Changes in the Density of Corneal Endothelial Cells in Elderly Diabetic Patients After Combined Phacovitrectomy and Ex-PRESS Glaucoma  Implants

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Abstract

Background & Objective

Corneal endothelial cells (ECD) are characterized by limited regenerative potential, which is additionally impaired in patients with diabetes. This retrospective study included 27 patients aged 58.1±13.6, 16 female and 11 males, who underwent 23-gauge vitrectomy in combination with cataract surgery (phacovitrectomy) and further Ex-PRESS shunt implantation throughout 2013-2017 at St. Barbara Hospital in Sosnowiec, Poland.

Methods

In our study, we distinguished 4 periods: initial period; post phacovitrectomy and removal of oil tamponade; and 3 and 12 months post implantation of the Ex-PRESS shunt. Statistical analysis was performed at the level of statistical significance of p<0.05. It included an analysis of variance (ANOVA) and Tukey’s post-hoc test in order to determine the differences in the density of ECD cells/mm ² between the periods of observation. The paired-samples t-Student test was also performed to determine whether the differences in visual acuity values before and after PPV and before and after Ex-PRESS shunt were statistically significant.

Results

The initial count of ECD cells was 2381.1±249, which decreased to 1872.8±350.7 cell/mm ² and finally to 1677.9±327 at the endpoint. Differences in the density of ECD cells/mm ² were observed to be statistically significant between the periods: after PPV vs. initial number of ECD (p = 0.000138); before 3 months after Ex-PRESS shunt vs. initial number of ECD (p = 0.000138); 12 months after Ex-PRESS shunt vs. initial number of ECD (p = 0000138). Analyzing the changes in visual acuity, we observed a deterioration both before and 3 months after Ex-PRESS shunt (p = 0.007944) and before and after PPV (p = 0.060334). In turn, correlation analysis indicated that there is a statistically significant, moderate, positive relationship. The relationship between visual acuity after Ex-PRESS shunt and ECD cells/mm ² density turned out to be statistically significant (r = +0.521381; p < 0.05).

Conclusion

Regardless of the period of observation and the choice of ophthalmic treatment of diabetic complications, we observed a decrease in the number of ECD cells and a deterioration in visual acuity. It is, therefore, reasonable to provide the patient with complete information about the proposed procedures and to consider the risk-benefit balance.

Related collections

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To obtain longitudinal data to estimate long-term morphometric changes in normal human corneal endothelia. Ten years after an initial study, the authors rephotographed the central corneal endothelium of 52 normal subjects with the same contact specular microscope. The findings for the 10 subjects younger than 18 years of age at the initial examination were considered separately. For the remaining 42 adult subjects, the time between examinations averaged 10.6 +/- 0.2 years (range, 10.1 to 11 years). At the recent examination, these subjects' ages averaged 59.5 +/- 16.8 years (range, 30 to 84 years). Outlines of 100 cells for each cornea were digitized. For the 42 adult subjects, the mean endothelial cell density decreased during the 10.6-year interval from 2715 +/- 301 cells/mm2 to 2539 +/- 284 cells/mm2 (P < 0.001). The calculated exponential cell loss rate over this interval was 0.6% +/- 0.5% per year. There was no statistically significant correlation between cell loss rate and age. During the 10.6-year interval, the coefficient of variation of cell area increased from 0.26 +/- 0.05 to 0.29 +/- 0.06 (P < 0.001), and the percentage of hexagonal cells decreased from 67% +/- 8% to 64% +/- 6% (P = 0.003). For the 10 subjects 5 to 15 years of age at the initial examination, the exponential cell loss rate was 1.1% +/- 0.8% per year. Human central endothelial cell density decreases at an average rate of approximately 0.6% per year in normal corneas throughout adult life, with gradual increases in polymegethism and pleomorphism.

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Author and article information

Journal

Journal ID (nlm-ta): Curr Pharm Biotechnol

Journal ID (iso-abbrev): Curr Pharm Biotechnol

Journal ID (publisher-id): CPB

Title: Current Pharmaceutical Biotechnology

Publisher: Bentham Science Publishers

ISSN (Print): 1389-2010

ISSN (Electronic): 1873-4316

Publication date (Electronic): October 2019

Publication date (Print): October 2019

Volume: 20

Issue: 12

Pages: 1037-1043

Affiliations

Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital-Trauma Centre, Plac Medyków 1, 42-200, Sosnowiec , Poland; Katowice School of Technology, The University of Science and Art in Katowice , Katowice, , Poland; Center of Oncology, M. Sklodowska-Curie Memorial Institute, Cracow Branch, Gliwice, , Poland; Department of Molecular Biology, School of Pharmacy with Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia , Katowice, , Poland; Chair and Clinical Department of Ophthalmology, School of Medicine with a Division of Dentistry in Zabrze, Medical University of Silesia , Katowice, , Poland

Author notes

[* ]Address correspondence to this author at the Department of Ophthalmology with Pediatric Unit, Santa Barbara Hospital—Trauma Centre, Plac Medyków 1, 42-200 Sosnowiec, Poland; Tel: +48323682571; Fax: +48323680028; E-mails: okulistyka@ 123456wss5.pl ; anitaboron3@ 123456gmail.com

Article

Publisher ID: CPB-20-1037

DOI: 10.2174/1389201020666190808154341

PMC ID: 7040517

PubMed ID: 31393242

SO-VID: 26f9c835-c029-480e-8b85-ccc1693d7fb5

License:

This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

History

Date received : 26 March 2019

Date revision received : 19 June 2019

Date accepted : 01 August 2019

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