Primary Congenital Glaucoma Worsens Corneal Endothelial Cell Parameters

Patients with primary congenital glaucoma (PCG) have significantly lower endothelial cell density (ECD) compared with study participants placed in a healthy control group, according to findings published in Ophthalmology Glaucoma. 

Researchers conducted a retrospective study comparing the corneal endothelial cell morphology between patients with PCG and participants from an age-matched healthy control group using specular microscopy imaging. The study authors also considered whether endothelial cell parameters vary between subtypes of PCG (neonatal, infantile, and late-onset). 

The researchers included 145 eyes of 145 patients (mean age, 13.5 years) that underwent surgery for PCG and returned for a followup in 2021 and 2022, as well as 310 healthy participants placed into a control group. The main outcome measures were specular microscope parameters, which included ECD, average cell size, coefficient of variation (CV), maximum and minimum cell size. The majority of patients (46%) had infantile PCG (n=67). 

The researchers report that all eyes with PCG demonstrated significantly lower ECDs compared with controls (2158.7±636.5 vs 2840.9±232.5 cell/mm²; P <.0001). By subtype, the participants had mean ECDs of 2344.3 cell/mm² (neonatal), 2131.9 cell/mm² (infantile), and 2054.2 cell/mm² (late-onset PCG). The researchers identified no significant differences in ECD between the 3 subgroups, though it was lowest in the late-onset PCG group.

The researchers explain that, especially in the cases of children who may require medical or surgical intervention, clinicians should be aware of the compromised state of endothelial imaging parameters in those with PCG. Additionally, they emphasized that some surgical measures may further damage the endothelium. 

“Glaucoma surgeons should be cognizant of the fact that placement of glaucoma drainage devices (GDDs) may expediate the endothelial cell loss, and eventual corneal decompensation in cases of refractory PCG,” the researchers explain.

Study limitations include the lack of comparison of corneal endothelial parameters by surgery type, given the small numbers of patients treated with trabeculectomy.