nd M y a ed g ic lo i o n i e B Kurysheva et al., Biol Med (Aligarh) 2016, 8:7 ISSN: 0974-8369 Biology and Medicine DOI: 10.4172/0974-8369.1000343 Research Article Open Access Polymegathism, Pleomorphism, and Endothelial Cell Count after Selective Laser Trabeculoplasty N. Kurysheva*, E. Shatalova Ophthalmological Center of the Federal Medical and Biological Agency, Clinical Hospital No. 86, 15 Gamalei St., Moscow 123098, Russia *Corresponding author: Kurysheva N, Diagnostic Department, Ophthalmological Center of the Federal Medical and Biological Agency, Clinical Hospital No. 86, 15 Gamalei St., Moscow 123098, Russia; E-mail: [email protected] Received: Jun 22, 2016; Accepted: Aug 25, 2016; Published: Oct 7, 2016 Copyright: © 2016 Kurysheva et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The purpose of the study was to investigate the changes in the endothelial cell count and cell’s polymegathism and pleomorphism after selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). SLT has been performed on 18 patients (22 eyes). Each patient underwent confocal microscopy 1 h prior to the laser surgery and then 1 h, 1 day, 1 week, and 1 month after SLT. The obtained micrographs were then analyzed in order to study the infl uence of SLT on the corneal endothelium. The difference in the mean corneal endothelial cell density, polymegathism, and pleomor- phism at different time intervals was found to be statistically signifi cant. The mean endothelial cell count was reduced in 1 week after SLT from 2442 6 326 per mm2 to 2352 6 460 per mm2; polymegathism was increased from 46.1 6 11.7% to 50.9 6 13.4%; and pleomorphism was decreased from 46.2 6 11.2% to 40.9 6 7.2%. Cellular damage was also observed on the micrographs that were made in the follow-up after SLT. The highest quantity of damaged cells was observed 1 h after SLT. After 1 month, endothelial integrity was completely restored. If damaging does occur after SLT, it is not severe enough to induce serious changes in the endothelial monolayer. Nevertheless, extra care should be taken when choosing an approach to treating patients with low endothelial cell density. Keywords: Glaucoma; Corneal endothelium; Corneal endothelial cell signifi cant morphological changes with respect to their size/area density; Pleomorphism; Polymegathism; Selective laser trabeculoplasty; (polymegathism) and shape/hexagonality (pleomorphism). Th is could Confocal microscopy be the reason for postoperative keratopathy with subsequent early and rapid corneal decompensation. In our previous study we reported about Introduction early changes of the corneal endothelium cells in some patients aft er Selective laser trabeculoplasty (SLT) has been used to lower IOP in SLT [9]. At that time there were only few studies concerning endothelial the management of primary open-angle glaucoma (POAG). For several cell count before and aft er SLT [10-13]. Th e results of these studies are decades, since the development of argon laser trabeculoplasty by controversial. In some of them scientists used specular microscopy, J. Wise, this procedure has been the operation of choice in the open-angle pleomorphism, and polymegathism of endothelium cells aft er SLT glaucoma treatment of patients in case of intolerance or ineff ectiveness were not evaluated. of drug therapy and refusal to undergo surgery. In the present study we have investigated the changes in the At the beginning of the new millennium, the quantity of performed endothelial cell count and cell’s polymegathism and pleomorphism laser surgeries doubled due to the introduction of a new method— aft er SLT in OAG. selective laser trabeculoplasty (SLT) [1]. Th e effi cacy and safety of SLT contributed to its becoming one of the best glaucoma treatment options. Materials and Methods Th e possibility of repeating the procedure facilitated an even faster Th e study has included 18 patients (22 eyes): 9 males and 9 females, spread of this method [2]. Moreover, SLT can be used as a means of aged 60 to 76 years (mean age 67.33 6 5.79) with diff erent stages of reintervention aft er previous surgeries, including phacoemulsifi cation POAG. Sixteen eyes had pseudoexfoliation (PXF). and procedures in refractory glaucoma [3]. Th e study has been conducted in accordance with the principles of Quite soon aft er SLT’s introduction to clinical practice, reports on the Declaration of Helsinki and had the approval of the ethics committees possible complications, mainly infl ammation, with or without visual of the hospital. We defi ned POAG as the presence of glaucomatous discomfort and IOP elevation, appeared [4,5]. Permanent corneal optic neuropathy (vertical cup-disc ratio 0.7 and/or neuroretinal rim changes aft er SLT are extremely rare with only two reported cases [6]. narrowing) with associated visual fi eld defect on automated perimetry Th ere were a few reports of