The role of surgical interventions and major clinical factors in the development of corneal endothelial disorders in patients with glaucoma

PURPOSE . To assess the influence of major factors, including the type of surgical intervention, on the structural and functional state of the corneal endothelium. METHODS . The study included 58 patients (61 eyes) diagnosed with primary open-angle glaucoma (POAG) who underwent three different types of surgical interventions: non-penetrating deep sclerectomy with implantation of the Reper-NN A2 device (22 patients, 23 eyes), implantation of the Ex-PRESS device (17 patients, 18 eyes), and modified sinus trabeculectomy (19 patients, 20 eyes). Endothelial cell density was assessed using the Tomey EM-4000 microscope before surgery and one month postoperatively. Additionally, the following parameters were considered: baseline intraocular pressure (IOP), the number of antiglaucoma drugs used before the surgery, and anterior chamber angle width as assessed with optical coherence tomography. The total follow-up period was one year, it included control examinations at each stage of the postoperative period. RESULTS. Statistically significant (p < 0.05) but weak correlations were found between endothelial cell density and the studied parameters: a weak negative correlation with baseline IOP (r=-0.145), a weak positive correlation with the number of antiglaucoma medications (r=0.0032), and a weak positive correlation with anterior chamber angle width (r=0.05). A decrease in mean endothelial cell density was recorded in all studied groups one month after surgery. The most pronounced decrease was observed in patients who underwent sinus trabeculectomy. CONCLUSION . Anatomical features of the anterior segment of the eye, drug history and the type of surgical intervention influence the postoperative state of the corneal endothelium. Although individual parameters do not demonstrate a significant relationship with changes in endothelial density, their combined effect may impair endothelial viability. These finding emphasize the importance of comprehensive preoperative assessment and individualized selection of surgical tactics, particularly in patients with initially compromised endothelium. When indicated, preference may be given to less invasive interventions to minimize the risk of endothelial decompensation.