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  • Endothelial Cell Loss After Baerveldt Implant Surgery

    By Jean Shaw
    Selected By: Henry D. Jampel, MD, MHS
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    Journal Highlights

    Ophthalmology Glaucoma, January/February 2021

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    Hau et al. set out to assess changes in corneal endothelial cell density (ECD) following insertion of a Baerveldt glaucoma implant and to determine prog­nostic factors for ECD loss. They found that ECD loss is greatest close to the tube. Moreover, they found that short tube length and tube insertion in the vicinity of—or anterior to—Schwalbe line (SL) were predictive of greater ECD loss over time.

    For this prospective study, 72 patients (72 eyes) were recruited from a single clinic. All implants were placed in the superotemporal quadrant via a limbal conjunctival peritomy. Primary outcomes were central and peripheral corneal ECD loss at five years. Second­ary outcomes included tube parameters as noted on optical coherence tomog­raphy, tube position relative to SL, ante­rior chamber flare, and clinical factors such as intraocular pressure (IOP).

    No intraoperative surgical compli­cations were noted. Postoperatively, six instances of hypotony without shallow­ing of the anterior chamber, one case of diplopia, and one case of hyphema occurred. In addition, three patients required further surgical procedures within the next three years.

    All told, 64 patients (64 eyes) com­pleted the study. The researchers ob­served a steady loss of ECD with time. At the five-year mark, the percentage of cell loss from baseline was 36.8% (range, 32.3% to 41.3%) for central corneal ECD and 50.1% (range, 45.3% to 54.9%) for peripheral corneal ECD. This equates to an average rate of loss of 7.4% per year for central corneal ECD and 10% per year for peripheral corneal ECD in the area of the tube.

    With regard to secondary outcomes, tube placement was the strongest pre­dictor of cell loss: The fastest rate of cell loss was associated with tube location in the vicinity of SL or anterior to it. In addition, a shorter tube length was a strong predictor for a lower peripheral corneal ECD at five years.

    The researchers noted that, in con­junction with evidence provided from other recent studies, the tube distance from the cornea and the insertion site of the tube into the drainage angle ap­pear to be key predictors of ECD loss. Thus, they concluded, placing the tube entry site posterior to SL and placing a longer tube, positioned away from the cornea, may be preferable surgical strategies.

    The original article can be found here.