The effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage: a preliminary study

Abstract

Purpose

We aimed to investigate the effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage.

Materials and methods

In this prospective and non-randomized study, three groups were identified each consisting of 20 eyes (Group I phacotrabeculectomy, group II trabeculectomy, group III phacoemulsification). In the pre- and postop month 1, corneal endothelial cell density (CECD), coefficient of variation (CV) (polymegathism) and hexagonality (Hex) (pleomorphism) were measured by means of a non-contact specular microscope (Nidek CEM-530, NIDEK Co., Ltd. Japan).

Results

The postop CECD in each of the three groups showed a significant decrease when compared with the preop period (6.1% in the phacotrabeculectomy group, 4.9% in the trabeculectomy group and 7.4% in the phacoemulsification group). The amount of decrease in the preop and postop CECD values showed no significant difference among these three groups. The postop CV value in each of the three groups showed a significant increase when compared with the preop period. The postop Hex value in each of the three groups showed no significant change when compared with the preop period.

Conclusion

In our study, we observed that performing a combined phacotrabeculectomy on patients with glaucoma and cataract association in the same session did not do more harm to the corneal endothelium than other surgical methods. For this reason, this method can be applied safely to a patient population that is likely to develop corneal decompensation.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Johns GE, Layden WE (1979) Combined trabeculectomy and cataract extraction. Am J Ophthalmol 88:973–981

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Dittmer K, Quentin CD (1998) Intraocular pressure regulation after combined glaucoma and cataract operation. Ophthalmology 95:499–503

    Article  CAS  Google Scholar 

  3. 3.

    Williams KK, Noe RL, Grossniklaus HE, Drews-Botsch C, Edelhauser HF (1992) Correlation of histologic corneal endothelial cell counts with specular microscopic cell density. Arch Ophthalmol 110:1146–1149

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Bourne WM, Kaufman HE (1976) Specular microscopy of human corneal endothelium in vivo. Am J Ophthalmol 81:319–323

    Article  CAS  Google Scholar 

  5. 5.

    Joyce NC (2003) Proliferative capacity of the corneal endothelium. Prog Retin Eye Res 22:359–389

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Soro-Martínez MI, Villegas-Pérez MP, Sobrado-Calvo P, Ruiz-Gómez JM, de Imperial M, Mora-Figueroa J (2010) Corneal endothelial cell loss after trabeculectomy or after phacoemulsification, IOL implantation and trabeculectomy in 1 or 2 steps. Graefes Arch Clin Exp Ophthalmol 248:249–256

    Article  PubMed  Google Scholar 

  7. 7.

    Chylack LT Jr, Wolfe JK, Singer DM et al (1993) The lens opacities classification system III. The longitudinal study of Cataract Study Group. Arch Ophthalmol 111:831–836

    Article  Google Scholar 

  8. 8.

    Hyndiuk RA, Schultz RO (1992) Overview of the corneal toxicity of surgical solutions and drugs: and clinical concepts in corneal edema. Lens Eye Toxic Res 9(3–4):331–350

    CAS  PubMed  Google Scholar 

  9. 9.

    Rhiu S, Hong S, Seong GJ, Kim CY (2010) Phacoemulsification alone versus phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma. Yonsei Med J 51(5):781–783

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Li SW, Chen Y, Wu Q, Lu B, Wang WQ, Fang J (2015) Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure. Int J Ophthalmol 8(4):742–747

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Melancia D, Pinto LA (2015) Cataract surgery and intraocular pressure. Ophthalmic Res 53:141–148

    Article  PubMed  Google Scholar 

  12. 12.

    Mishima S (1982) Clinical investigations on the corneal endothelium. Ophthalmology 89(6):525–530

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Bourne WM, Nelson LR, Hodge DO (1997) Central corneal endothelial cell changes over a ten-year period. Investig Ophthalmol Vis Sci 38:779–782

    CAS  Google Scholar 

  14. 14.

    Walkow T, Anders N, Klebe S (2000) Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg 26:727–732

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Alsmman AH, Ezzeldawla M, Mounir A, Elhawary AM, Mohammed OA, Farouk M, Sherif AM (2018) Effect of reformation of the anterior chamber by air or by a balanced salt solution (BSS) on corneal endothelium after phacoemulsification: a comparative study. J Ophthalmol 8:6390706

    Google Scholar 

  16. 16.

    Moschos MM, Chatziralli IP, Sergentanis TN (2011) Viscoat versus Visthesia during phacoemulsification cataract surgery: corneal and foveal changes. BMC Ophthalmol 11:9

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Arslan OS, Arici C (2014) Safety of prophylactic intracameral moxifloxacin ophthalmic solution after cataract surgery in patients with penetrating keratoplasty. Int J Ophthalmol 7(5):795–799

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Espiritu CR, Caparas VL, Bolinao JG (2007) Safety of prophylactic intracameral moxifloxacin 0.5% ophthalmic solution in cataract surgery patients. J Cataract Refract Surg 33(1):63–68

    Article  PubMed  Google Scholar 

  19. 19.

