Assessment of Changes in Corneal Endothelial Characteristics in Primary Open-Angle Glaucoma: Corneal Endothelial Characteristics in Primary Open-Angle Glaucoma

Tehreem Tanveer; Mahmood Ali; Abeera Ahmed; Nadia Rasool; Asma Anwar; Khadija Hussain; Farah Akhtar

doi:10.54393/pjhs.v6i3.2829

Authors

Tehreem Tanveer Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Mahmood Ali Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Abeera Ahmed Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Nadia Rasool Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Asma Anwar Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Khadija Hussain Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Farah Akhtar Department of Glaucoma, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i3.2829

Keywords:

Primary Open-Angle Glaucoma, Endothelial Cell Density, Intraocular Pressure, Correlation

Abstract

Patients with glaucoma undergo significant changes in corneal endothelial characteristics due to chronically elevated Intraocular pressure (IOP). Objectives: To compare endothelial cell density between primary open-angle glaucoma (POAG) patients and age-matched non-glaucomatous controls. Also to explore the relationship between endothelial cell density and Intraocular pressure. Methods: This case-control study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. It included 41 eyes of patients with POAG aged between 35-70 years and 41 eyes of age-matched non-glaucomatous subjects were taken as controls. The POAG was diagnosed based on Intraocular pressure, optic disc changes, and visual field defects. All participants went through a comprehensive ocular evaluation, that included slit-lamp examination, gonioscopy and Intraocular pressure assessment. The endothelial cell density was assessed via specular microscopy. SPSS version 26.0 was utilized to perform statistical analysis. Results: The average corneal endothelial cell density in healthy control subjects was 2484.51 ± 286.44 cells/mm², but those with POAG showed a statistically significant decline, measuring 2345 ± 270.29 cells/mm² (p=0.02). A notable decrease in endothelial cell density was seen in patients using dorzolamide 2262.00 ± 287.15 relative to patients not using dorzolamide 2451.28 ± 209.56 (0=0.02). Endothelial cell density and the average Intraocular pressure revealed a weak inverse correlation (r= -0.204, p=0.06). Conclusions: It was concluded that POAG patients show reduced corneal endothelial cell density. It also suggests that endothelial cell density declines with higher Intraocular pressure and increased disease severity, making it a possible biomarker of disease progression in POAG.

References

Michels TC and Ivan O. Glaucoma: Diagnosis and Management. American Family Physician. 2023 Mar; 107(3): 253-62.

Joshi P, Dangwal A, Guleria I, Kothari S, Singh P, Kalra JM et al. Glaucoma in Adults-Diagnosis, Management, and Prediagnosis to End-Stage, Categorizing Glaucoma's Stages: A Review. Journal of Current Glaucoma Practice. 2022 Sep; 16(3): 170. doi: 10.5005/jp-journals-10078-1388. DOI: https://doi.org/10.5005/jp-journals-10078-1388

Stein JD, Khawaja AP, Weizer JS. Glaucoma in Adults—Screening, Diagnosis, and Management: A Review. Journal of the American Medical Association. 2021 Jan; 325(2): 164-74. doi: 10.1001/jama.2020.21899. DOI: https://doi.org/10.1001/jama.2020.21899

Kang D, Kaur P, Singh K, Kumar D, Chopra R, Sehgal G. Evaluation and Correlation of Corneal Endothelium Parameters with the Severity of Primary Glaucoma. Indian Journal of Ophthalmology. 2022 Oct; 70(10): 3540-3. doi: 10.4103/ijo.IJO_234_22. DOI: https://doi.org/10.4103/ijo.IJO_234_22

Aoki T, Kitazawa K, Inatomi T, Kusada N, Horiuchi N, Takeda K et al. Risk Factors for Corneal Endothelial Cell Loss In Patients with Pseudoexfoliation Syndrome. Scientific Reports. 2020 Apr; 10(1): 7260. doi: 10.1038/s41598-020-64126-w. DOI: https://doi.org/10.1038/s41598-020-64126-w

Zhang N, Wang J, Li Y, Jiang B. Prevalence of Primary Open Angle Glaucoma in the Last 20 Years: A Meta-Analysis and Systematic Review. Scientific Reports. 2021 Jul; 11(1): 13762. doi: 10.1038/s41598-021-92971-w. DOI: https://doi.org/10.1038/s41598-021-92971-w

Allison K, Morabito K, Appelbaum J, Patel D. Primary Open Angle Glaucoma: Where Are We Today. EC Ophthalmology. 2024; 15: 1-5.

