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Editors Selection IGR 13-4
Laser and surgical treatment: Ahmed glaucoma valve and cornea
Comment by Malik Kahook on:
20932 Changes in corneal endothelial cell density and morphology after Ahmed glaucoma valve implantation during the first year of follow up, Kim CS; Yim JH; Lee EK et al., Clinical and Experimental Ophthalmology, 2008; 36: 142-147
While the risk of corneal decompensation associated with glaucoma drainage device (GDD) implantation has been described, there are few published reports investigating corneal endothelial cell (CEC) changes after such procedures. Kim et al. (860) re-port on the changes in CEC density and morphology in patients undergoing superotemporal Ahmed glaucoma valve implantation with one year follow-up. The study enrolled 56 patients, 26 of whom were excluded from analysis. In the 30 remaining patients who were eligible for analysis, a mean percent decrease in CEC density was noted compared to baseline (p = 0.001). The superotemporal area was noted to have the greatest decrease in cell density at one year follow-up. The authors conclude that care should be taken during intra and post-operative management of Ahmed valve implantation to decrease potential damage to the corneal endothelium. All surgeries were performed by a single surgeon who also interpreted CEC data with no mention of masking this process. Masking data collection and using more than one evaluator is more desirable. A more thorough discussion of the high exclusion rate of enrolled patients is needed. There were significant differences in types of glaucoma between operated and fellow eyes with the operated eyes having nearly twice the rate of neovascular glaucoma. It is not clear how differences in ocular health between the two groups influenced CEC data. Significant decreases in CEC density in the superior region, presumably a result of the traction suture at time of surgery, were not fully discussed. While the authors conclude that the data obtained in this study may guide intra and post-operative care, no such data were discussed in the study and no explanations were given as to how modification of care might influence CEC health. The authors should be commended for carrying out this prospective study that attempts to shed light on a potentially serious risk of GDD implantation. Further studies are needed to verify their results and tease out the differences in surgical technique and post-operative care that might help avoid damage to the corneal endothelium thus leading to improved patient care.
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