Ahmed or Baerveldt GDD implantation decreases corneal endothelial cell density by 204.7 cells/mm2 at 12 months in anterior chamber settings
Photo by Lucas Vasques / Unsplash
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.
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.
Systematic review of extensive macular atrophy with pseudodrusen reports visual acuity decline and atrophy progression
Eye disease linked to vision loss and thicker eye layers in study
Related in Ophthalmology
Simulation-based training improves fundus identification success in ophthalmology education
Simulation training improves eye exam skills in early review
This systematic review and meta-analysis of 772 participants found that simulation-based training led to a 63.1% fundus identification succe…
A review of 772 participants found simulation training helped identify eye structures better than traditional methods, with most preferring …
Netarsudil plus latanoprost cuts diurnal IOP 2.36 mmHg vs latanoprost alone in Japanese glaucoma
Adding netarsudil to latanoprost lowers eye pressure faster in Japanese patients with glaucoma
This Phase III randomized controlled trial in 246 Japanese participants with primary open-angle glaucoma or ocular hypertension found that n…
Japanese patients with glaucoma saw lower eye pressure when adding netarsudil to their current latanoprost drops compared to a placebo plus …
Seasonal variation linked to central serous chorioretinopathy incidence
Spring and autumn bring higher risk of central serous chorioretinopathy in working-age men
A meta-analysis found significantly higher CSC incidence in spring and autumn compared to summer, suggesting seasonal patterns in working-ag…
Working-age men face higher rates of central serous chorioretinopathy in spring and autumn compared to summer, according to a new analysis o…
Perioperative anti-VEGF injections improve vision and reduce bleeding in proliferative diabetic retinopathy
Anti-VEGF injections before eye surgery improve vision and reduce bleeding in diabetic retinopathy
This network meta-analysis evaluated the timing of perioperative anti-VEGF injections for proliferative diabetic retinopathy. Results indica…
A network meta-analysis of 2,646 eyes found that perioperative anti-VEGF injections improved vision and reduced bleeding in patients with pr…
From Other Specialties
Acupuncture Boosts Cognition in Alzheimer's and Mild Cognitive Impairment
Meta-analysis shows acupuncture improves cognitive function in Alzheimer's and mild cognitive impairment
A meta-analysis of 3362 patients finds acupuncture, alone or with Western medicine, significantly improves cognitive function in Alzheimer's…
A large analysis of 3,362 patients suggests acupuncture may improve cognitive function in Alzheimer's disease and mild cognitive impairment,…
Antibiotic stewardship bundle aims to cut antibiotic use in Chinese NICUs
A new plan aims to cut unnecessary antibiotics for sick newborns in China
This protocol describes a multicenter, before-and-after, interrupted time series quality improvement study testing a bundled antimicrobial s…
This ongoing project in China seeks to reduce antibiotic use for newborns with sepsis while keeping them safe during treatment.
Metabolic subtypes identify Japanese adults with prediabetes at highest or lowest T2D risk
Japanese adults with prediabetes benefit most from lifestyle changes in one specific metabolic group
This randomized controlled trial enrolled 295 Japanese adults with impaired glucose tolerance in the Japanese Diabetes Prevention Program. P…
A study of 295 Japanese adults found that lifestyle changes work best for those with a specific metabolic pattern. This group had the lowest…
Digital AMS tools show no significant impact on antibiotic prescribing or patient outcomes
Digital tools show no clear benefit for antibiotic use or patient outcomes
A meta-analysis of eleven RCTs found digital antimicrobial stewardship interventions did not significantly improve antibiotic appropriatenes…
A large review of trials found digital antimicrobial stewardship tools did not significantly change antibiotic prescribing or patient health…