post-SLT edema of the central corneal (Swedish interactive thresholding algorithm standard 24-2 program; stroma, haze and subsequent corneal thinning, and scarring [7,8]. Humphrey fi eld analyzer II 750i; Carl Zeiss Meditec) if the following Much attention should be paid to the corneal endothelium. were found: (1) glaucoma hemifi eld test results outside normal limits; Th e cornea is the frontal transparent layer of the eye that covers (2) a cluster of 3 or more nonedge, contiguous points on the pattern the pupil and iris. Its endothelium is composed of a monolayer of deviation plot, not crossing the horizontal meridian with less than a 5% hexagonal cells and plays a pivotal role in the homeostasis of the cornea. probability of being present in age-matched healthy individuals (one Th ese cells are characterized by polymegathism (cell size variability) of which was 1%); and (3) pattern standard deviation less than 0.05. and pleomorphism (cell shape variation). Even though endothelial Written informed consent was obtained from all the participants. All cell count may be normal in POAG eyes, the latter may demonstrate patients received topical hypotensive treatment, mainly prostaglandin Biol Med (Aligarh) ISSN: 0974-8369 BLM, an open access journal Volume 8 • Issue 7 • 1000343 Citation: Kurysheva N, Shatalova E (2016) Polymegathism, Pleomorphism and Endothelial Cell Count after Selective Laser Trabeculoplasty. Biol Med (Aligarh) 8: 343. doi:10.4172/0974-8369.1000343. Page 2 of 5 analogues and beta-blockers. Assessments of IOP were performed at In the postoperative period, all patients were treated with a single 9 am, 12 pm, and 5 pm (3 consecutive IOP measurements by Goldmann instillation of timolol 0.25% and indomethacin 0.1%. applanation tonometry, each was documented) and averaged to obtain the mean IOP. Central corneal thickness and corneal endothelial cell Confocal microscopy counts (ECCs) were also obtained. The mean endothelial cell density (ECD) in the central cornea, Patients with corneal pathology were excluded from the study. The pleomorphism, and polymegathism were evaluated using micrographs clinical data, including the stage of glaucoma, topical treatment prior to taken on a confocal microscope (Confoscan 4 Nidek). The topical SLT, and laser settings, are given in Tables 1 and 2. ocular anaesthetic was proxymetacain 0.5%. The surface of the objective lens was coated with a transparent gel (Vidisic). The step All the eyes requiring SLT were pretreated with brimonidine tartrate distance was set to 4 μm, and the lamp intensity was set to 80%. Only 0.15% and pilocarpine hydrochloride 2.0% prior to the procedure. The central corneal endothelium was analyzed. Of the each micrographs set, SLT procedure was performed under topical anesthesia using the Latina one micrograph of the best quality was selected to study ECD. These lens (Ocular Instruments Inc); power was initially set at 0.6 mJ and was parameters were calculated automatically by means of the built-in increased in 0.1-mJ steps until small bubbles appeared from the treated software. The area for evaluation included at least 100 cells. In case area of the trabecular meshwork (TM). Contiguous nonoverlapping of low-quality image series, automatic cell counting was considered shots were placed onto at least 1808 of the visible TM, avoiding areas of unreliable, and counting was performed manually. The pleomorphism peripheral anterior synechiae. More nonoverlapping shots were placed and polymegathism values were defined against normal values of 59.0 when a greater extent of the trabeculum was visible. Pre-SLT IOP for pleomorphism and 30.0% for polymegathism, which means that measurement and confocal microscopy were performed an hour prior a normal healthy cornea should have at least 60% endothelial cells to the surgery. The IOP was checked 60 min, 24 h, 1 day, 1 week, and with regular shape or hexagonality and should not have abnormal 1 month after SLT. Patients developing inflammation shortly after the endothelial cell sizes or areas (normal 312-320 micron square) in more surgery were prescribed instillations of indomethacin 0.1% eyedrops than 30% of cells [10]. twice a day for 1 week after the procedure. If IOP was 28 mm Hg or higher, the patients were prescribed timolol 0.5% twice a day. One hour Statistical analysis after SLT, the operated eye was examined using biomicroscopy in order All statistical analyses were performed with the SPSS software. to reveal inflammatory response and to perform confocal microscopy. Mean values were tested for statistical significance with a Student’s The same examination was done 1 day, 1 week, and 1 month after SLT. t-test. Results Minimum Maximum Mean Standard Parameter value Value value deviation Three patients (3 eyes) showed moderate irritation (mixed injection) Age (years) 60.00 76.00 67.33 5.79 during 24 h after SLT.