Evaluation of Angle Closure as a Risk Factor for Reduced Corneal Endothelial Cell Density

Purpose: Acute angle closure attacks are frequently accompanied by corneal edema. However, little is known about corneal endothelial cell status at different stages of angle closure. Here, we compared endothelial cell density (ECD) in unoperated eyes with that in eyes with open angles (OAs) and various stages of angle closure disease. Materials and Methods: The study was conducted at Aravind Eye Hospitals in India. Masked examiners performed gonioscopy to classify each eye as follows: (1) OA, (2) primary angle closure suspect, or (3) primary angle closure (PAC)/primary angle closure glaucoma (PACG). Specular microscopy was performed and differences in ECD were analyzed using hierarchical models. Results: A total of 407 patients and 814 eyes were studied, including 127 (15.6%), 466 (57.3%), and 221 (27.1%) with PAC/PACG, primary angle closure suspect, and OA, respectively. Participants were predominantly female (69.8%) and the mean age was 49.2 (SD: 8.6) years. Lower ECD was observed with increasing age [β=-6.3 cells/mm 2; 95% confidence interval (CI), -9.3 to -3.3, per year; P<0.001], greater iridotrabecular contact [β=-15.6 cells/mm 2; 95% CI, -28.3 to -2.9, per quadrant of contact; P=0.016), and shallow (<2.5 mm) anterior chamber depth (β=-40 cells/mm 2; compared to deeper AC's (≥2.5 mm), 95% CI, 78.9-1.1; P=0.044). In age-adjusted analyses, angle closure suspects had lower ECD than OA eyes (β=-54.7 cells/mm 2; 95% CI, -47.8 to -85.3; P=0.018), although PAC/PACG eyes were not significantly different from OA eyes (β=-18.6 cells/mm 2; 95% CI, -85.9 to 2.5; P=0.058). Conclusion: In untreated eyes, only mild, clinically insignificant decrement in ECD was noted with angle closure.