Estudio del endotelio corneal y de la presión intraocular en pacientes intervenidos de glaucoma y catarata en uno o dos tiempos

Résumé

OBJECTIVES To assess changes in morphology and density of the corneal endothelial cells after glaucoma and cataract surgery in one or two stages and to analyze which type of surgery causes most damage to the corneal endothelial cells. To assess the decrease of the intraocular pressure after glaucoma and cataract surgery in one or two stages and to analyze which type of surgery causes a greater decrease of the intraocular pressure and more stability of the intraocular pressure in the postoperative period. METHODS This is a randomized prospective cohort study that included 46 eyes with glaucoma and cataract from 39 patients aged between 66 and 80 years. Informed consent was obtained, after which the patients and were randomly assigned to receive trabeculectomy and phacoemulsification and intraocular lens (IOL) implantation in one (Group 1) or two stages (Group 2). Demographic as well as other parameters were determined: Best Corrected Visual Acuity (BCVA), corneal endothelial cell status (using confocal microscopy with the Confoscan 4¿), central corneal thickness (using ultrasonic biometry Ocuscan¿) and anterior chamber depth (using optic biometry IOLMaster¿). Patients were assessed prior to surgery and 3,6,12 and 24 months after surgery. Statistical analysis was performed using the software Minitab¿ and published international clinical standards. RESULTS Best corrected visual acuity increased significantly in both groups after surgery (p<0.0001) and the intraocular pressure diminished significantly in both groups after surgery (p<0.0001), but there were not significant differences between groups at any of the periods studied (at one month, p=0.568; at three months, p=0.629; at six months, p=0.208; and at twelve months, p=838). Mean number of topical ocular hypotensive treatments diminished from 1.21±0.55 to 0.20±0.43 in Group 1 and from 1.26±0.2 to 0.25±0.46 in Group 2 twelve months after surgery and there were no significant differences between groups (p=0.704). Corneal endothelial cell density decreased significantly after surgery in both groups (p<0.0001). Endothelial cell density 12 months after surgery was 1,769± 509 cells/mm2 in Group 1 and 1,396±514 cells/mm2 in group 2, and this difference was statistically significant (p<0.0001). Mean percentage of decrease of corneal endothelial cells was 31.62±14.73% in Group 1 and 42.55±17.68% in Group 2, twelve months after surgery. The variation coefficient did not change significantly in any of the groups with surgery, but the hexagonality coefficient decreased significantly after surgery in Group 2. There was no significant correlation between the decrease of the endotelial cell densities and the preoperative anterior chamber depth or the preoperative central corneal thickness in any of the groups. However, we did not observe any clinically significant corneal edemas in any of the eyes included.