Long-term Changes of Endothelial Cell Density after Pars Plana Vitrectomy with Fragmentation

Soo Youn Choi; Ji Yun Han; Youngsub Eom; Seong-Woo Kim

doi:10.3341/jkos.2017.58.4.408

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Choi, Han, Eom, and Kim: Long-term Changes of Endothelial Cell Density after Pars Plana Vitrectomy with Fragmentation

Original Article

J Korean Ophthalmol Soc 2017;58(4):408-414.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.4.408

Long-term Changes of Endothelial Cell Density after Pars Plana Vitrectomy with Fragmentation

Soo Youn Choi, M.D., Ji Yun Han, M.D., Youngsub Eom, MD, PhD, Seong-Woo Kim, MD, PhD

Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Seong-Woo Kim, MD, PhD Department of Ophthalmology, Korea University Ansan Hospital, #123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea Tel: 82-31-412-5160, Fax: 82-31-412-4267 E-mail: vitreokim@gmail.com

This study was supported in part by Alumni of Department of Ophthalmology, Korea University College of Medicine.

Received 15 December 201614 February 2017 Accepted 31 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term changes in cornea endothelial cell density (ECD) after pars plana vitrectomy (PPV) with fragmentation.

Methods

Twenty patients (20 eyes) who underwent PPV with fragmentation and who were followed up for 2 years were enrolled in this retrospective study. The cornea ECD, coefficient of variation (CV), and hexagonality (HA) were calculated using a spec-ular microscopy at 1, 3, 6, 12 months, and 2 years after surgery.

Results

The preoperative mean ECD was 1,782 ± 623 cells/mm², and the postoperative mean ECD did not significantly change at 1, 3, 6, and 12 months. Additionally, there were no significant changes in CV or HA. At 2 years after surgery, the mean ECD was 1,722 ± 532 cells/mm², the mean CV was 35.50 ± 3.03%, and the mean HA was 53.00 ± 4.91%. There were no significant changes in ECD, CV, or HA preoperatively and postoperatively at 1, 3, 6, and 12 months.

Conclusions

In this study, the mean ECD did not significantly decrease after PPV with fragmentation at 2 years after surgery. A PPV with fragmentation was an appropriate surgical procedure for patients with low cornea endothelial cell density.

Keywords: Cornea endothelial cell density, Pars plana vitrectomy with fragmentation

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Figure 1.

Changes in endothelial cell density(ECD). No sig-nificant changes in ECD at 1, 3, 6, 12 and 24 months after pars plana vitrectomy with fragmentation.

Figure 2.

Changes in coefficient of variation (CV) of endothe-lial cells. No significant changes in CV at 1, 3, 6, 12 and 24 months after pars plana vitrectomy with fragmentation.

Figure 3.

Changes in endothelial cell hexagonality (HA). No significant changes in HA at 1, 3, 6, 12 and 24 months after pars plana vitrectomy with fragmentation.

Table 1.

Baseline clinical characteristics

Parameter (mean)	PPV with fragmentation (n = 20)
Mean age (years)	63.75 ± 8.79
Gender (n, %)
Male	9 (45.0)
Female	11 (55.0)
Laterality (n, %)
Right eye	9 (45.0)
Left eye	11 (55.0)
Diabetes mellitus (n, %)
No	11 (55.0)
Non proliferative diabetic retinopathy	8 (40.0)
Proliferative diabetic retinopathy	1 (5.0)
Cataract grade
NS	2.3 ± 0.7
Mean corneal power (D)	44.3 ± 1.4
Mean axial length (mm)	23.3 ± 1.0

Values are presented as n (%) unless otherwise indicated.

PPV = pars plana vitrectomy; NS = nuclear sclerosis.

Table 2.

Surgical indications for pars plana vitrectomy

	PPV with fragmentation (n = 20)
Epiretinal membrane	2 (10.0)
BRVO hemorrhage	2 (10.0)
Low endothelial cell counts	10 (50.0)
Zonulysis	6 (30.0)

Values are presented as n (%).

