RESUMO
BACKGROUND: Glaucoma is a leading cause of blindness worldwide for which trabeculectomy is the most effective surgical intervention for advanced disease. However, trabeculectomy has been associated with alterations to corneal endothelium, including a decrease in corneal endothelial cell density (CECD). The purpose of this study was to investigate changes in CECD after trabeculectomy, and identify factors contributing to cell loss, such as pre-operative biometry and lens status. METHODS: This retrospective study included 72 eyes of 60 patients who underwent trabeculectomy between January 2018 and June 2021 at two private hospitals. Demographic and clinical data were obtained at baseline. Corneal specular microscopy was performed pre-operatively and at 6 months after surgery. CECD was evaluated and compared between groups to quantify changes to corneal endothelium and identify significant factors affecting decreases in cell density. RESULTS: Mean CECD was 2284.66 ± 375.59 pre-operatively and 2129.52 ± 401.96 after 6 months (p < 0.001). A greater decrease in CECD (p = 0.005) was observed in phakic eyes (235.45 ± 118.32) compared to pseudophakic eyes (137.82 ± 107.30). The amount of cell loss was negatively correlated with pre-operative central corneal thickness (p = 0.009) and anterior chamber (AC) depth (p = 0.033). There were no significant correlations between changes to CECD and patient age, gender, number of pre-operative glaucoma medications and number of post-operative antifibrotic agents. CONCLUSIONS: Significant decreases in CECD occurred after trabeculectomy. Less corneal endothelial cell loss occurred in pseudophakic eyes. Hence, if patients need trabeculectomy and cataract surgery, it may be better to perform cataract surgery first. Longer term studies should derive more information.
RESUMO
Background: Gestational diabetes mellitus (GDM) is diabetes first diagnosed in pregnancy. GDM, together with its short- and long-term negative outcomes, is increasing in incidence all over the world. The current diagnostic method for GDM, the oral glucose tolerance test (OGTT), is dated and has been reported as inconvenient for women as well as poorly reproducible and reliable. Aims: We aimed at assessing the acceptability, feasibility, and accuracy of continuous glucose monitoring (CGM) as a diagnostic test for GDM and explore its correlation with the OGTT and risk factors for GDM. Methods: In this prospective cohort study, pregnant women due for or having completed OGTT underwent CGM for seven days, performing daily finger-prick blood glucose levels before completing an acceptability questionnaire. Data on GDM risk factors and CGM variability were analyzed and compared with OGTT results. Results: Seventy-three women completed CGM (40 GDM, 33 normal glucose tolerances); 34 concurrently underwent OGTT. CGM was acceptable and generally well-tolerated, with skin irritation/itchiness the only adverse event (11 mild, one severe). CGM and OGTT strongly correlated for fasting glucose values (r = 0.86, p < 0.05) only. Triangulating GDM risk factors, OGTT results and CGM variability parameters with the application of machine learning highlighted the possibility of unmasking false positive (11 showed low CGM variability and demographic risks but positive OGTT) and false-negative OGTT diagnoses (1 showed high CGM variability and demographic risks but negative OGTT). Conclusions: CGM was well-tolerated, showing poorer glycaemic control in GDM, and revealing potential misdiagnosis of the OGTT when combined with GDM risk factors. Future research is needed to determine cut-off values for CGM-defined and OGTT-independent screening criteria for GDM.
