title: Corneal endothelial damage after trabeculectomy with mitomycin C in two patients with glaucoma with cornea guttata.
abstract: OBJECTIVE
  To report two patients with glaucoma who exhibited severe damage to the corneal endothelium after a trabeculectomy with mitomycin C (MMC).
  
  
  METHODS
  This study includes clinical histories and specular microscopic pictures of the cases.
  
  
  RESULTS
  Both patients were middle-aged women, underwent trabeculectomy with MMC, had moderate to severe cornea guttata preoperatively, and developed a shallow to flat anterior chamber, classified as grade 2 according to Spaeth early in the postoperative period. Stromal opacity caused by corneal edema associated with severe Descemet's membrane folds appeared within 2 to 5 days in both cases. The density of the corneal endothelium was decreased on specular microscopic examination. The severe corneal endothelial damage seen after the trabeculectomy with MMC was likely owing to a combination of the preexisting cornea guttata, the flat anterior chamber, and possibly the administration of MMC.
  
  
  CONCLUSIONS
  Severe endothelial damage after trabeculectomy with MMC may occur in patients with glaucoma and associated cornea guttata. The use of tight sutures on the scleral flap or a modified operative method, nonpenetrating trabeculectomy, may be effective in preventing a shallow to flat anterior chamber postoperatively.
authors.affiliation: Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. tfuku@med.niigata-u.ac.jp
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukuchi
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Hayakawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hara
authors.forename: Haruki
authors.initials: H
authors.lastname: Abe
mesh_terms: D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000473:pathology; D002452:Cell Count; D003316:Corneal Diseases / Q000150:complications / Q000209:etiology*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D014130:Trabeculectomy / Q000009:adverse effects*
chemical_list: D016685:Mitomycin