PPV = pars plana vitrectomy; BRVO = branch retinal vein occlusion.

Table 3.

Changes in endothelial cell density (ECD)

Period	No. of Eyes	Mean ECD (cells/mm²)	Mean observed percentage ECD change	p-value^*
Preoperative	20	1,782 ± 623	NA	NA
Postop 1 month	19	1,665 ± 685	4.52 ± 16.78	0.953
Postop 3 months	13	1,791 ± 518	-2.72 ± 21.48	0.980
Postop 6 months	13	1,859 ± 719	11.92 ± 39.48	0.989
Postop 1 year	17	1,642 ± 695	5.02 ± 19.85	0.808
Postop 2 years	20	1,722 ± 532	-1.30 ± 26.94	0.973

Values are presented as mean ± SD unless otherwise indicated.

Postop = postoperative; NA = not applicable.

^* General linear model with compound symmetry covariance structure.

Table 4.

Changes in coefficient of variation (CV)

Period	No. of Eyes	Mean CV	Mean observed percentage CV change	p-value^*
Preoperative	20	35.55 ± 3.03	NA	NA
Postop 1 month	19	33.00 ± 3.06	-3.31 ± 29.57	0.932
Postop 3 months	12	33.78 ± 3.46	-2.54 ± 41.96	0.993
Postop 6 months	13	35.98 ± 3.38	9.01 ± 30.80	1.000
Postop 12 months	16	33.70 ± 3.19	0.35 ± 27.01	0.986
Postop 2 years	20	35.50 ± 3.03	3.45 ± 24.69	1.000

Values are presented as mean ± SD unless otherwise indicated.

Postop = postoperative; NA = not applicable.

^* General linear model with compound symmetry covariance structure.

Table 5.

Changes in hexagonality (HA)

Period	No. of Eyes	Mean HA (%)	Mean observed percentage HA change	p-value^*
Preoperative	15	49.86 ± 5.60	NA	NA
Postop 1 month	18	66.88 ± 5.15	-77.44 ± 125.85	0.141
Postop 3 months	11	60.48 ± 6.74	-48.44 ± 67.26	0.776
Postop 6 months	12	49.35 ± 6.19	-49.61 ± 132.89	1.000
Postop 12 months	16	55.70 ± 5.43	-75.79 ± 128.32	0.960
Postop 2 years	20	53.00 ± 4.91	-38.08 ± 122.78	0.997

Values are presented as mean ± SD unless otherwise indicated.

Postop = postoperative; NA = not applicable.

^* General linear model with compound symmetry covariance structure.

Table 6.

Comparison of ECD, CV and HA of corneal endothelial cells after pars plana vitrectomy with fragmentation

Period	p-value^*
Period	ECD	CV	HA
Baseline vs. postop 1 month	0.953	0.932	0.141
Baseline vs. postop 3 months	0.980	0.993	0.776
Baseline vs. postop 6 months	0.989	1.000	1.000
Baseline vs. postop 12 months	0.808	0.986	0.960
Baseline vs. postop 2 years	0.973	1.000	0.997
Postop 1 month vs. 3 months	1.000	0.999	0.962
Postop 1 month vs. 6 months	0.746	0.927	0.180
Postop 1 month vs. 12 months	0.998	0.999	0.557
Postop 1 month vs. 2 years	1.000	0.937	0.252
Postop 3 month vs. 6 months	0.848	0.989	0.790
Postop 3 month vs. 12 months	0.998	1.000	0.991
Postop 3 month vs. 2 years	1.000	0.994	0.924
Postop 6 month vs. 12 months	0.540	0.980	0.959
Postop 6 month vs. 2 years	0.793	1.000	0.996
Postop 1 year vs. 2 years	0.994	0.988	0.998

ECD = endothelial cell density; CV = coefficient of variation; HA = hexagonality; Postop = postoperative.

^* General linear model with compound symmetry covariance structure.

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