A comparison of corneal endothelial cell density between a group of black South Africans with glaucoma and a group of black South African healthy controls

Abstract Background: The endothelial layer of the cornea is crucial to corneal clarity and function, and the cell density of this layer gradually decreases with age and due to disease processes. Primary open-angle glaucoma, a subtype of glaucoma, is associated with reduced corneal endothelial cell density in various populations outside of South Africa. Methods: This cross-sectional, descriptive, observational study assessed the corneal endothelial density of black South Africans with primary open-angle glaucoma on topical medical management only and compared it to a control group with no eye pathology from the same population. Results: The study included 112 participants, with an equal number in each group. The baseline characteristics of the two groups were similar. Corneal endothelial cell density in cells per square millimetre was significantly lower in the cohort of participants with primary open-angle glaucoma compared to control participants with healthy corneas. The mean endothelial cell density overall was 2323 (SD 331, 95% CI 2261–2385), with the glaucoma group having a mean of 2213 (SD 365, 95% CI 2115–2311) and the control group having a mean of 2433 (SD 251, 95% CI 2365–2500). Conclusion: The corneal endothelial cell density of a cohort of black South Africans with primary open angle glaucoma being managed with topical mediation alone was found to be significantly lower than a control group from the same population. This is important for managing black patients with primary open-angle glaucoma, as low endothelial cell density can affect long-term post-operative corneal clarity.