Price MO, Mehta JS, Jurkunas UV, Price Jr FW. Corneal Endothelial Dysfunction: Evolving Understanding and Treatment Options. Progress in Retinal and Eye Research. 2021 May; 82: 100904. doi: 10.1016/j.preteyeres.2020.100904. DOI: https://doi.org/10.1016/j.preteyeres.2020.100904

Vaiciuliene R, Rylskyte N, Baguzyte G, Jasinskas V. Risk Factors for Fluctuations in Corneal Endothelial Cell Density. Experimental and Therapeutic Medicine. 2022 Feb; 23(2): 129. doi: 10.3892/etm.2021.11052. DOI: https://doi.org/10.3892/etm.2021.11052

Gupta PK, Berdahl JP, Chan CC, Rocha KM, Yeu E, Ayres B et al. The Corneal Endothelium: Clinical Review of Endothelial Cell Health and Function. Journal of Cataract and Refractive Surgery. 2021 Sep; 47(9): 1218-26. doi: 10.1097/j.jcrs.0000000000000650. DOI: https://doi.org/10.1097/j.jcrs.0000000000000650

Fang CE, Khaw PT, Mathew RG, Henein C. Corneal Endothelial Cell Density Loss Following Glaucoma Surgery Alone or in Combination with Cataract Surgery: A Systematic Review Protocol. British Medical Journal Open. 2021 Sep; 11(9): E050992. doi: 10.1136/bmjopen-2021-050992. DOI: https://doi.org/10.1136/bmjopen-2021-050992

Vallabh NA, Kennedy S, Vinciguerra R, McLean K, Levis H, Borroni D et al. Corneal Endothelial Cell Loss in Glaucoma and Glaucoma Surgery and the Utility of Management with Descemet Membrane Endothelial Keratoplasty (DMEK). Journal of Ophthalmology. 2022; 2022(1): 1315299. doi: 10.1155/2022/1315299. DOI: https://doi.org/10.1155/2022/1315299

Shah R, Amador C, Tormanen K, Ghiam S, Saghizadeh M, Arumugaswami V et al. Systemic Diseases and the Cornea. Experimental Eye Research. 2021 Mar; 204: 108455. doi: 10.1016/j.exer.2021.108455. DOI: https://doi.org/10.1016/j.exer.2021.108455

Kandarakis SA, Togka KA, Doumazos L, Mylona I, Katsimpris A, Petrou P et al. The Multifarious Effects of Various Glaucoma Pharmacotherapy On Corneal Endothelium: A Narrative Review. Ophthalmology and Therapy. 2023 Jun; 12(3): 1457-78. doi: 10.1007/s40123-023-00699-9. DOI: https://doi.org/10.1007/s40123-023-00699-9

Realini T, Gupta PK, Radcliffe NM, Garg S, Wiley WF, Yeu E et al. The Effects of Glaucoma and Glaucoma Therapies On Corneal Endothelial Cell Density. Journal of Glaucoma. 2021 Mar; 30(3): 209-18. doi: 10.1097/IJG.0000000000001722. DOI: https://doi.org/10.1097/IJG.0000000000001722

Inoue K, Okugawa K, Oshika T, Amano S. Influence of Dorzolamide On Corneal Endothelium. Japanese Journal of Ophthalmology. 2003 Mar; 47(2): 129-33. doi: 10.1016/S0021-5155(02)00667-6. DOI: https://doi.org/10.1016/S0021-5155(02)00667-6

Baratz KH, Nau CB, Winter EJ, McLaren JW, Hodge DO, Herman DC et al. Effects of Glaucoma Medications On Corneal Endothelium, Keratocytes, and Subbasal Nerves Among Participants in the Ocular Hypertension Treatment Study. Cornea. 2006 Oct; 25(9): 1046-52. doi: 10.1097/01.ico.0000230499.07273.c5. DOI: https://doi.org/10.1097/01.ico.0000230499.07273.c5

Yu ZY, Wu L, Qu B. Changes in Corneal Endothelial Cell Density in Patients with Primary Open-Angle Glaucoma. World Journal of Clinical Cases. 2019 Aug; 7(15): 1978. doi: 10.12998/wjcc.v7.i15.1978. DOI: https://doi.org/10.12998/wjcc.v7.i15.1978

OpenEpi Menu. 2025 Feb. Available from: https://www.openepi.com/Menu/OE_Menu.htm.

Kaur K, Gurnani B. Specular Microscopy. Treasure Island (FL): Stat-Pearls Publishing. 2025 Mar. Available from: http://www.ncbi.nlm.nih.gov/books/NBK585127/.

Chaurasiya RK and Gupta A. Comment On: Evaluation and Correlation of Corneal Endothelium Parameters with the Severity of Primary Glaucoma. Indian Journal of Ophthalmology. 2023 Jun; 71(6): 2612-3. doi: 10.4103/IJO.IJO_2737_22. DOI: https://doi.org/10.4103/IJO.IJO_2737_22

Mahabadi N, Zeppieri M, Tripathy K. Open Angle Glaucoma. Treasure Island (FL): Stat-Pearls Publishing. 2025 Feb. Available from: http://www.ncbi.nlm.nih.gov/books/NBK441887/.