Endothelial Cell Density Following Ab Interno Gelatin Stent Implantation with Mitomycin C
Authors: Diana L. Martinez, Jessica Cao, Iqbal Ike K. Ahmed. Prism Eye Institute.
Author Disclosure Block: D.L. Martinez: None. J. Cao: None. I.K. Ahmed: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Alcon(C,S,R), Allergan(C,S,R), Carl Zeiss Meditec(C,S), Johnson & Johnson Vision(C,S,R), New World Medical(C,R), Mundipharma(S), Aequus(C), Aerie Pharmaceuticals(C,R), Akorn(C), Aquea Health, Inc(C), ArcScan(C), Bausch Health(C), Beaver Visitec(C), Beyeonics(C), Centricity Vision, Inc(C), CorNeat Vision(C), Costum Surgical(C), ELT Sight(C), ElutiMed(C), Equinox(C), eyeFlow, Inc(C),Genentech(C0, Glaukos(C,R), Gore(C), Iantrek(C), InjectSense(C), Iridex(C), iStar(C), Ivantis(C,R), LayerBio(C), Leica Microsystems(C), Long Bridge Medical, Inc(C), MicroOptx(C), MST Surgical(C,S), Ocular Instruments(C), Ocular Therapeutix(C), Oculo(C), Omega Ophthalmics(C), PolyActiva(C), Radiance Therapeutics, Inc(C), Ripple Therapeutics(C), Sanoculis(C), Santen(C,R), Shifamed(C), Sight Sciences(C), Smartlens, Inc(C), Stroma(C), Thea Pharma(C), ViaLase(C), Vizzario(C). Any direct financial payments including receipt of honoraria; Description of relationship(s); C: Consulting Fees, S: Speakers Honoraria, R: Research Grant/Support.
Purpose: The ab interno gelatin microstent (Xen45) is a commonly-used bleb-forming device for treatment of glaucoma. Progressive corneal endothelial cell loss has been shown after some types of minimally invasive glaucoma surgeries. As the impactof Xen45 on the cornealendothelium is not well understood, this study aims to characterize the endothelial cell density (ECD) of patients up to 63 months after receiving Xen45.
Study Design:Cross-sectional study.
Methods: Central ECD levels were obtained from patients with a history of Xen45 implantation. Patients were between 12 and 63 months after surgery. Patients were then divided into 5 groups by postoperative year. ECD means were analyzedbetween groups. Treatedeyes were also compared to the contralateral eye where data was available, excluding patients who received bilateral surgery.
Results: The study included a total of 101 eyes from 77 patients for central ECD, of which 47 eyes were compared to the contralateral eye. Mean centralECD was 2079±466for the postoperative year 2 group (mean age 70±7.9 years), 1973±503 for the postoperative year 3 group (mean age 69±10.3 years), 2079±521 for the postoperative year 4 group (mean age 76±8.2 years), 2260±394 for the postoperative year 5 group (mean age 67±13.5 years), and 2144±291 for the postoperative year 6 group (mean age 67±12.1 years). There was no statistically significant difference between the groups for central ECD (p=.27). When comparing to the contralateral eye, there was also no significant difference in central ECD (p=.67). Three patients (6%) had greater than 30% ECD difference between the treated and contralateral eye. One patient experienced prolonged corneal edema, which eventually lead to corneal graft at 28 months post-Xen implantation.
Conclusions: Patients at various time intervals after Xen45 implantation had no significant differences in ECD, nor when compared to the contralateral eye. Regarding complications, only one patient required corneal graft due to prolonged corneal edema. Longitudinal comparison of ECD levels is encouraged.