    Nuyts RM, Pels E, Greve EL (1992) The effects of 5-fluorouracil and mitomycin C on the corneal endothelium. Curr Eye Res 11(6):565–570

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Hou X, Dan H (2015) Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract. BMC Ophthalmol 15:88

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Martínez-Belló C, Rodriguez-Ares T, Pazos B, Capeáns C, Sánchez-Salorio M (2000) Changes in anterior chamber depth and angle width after filtration surgery: a quantitative study using ultrasound biomicroscopy. J Glaucoma 9:51–55

    Article  PubMed  Google Scholar 

  22. 22.

    Mohammad JM, Moghadam RS, Behboudi H, Ghanbari A, Moghadam SH, Khoshbakht M (2013) The effect of phacoemulsification with posterior chamber intraocular lens implantation on intraocular pressure and anterior chamber depth. Iran J Ophthalmol 25(4):304–308

    Google Scholar 

  23. 23.

    Alvani A, Pakravan M, Esfandiari H, Yaseri M, Yazdani S, Ghahari E (2016) Biometric changes after trabeculectomy with contact and non-contact biometry. Optom Vis Sci 93(2):136–140

    Article  PubMed  Google Scholar 

  24. 24.

    Rahat H, Li W (2013) Longitudinal changes in anterior chamber depth and axial length in Asian subjects after trabeculectomy surgery. Br J Ophthalmol 97:852–856

    Article  Google Scholar 

  25. 25.

    Casini G, Loiudice P, Pellegrini M, Sframeli AT, Martinelli P, Passani A, Nardi M (2015) Trabeculectomy versus EX-PRESS shunt versus ahmed valve implant: short-term effects on corneal endothelial cells. Am J Ophthalmol 160(6):1185–1190

    Article  PubMed  Google Scholar 

  26. 26.

    Storr-Paulsen T, Norregaard JC, Ahmed S, Storr-Paulsen A (2008) Corneal endothelial cell loss after mitomycin C-augmented trabeculectomy. J Glaucoma 17(8):654–657

    Article  PubMed  Google Scholar 

  27. 27.

    Lázaro García C, Castillo Gómez A, García Feijóo J, Macías Benítez JM, García SJ (2000) Estudio del endotelio corneal tras la cirugía del glaucoma. Arch Soc Esp Oftalmol 75:75–80

    PubMed  Google Scholar 

  28. 28.

    Gagnon MM, Boisjoly HM, Brunette I, Charest M, Amyot M (1997) Corneal endothelial cell density in glaucoma. Cornea 16(3):314–318

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Topouzis F, Coleman AL, Choplin N, Bethlem MM, Hill R, Yu F, Panek WC, Wilson MR (1999) Follow-up of the original cohort with the Ahmed glaucoma valve implant. Am J Ophthalmol 128(2):198–204

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Walkow T, Anders N, Klebe S (2000) Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg 26:727–732

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Ventura AC, Wälti R, Böhnke M (2001) Corneal thickness and endothelial density before and after cataract surgery. Br J Ophthalmol 85(1):18–20

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Bourne RR, Minassian DC, Dart JK, Rosen P, Kaushal S, Wingate N (2004) Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology 111(4):679–685

    Article  PubMed  Google Scholar 

  33. 33.

    Inal A, Bayraktar Ş, Inal B, Bayraktar Z, Yılmaz ÖF (2005) Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study. Acta Ophthalmol 83:554–560

    Article  Google Scholar 

  34. 34.

    Ehrnrooth P, Lehto I, Puska P, Laatikainen L (2005) Phacoemulsification in trabeculectomized eyes. Acta Ophthalmol Scand 83(5):561–566

    Article  PubMed  Google Scholar 

  35. 35.

    Longo A, Uva MG, Reibaldi A, Avitabile T, Reibaldi M (2015) Long-term effect of phacoemulsification on trabeculectomy function. Eye (Lond). 29(10):1347–1352

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Jampel HD, Friedman DS, Lubomski LH, Kempen JH, Quigley H, Congdon N, Levkovitch-Verbin H, Robinson KA, Bass EB (2002) Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: an evidence-based review. Ophthalmology 109:2215–2224

    Article  PubMed  Google Scholar 

  37. 37.

    Friedman DS, Jampel HD, Lubomski LH, Kempen JH, Quigley H, Congdon N, Levkovitch-Verbin H, Robinson KA, Bass EB (2002) Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmol 109:1902–1913

    Article  Google Scholar 

  38. 38.

    Vergés C, Cazal J, Lavin C (2005) Surgical strategies in patients with cataract and glaucoma. Curr Opin Ophthalmol 16(1):44–52

    Article  PubMed  Google Scholar 

  39. 39.

    Napoli PE, Zucca I, Fossarello M (2014) Qualitative and quantitative analysis of filtering blebs with optical coherence tomography. Can J Ophthalmol 49:210–216

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Atila Gokce Demir.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Demir, A.G., Olgun, A., Guven, D. et al. The effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage: a preliminary study. Int Ophthalmol 39, 2121–2128 (2019). https://doi.org/10.1007/s10792-018-1044-6

Download citation

Keywords

  • Combined phacotrabeculectomy
  • Trabeculectomy
  • Phacoemulsification
  • Corneal endothelial cell density
  • Specular microscopy