This review combined data from studies on eyes without pre-existing corneal disease that received an Ahmed or Baerveldt glaucoma drainage device. The analysis included 572 eyes followed for about one year. The main finding was a decrease in corneal endothelial cell density after device implantation. The average loss was about 205 cells per square millimeter within the first year. The review also noted that cell loss was greater in predominantly Asian populations compared to predominantly Caucasian populations. Safety events were not reported in the included studies. The main reason to be careful is that the evidence had significant differences between studies, which limited the analysis for some device placements. Readers should know this is a summary of existing research, not a new trial. It suggests a link between device implantation and cell loss, but more high-quality studies are needed for definitive estimates.
Ahmed or Baerveldt GDD implantation decreases corneal endothelial cell density by 204.7 cells/mm2 at 12 months in anterior chamber settingsGlaucoma device implantation linked to corneal cell loss
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Key Takeaway
Note clinically relevant corneal endothelial cell loss after GDD implantation in anterior chamber settings.
This systematic review and meta-analysis assessed corneal endothelial cell density changes following Ahmed or Baerveldt glaucoma drainage device implantation in eyes without pre-existing corneal endothelial pathologies. The study included 572 eyes in an anterior chamber setting with a follow-up of 12.0 months.
The primary outcome showed that ECD decreased by 204.7 cells/mm2 with a 95% CI of 149.2 to 260.1. ECD loss at 24 months decreased by 287.8 cells/mm2 with a 95% CI of 233.0 to 342.7. Loss varied between 12 and 629.6 cells/mm2 at 12 months after sulcus or pars plana placement where p-values were not reported.
Subgroup analysis indicated ECD loss was greater in predominantly Asian populations with a mean difference of 225.5 cells/mm2 compared to predominantly Caucasian populations with a mean difference of 155.3 cells/mm2. No difference was found between Ahmed and Baerveldt GDD types regarding ECD loss.
Limitations include existing evidence heterogeneity and significant heterogeneity in studies that precluded meta-analysis of available data for sulcus or pars plana placement. The authors state that further high-quality randomized controlled trials are necessary to establish definitive estimates. Implantation of a GDD leads to clinically relevant corneal endothelial cell loss.
What this means for you:
Glaucoma drainage devices may reduce corneal cell density, with greater loss in some groups. View Original Abstract ↓
PRCIS: GDD implantation in the anterior chamber is associated with progressive corneal endothelial cell loss over time, with evidence suggesting a more pronounced effect in Asian compared with Caucasian eyes.
PURPOSE: Corneal endothelial cell damage occurs with various surgical procedures. This systematic review and meta-analysis aims to investigate the impact of Ahmed or Baerveldt glaucoma drainage device (GDD) implantation on corneal endothelial cell density (ECD).
METHODS: Database search involved MEDLINE, EMBASE, Scopus, NIH Clinical Trials ( http://www.clinicaltrials.gov/ ), and Google Scholar (PROSPERO ID:CRD42024521140). The included studies focused on standalone GDD implantation in eyes without pre-existing corneal endothelial pathologies and with a minimum follow-up of 12 months. The quality of the studies was assessed using the Cochrane Risk of Bias Tool (ROBINS-I).
RESULTS: Fourteen studies were included in the quantitative synthesis, comprising 572 eyes. ECD after anterior chamber GDD implantation decreased by 204.7 cells/mm 2 (95% CI: 149.2, 260.1, I 2 =61.04%) at 12 months. Subgroup analysis revealed a greater ECD loss in predominantly Asian (MD, 225.5 cells/mm 2 ; 95% CI: 151.1, 300.0, I 2 =67.4%) compared with predominantly Caucasian population (MD, 155.3 cells/mm 2 ; 95% CI: 94.5, 216.2, I 2 =0%) and no difference between Ahmed and Baerveldt GDD. Sensitivity analysis showed ECD loss of 227.1 cells/mm 2 (95% CI: 182.6, 271.6, I 2 =32.6%). At 24 months after anterior chamber GDD implantation, ECD decreased by 287.8 cells/mm 2 (95% CI: 233.0, 342.7, I 2 =53.4%). ECD loss at 12 months after sulcus or pars plana placement varied between 12 and 629.6 cells/mm 2 , but significant heterogeneity in studies precluded meta-analysis of available data.
CONCLUSION: Overall, implantation of a GDD leads to clinically relevant corneal endothelial cell loss. ECD loss may be more pronounced in Asians compared with Caucasians. No difference in ECD loss was observed between the 2 GDD types GDD. The existing evidence is characterized by heterogeneity, and further high-quality randomized controlled trials are necessary to establish definitive estimates.
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