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Review
. 2022 Mar 1;33(2):119-129.
doi: 10.1097/ICU.0000000000000830.

Endothelial cell loss associated with minimally invasive glaucoma surgery

Ivan Seah  1 , Chelvin C A Sng  1   2   3 , Marcus Ang  3   4   5
Affiliations
Review

Endothelial cell loss associated with minimally invasive glaucoma surgery

Ivan Seah et al. Curr Opin Ophthalmol. .

Abstract

Purpose of review: Minimally invasive glaucoma surgery (MIGS) represents a safer, albeit moderately effective surgical option for intraocular pressure control. However, the CyPass Micro-Stent (Alcon Laboratories) was withdrawn from the market in 2018 as the COMPASS-XT study demonstrated greater cornea endothelial cell (CEC) loss in patients who received the CyPass Micro-Stent with phacoemulsification compared with phacoemulsification alone. This led to the increased attention on MIGS-associated CEC loss and thus, this review will summarise the recent, available evidence on MIGS-associated CEC loss.

Recent findings: Prospective clinical trials and retrospective observational studies published between 2011 and 2021 reported a wide range of 12 month CEC loss from 'insignificant', and up to 14.6%, for phacoemulsification combined with various MIGS procedures. Recent clinical trials over the same time period reported CEC loss of 12.8-15.2% associated with phacoemulsification alone.

Summary: Apart from the CyPass Micro-Stent clinical trial, no other studies on combined phacoemulsification with MIGS that is 'phaco-plus' procedures have reported a higher short-term CEC loss compared with phacoemulsification alone. However, studies that specifically examine postprocedural CEC loss following phacoemulsification compared to 'phaco-plus' procedures over a longer follow-up period are required.

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