Corneal Endothelium Cell Loss After Ahmed and Baerveldt Glaucoma Drainage Device Implantation

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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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