Corneal endothelial morphology in eyes implanted with anterior chamber aqueous shunts

To investigate risk factors for lower corneal endothelial cell density after anterior chamber aqueous shunt implantation.

Forty eyes implanted with aqueous shunts were examined using anterior segment optical coherence tomography to document shunt position and specular microscopy for central corneal endothelial cell density (CCED) and peripheral (in the vicinity of the tube) corneal endothelial cell density (PCED). Other clinical parameters relating to shunt implantation were also recorded and analyzed.

Mean CCED and PCED were 1537 ± 681 cells per square millimeter and 1310 ± 586 cells per square millimeter. The median follow-up was 36 months (range: 24-72 months) after shunt implantation. There was a significant association among the time from shunt implantation (β coefficient = -0.325; P = 0.040), the degree of peripheral anterior synechiae (PAS) in clock hours (β = -0.439; P = 0.004), and the number of previous operations (β = -0.316; P = 0.047) with CCED, whereas the degree of PAS was the only factor associated with PCED (β = -0.391; P = 0.013) on univariate analysis. Multiple linear regression analysis revealed that the degree of PAS was the only factor associated with CCED (β = -0.351; P = 0.023). There was no correlation between shunt position parameters and corneal cell density.

The association between lower corneal cell density and aqueous shunt implantation appeared to be multifactorial, with the degree of PAS to be the most significant. Anterior segment optical coherence tomography is a promising technique for quantifying tube position in the anterior chamber after aqueous shunt implantation.