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A Comparison of Corneal Endothelial Cell Changes After 1-Site and 2-Site Phacotrabeculectomy

Purpose: To compare the corneal endothelial cell (CEC) changes that occurred after phacotrabeculectomy performed at 1 or 2 sites. Design: A historical cohort study. Methods: The records of patients who had 1-site (n = 61) or 2-site (n = 52) limbus-based phacotrabeculectomy over a 4-year period (2002-2005) at 1 eye surgery center (Vanak Eye Surgery Center, Tehran, Iran) by a single surgeon were reviewed, and postoperative CEC indices were measured. Preoperative CEC indices, performed for a then-ongoing trial, were compared with postoperative measurements of the last follow-ups. The main outcome measure was endothelial cell count. Results: The median follow-up time was 12 months (range 9-24 months). There was no difference between the operations in improving visual acuity, lowering intraocular pressure, and decreasing the number of antiglaucoma medications required. However, 2-site surgery was associated with significantly more expansion in the CEC area (P < 0.001). On multivariate analysis, longer follow-up, 2-site surgery, and grade 4 cataract density were independently associated with more CEC loss, and longer follow-up, 2-site surgery, and steroid-induced glaucoma were associated with CEC area expansion. Postoperative complications were not markedly different between the 2 groups. Conclusions: In both groups, the longer the follow-up time was, the higher the CEC loss and the CEC area expansion were. One-site surgery seems to cause less CEC damage than the 2-site operation during the median follow-up time of 1 year.