Glaucoma and its various forms of treatment (topical medical therapy, laser procedures, surgeries) can have variable effects on the corneal endothelium, which can be concerning for patients’ corneal clarity. In a recent literature review, researchers investigated which treatments had more adverse effects on endothelial cell density (ECD) than others.

In general, the authors explain, topical IOP-lowering medical therapy has no consistent effect on ECD, although some small studies of individual medications report significant, but often conflicting effects. Argon laser peripheral iridotomy (LPI) appears to have no effect on ECD, while mixed results do not rule out a possible adverse effect of Nd:YAG laser LPI on ECD. Likewise, argon laser trabeculoplasty has no significant effect on ECD. Selective laser trabeculoplasty has not been shown to adversely affect ECD, but several case reports of corneal edema and/or decompensation have been reported, the cause of which remains undetermined.

Surgical procedures have the most significant effects on ECD, which may be partially mitigated by proper device placement as far as possible from the corneal endothelial surface.

The authors suggest concerns for corneal endothelial cell health should be part of the decision-making process when planning glaucoma surgery for lowering IOP, with added caution in case of planned device implantation in eyes with pre-existing ECL and low ECD counts at high risk for corneal endothelial decompensation.

Realini T, Gupta PK, Radcliffe NM, et al. The effects of glaucoma and glaucoma therapies on corneal endothelial cell density. J Glaucoma 2021;30:209-218.