Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2019; 7(15): 1978-1985
Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.1978
Changes in corneal endothelial cell density in patients with primary open-angle glaucoma
Zi-Yan Yu, Ling Wu, Bo Qu
Zi-Yan Yu, Bo Qu, Department of Ophthalmology, 4th Affiliated Hospital of China Medical University, Eye hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China
Ling Wu, Department of Ophthalmology, the 4th people’s Hospital of Shenyang, Shenyang 110005, Liaoning Province, China
Author contributions: All authors helped to perform the research; Qu B drafted the manuscript; Yu ZY and Wu L reviewed the published articles and analyzed the data; All authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the 4th Affiliated Hospital of China Medical University, No. EC-2019-KS-018.
Informed consent statement: Written informed consent was obtained from all of the patients.
Conflict-of-interest statement: The authors have stated that they have no conflicts of interest.
Data sharing statement: The datasets of this study are readily available from the corresponding author upon reasonable request.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bo Qu, MD, PhD, Associate Professor, Dr., Department of Ophthalmology, 4th affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China. dolphinemu@foxmail.com
Telephone: +86-130-66660193 Fax: +86-024-62037227
Received: April 9, 2019
Peer-review started: April 12, 2019
First decision: May 31, 2019
Revised: June 28, 2019
Accepted: July 3, 2019
Article in press: July 4, 2019
Published online: August 6, 2019
Processing time: 119 Days and 23.6 Hours
ARTICLE HIGHLIGHTS
Research background

The corneal endothelial monolayer maintains corneal clarity, and its damage is irreversible. Cornea endothelial cell loss is attributed to open-angle glaucoma, medicine and surgery treatments.

Research motivation

The main topic is the changes in corneal endothelial cell density in primary open-angle glaucoma (POAG) patients.

Research objectives

To investigate the corneal endothelium changes and the correlations to the mean intraocular pressure (IOP) in POAG patients.

Research methods

Sixty POAG patients were selected as the patient group (32 male, 28 females; mean age 63 ± 13 years, age range 50-80 years). Meanwhile, 60 age-matched healthy controls who underwent physical examination were selected. IOP was measured by Goldmann tonometry. Corneal endothelial cell density, percentage of hexagonal cells, average cell area, maximum cell area, minimum cell area, standard deviation of cell area and coefficient of variation in cell area were measured by specular microscopy.

Research results

Endothelial cell density was 2959 ± 236 cells/mm2 in healthy controls and 2757 ± 262 cells/mm2 in patients with POAG. The POAG eyes had significantly lower endothelial cell density compared to healthy control eyes (P < 0.001). In the POAG group, endothelial cell density was 2686 ± 233 cells/mm2 in the patients receiving medication and 2856 ± 272 cells/mm2 in the untreated subgroup. The eyes receiving medication had significantly lower endothelial cell density compared to untreated eyes. There was a negative correlation between cell density and mean IOP (r = −0.286, P = 0.004) and positive correlation between the average cell area and mean IOP (r = 0.228, P = 0.022), maximum cell area and mean IOP (r = 0.218, P = 0.029) and minimum cell area and mean IOP (r = 0.290, P = 0.003). The percentage of hexagonal cells was not correlated with mean IOP.

Research conclusions

For glaucoma patients, quantitative analysis of CEC morphology is necessary, and high IOP should be controlled as soon as possible to prevent corneal endothelial damage.

Research perspectives

Patients with POAG have lower corneal endothelial cell density than healthy controls of the same age. This may be attributed to mechanical damage from elevated IOP and toxicity of glaucoma medications.