneal conditions, intraocular pressure (IOP) severity, and prior surgeries influence corneal outcomes.
- Most glaucoma procedures, excluding aqueous shunts, do not cause progressive endothelial cell loss.
Purpose of the Study:
- To review the corneal effects of various glaucoma surgical procedures.
- To identify specific surgical techniques and adjuncts associated with corneal complications.
- To highlight the need for further research into endothelial cell loss factors.
Main Methods:
- Review of existing literature on glaucoma surgery and corneal complications.
- Analysis of reported corneal adverse events, including endothelial cell loss, decompensation, and structural changes.
- Evaluation of the impact of specific surgical approaches (e.g., trabeculectomy, aqueous shunts) and adjunctive therapies (e.g., mitomycin C).
Main Results:
- Aqueous shunts are most frequently associated with corneal problems, particularly tube-endothelial touch in pediatric patients.
- Antiproliferative drugs can be toxic to the endothelium, though viscoelastics may mitigate this effect.
- Combined phacoemulsification and trabeculectomy at one site causes less endothelial trauma than a two-site approach. Overhanging blebs and Descemet's membrane detachment are other reported complications.
Conclusions:
- Corneal complications are most prevalent in patients undergoing aqueous shunt surgery.
- Long-term prospective studies are essential to determine factors predisposing to corneal endothelial cell loss after glaucoma surgery.
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