Factors influencing the reduction in corneal endothelial cells after Ex-Press® surgery
We investigated the factors that influence the reduction in corneal endothelial cells after Ex-Press® surgery.
This was a retrospective study. We included patients who had undergone Ex-Press surgery and were followed up for > 2. We analyzed the corneal endothelial cell density (ECD) before and after Ex-Press surgery. We investigated the insertion position (Ex-Press device was inserted into cornea or trabecular meshwork (TM)), Ex-Press–iris touch, cornea–iris touch, peripheral anterior synechiae, history of trabeculotomy, history of selective laser trabeculoplasty, type of glaucoma, and simultaneous cataract surgery as influencing factors. We used multivariate analysis to determine the factors influencing the reduction rate of ECD.
We included 129 eyes. The mean of ECD had decreased 7.0% at 2 years. Ex-Press surgeries significantly decreased the ECD after 2 years (p = 0.0118). As a result of the multivariate analysis, the factor that led to a significantly faster reduction in ECD was the insertion position of the Ex-Press (p < 0.0001). The reduction rate of ECD after 2 years in cases of insertion into the cornea (27 eyes) was 15.1 ± 3.6%, and in cases of insertion into a TM (102 eyes), it was 5.2 ± 1.4%.
Insertion into the cornea was a risk factor for rapid ECD loss. The Ex-Press should be inserted into a TM for long-term protection of the corneal endothelial cells.
KeywordsEx-Press Glaucoma Corneal endothelial cells Factors
No funding was received.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
Human and animals rights
All procedures performed were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards, and ethical approval was obtained from the Institutional Review Board of the University of Toyama.
Informed consent was obtained from all individual participants included in the study.
- 3.Netland PA, Sarkisian SR Jr, Moster MR, Ahmed II, Condon G, Salim S, Sherwood MB, Siegfried CJ (2014) Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol 157(433–440):e433. https://doi.org/10.1016/j.ajo.2013.09.014 CrossRefGoogle Scholar
- 4.Arimura S, Takihara Y, Miyake S, Iwasaki K, Gozawa M, Matsumura T, Tomomatsu T, Takamura Y, Inatani M (2016) Randomized clinical trial for early postoperative complications of Ex-PRESS implantation versus trabeculectomy: complications postoperatively of Ex-PRESS versus trabeculectomy study (CPETS). Sci Rep 6:26080. https://doi.org/10.1038/srep26080 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Arimura S, Miyake S, Iwasaki K, Gozawa M, Matsumura T, Takamura Y, Inatani M (2018) Randomised clinical trial for postoperative complications after Ex-PRESS implantation versus trabeculectomy with 2-Year follow-up. Sci Rep 8:16168. https://doi.org/10.1038/s41598-018-34627-w CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Ishida K, Moroto N, Murata K, Yamamoto T (2017) Effect of glaucoma implant surgery on intraocular pressure reduction, flare count, anterior chamber depth, and corneal endothelium in primary open-angle glaucoma. Jpn J Ophthalmol 61:334–346. https://doi.org/10.1007/s10384-017-0512-2 CrossRefPubMedGoogle Scholar
- 15.Soro-Martinez MI, Villegas-Perez MP, Sobrado-Calvo P, Ruiz-Gomez JM, de Imperial Miralles, Mora-Figueroa J (2010) Corneal endothelial cell loss after trabeculectomy or after phacoemulsification, IOL implantation and trabeculectomy in 1 or 2 steps. Graefe’s Arch Clin Exp Ophthalmol 248:249–256. https://doi.org/10.1007/s00417-009-1185-4 CrossRefGoogle Scholar