The effect of sodium hyaluronate on corneal endothelial cells in trabeculectomy

Objective To investigate the effect of sodium hyaluronate (SH) on corneal endothelial cells in trabeculectomy.Methods Seventy-five patients (75 eyes) with primary acute closed-angle glaucoma underwent a trabeculectomy.SH was injected into the anterior chamber and under the sutured scleral flaps in 37 cases (37 eyes),and in the other 38 cases (38 eyes),the control group,it was injected into BSS.All cases had undergone tests for corneal endothelium cell density and cellular morphology with a non-contact corneal endothelial microscope before and 1 week and 3 months after the operation.Postoperative intraocular pressure (IOP),the form of the anterior chamber,filtration and postoperative complications were compared between the two groups.Results The endothelium cell density,average cell area,cell size variation coefficient and percentage of hexagonal cells before and 1 week and 3 months after the operation were (2183±325)mm 2,(2096±332)mm 2,(2112±261)mm 2 and (462.7±42.8)μm 2,(422.9±53.1)μm 2,(430.8± 55.2)μm 2 and (47.3±15.7)%,(48.1±12.5)%,(42.6±10.9)% and (52.3±14.8)%,(51.6±13.3)%,(55.7±11.2)%,respectively,in the treatment group.The results for the control group were (2098±314) mm 2,(1631 ±388)mm 2,(1855 ±402)mm 2 and (462.7 ±42.8)μm 2,(562.7 ±73.8)μm 2,(536.6 ±65.1)μm 2 and (49.5 ±14.3)%,(59.2 ± 12.6)%,(58.7 ±12.3)% and (53.2 ±16.1)%,(40.4 ±13.2)%,(42.6 ± 11.8)%,respectively.There were no statistically significant differences before the operation and 1 week or 3 months after the operation when endothelium cell density,average cell area,cell size variation coefficient and percentage of hexagonal cells in the treatment group were compared (P 0.05).But there were statistically significant differences in the control group (P0.05).The loss rate of corneal endothelium cells in the treatment group was 4.0% and 3.3% at 1 week and 3 months after the operation.The rate was lower than the 17.5% and 11.6% in the control group (P 0.05).The shallow anterior chamber angle (in degrees) in the treatment group after the operation was lower than that in the control group (P 0.05).There were significant differences in the loss rate of corneal endothelium cells among the different anterior chamber angle groups before and 1 week or 3 months after the operation (P 0.01).The more shallow the anterior chamber was,the higher the loss rate of corneal endothelium cells.There was a positive correlation between the anterior chamber angle and loss rate of corneal endothelium cells 1 week or 3 months after the operation (r=0.7825,r=0.7603,respectively,P0.01).Conclusion Trabeculectomy,especially in a postoperative shallow anterior chamber,can injure corneal endothelium cells.The use of sodium hyaluronate in trabeculectomy can decrease the occurrence and angle of a postoperative shallow anterior chamber and protect corneal endothelium cells.