Review ArticlesThe Effects of Glaucoma and Glaucoma Therapies on Corneal Endothelial Cell DensityRealini, Tony MD, MPH*; Gupta, Preeya K. MD†; Radcliffe, Nathan M. MD‡; Garg, Sumit MD§; Wiley, William F. MD∥; Yeu, Elizabeth MD¶; Berdahl, John P. MD#; Kahook, Malik Y. MD**Author Information *Department of Ophthalmology and Visual Sciences, West Virginia University Eye Institute, Morgantown, WV †Department of Ophthalmology, Duke University, Durham, NC ‡Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY §Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA ∥Cleveland Eye Clinic, Cleveland, OH ¶Virginia Eye Consultants, Norfolk, VA #Vance Thompson Vision, Sioux Falls, SD **Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO Disclosure: T.R. serves as a consultant in Aerie, Asclepix, Ivantis, New World Medical, Nicox, Notal Vision, Ocular Therapeutix, Sight Sciences. M.Y.K. has ownership (all current) at Spyglass Ophthalmics, Ivantis, Equinox, Aurea Medical, ShapeTech; has royalties (all current) in Alcon, Johnson and Johnson Vision, New World Medical, ShapeTech, Spyglass Ophthalmics; serves as a consultant (all current) in Alcon and New World Medical. E.Y.: Alcon: C, R. Allergan: C. Avedro: C. Bausch & Lomb/Valeant: C. BioTissue: C, R. Beaver Visitec: C. BlephEx: C, O. Bruder: C. CorneaGen: C, O. Dompe: C. Equinox: O. Expert Opinion: C. EyePoint Pharmaceuticals: C. Glaukos: S. Guidepoint: C. J & J Vision: C. Kala Pharmaceuticals: C. LENSAR: C. Mati: O. Melt: C, O. Modernizing Medicine: O. Merck: C. Mynosys: C. Novartis: C. Ocular Science: C, R, O. Ocular Therapeutix: C. Ocusoft: C. Omeros: C. Oyster Point Pharmaceuticals: C, O. Science Based Health: C. Shire: C. Sight Sciences: C. Sun: C. Surface: C. Thea: C. Tarsus: C, O. TopCon: C, R. Tear Lab Corporation: C, R. Visus Therapeutics: C. Zeiss: C. P.K.G.:. Consultant to:. Alcon. Allergan. HanAll Biopharma. J&J Vision. Kala. New World Medical. Novartis. Ocular Therapeutix. Oyster Point. ReGenTree. Sight Sciences. Sun Pharmaceuticals. Tear Lab. Tissue Tech Inc. Zeiss. S.G.: Aerie—C (past). Alcon—C (past). Allergan—C (current). CorneaGen—C (current). Dompe—C (current). Eyepoint—C (past). Glaukos—C (current). Ivantis—C (past). Johnson and Johnson Vision—C (current). Kala—C (past). LensGen—C, O (current). New World Medical—C (past). Novartis—C, (current). OcuTrx—C, O (past). SightSciences—C (current). Spyglass—C, O (current). Tarsus—C, O (current). Verana Health—C (past). Visioncare—C (current). Zeiss—C (current). W.F.W.:. Ivantis: consultant, stock options. Glaucos: consultant. New World Medical: consultant. Alcon: consultant. Allergan: consultant. N.M.R.: CATS LLC—Consultant. Allergan—Consultant, speaker. Alcon—Consultant, speaker. Novartis—Consultant, speaker. Eyenovia—Consultant. Lumenis—Consultant. Equinox—Consultant, investor. Iridex—Consultant. Aerie—Consultant, speaker. Bausch & Lomb/Valeant—Consultant, speaker. BVI—Consultant, speaker. Eyepoint—Consultant. Ivantis—Consultant, speaker. Glaukos—Consultant, speaker. Alimera—Consultant, speaker. New World Medical—Consultant, speaker. SpyGlass—Consultant. Sight Sciences—Consultant, speaker. Thea—Consultant. Reichert—Consultant. Shire—Consultant. Carl Zeiss Meditec—Consultant. Omeros—Consultant. J.P.B.: Alcon L, C. Allergan L, C. Avedro C. Aurea Medical C. Bausch And Lomb C. CorneaGen C, O. Dakota Lions Eye Bank C. Equinox C, O. Expert Opinion C, O. Glaukos C, L. Gore C. Imprimis/Harrow Health C, P. JNJ C. Kala C. Kedalion C. MELT Pharmaceuticals C. MicroOptix C. New World Medical C. Ocular Surgical Data C, O. Ocular Theraputix C. Omega Ophthalmic C, O. Orasis C. Oyster Point. RxSight C. Surface Inc C, O. Tarsus C. Tear Clear C. Vittamed C. Vance Thompson Vision C, O. Verana Health (Digisight) O. Visionary Ventures C. Zeiss C, O. The remaining authors declare no conflict of interest. Reprints: Tony Realini, MD, MPH, 1 Medical Center Drive, Morgantown, WV 26505 (e-mail: [email protected]). Journal of Glaucoma: March 2021 - Volume 30 - Issue 3 - p 209-218 doi: 10.1097/IJG.0000000000001722 Buy Metrics Abstract A healthy corneal endothelium is required for corneal clarity. Both the glaucoma disease state and its various forms of treatment can have adverse effects on the corneal endothelium. Both the presence of glaucoma and the magnitude of intraocular pressure elevation are related to endothelial cell loss (ECL). Topical medical therapy, laser procedures, and both traditional surgeries—trabeculectomy and tube-shunts—and newer minimally invasive glaucoma surgeries have variable effects on ECL. This review will summarize the reported effects of glaucoma and its treatment on ECL. Concerns for corneal endothelial cell health should be part of the decision-making process when planning glaucoma therapy for lowering intraocular pressure, with added caution in case of planned device implantation in eyes with preexisting ECL and low endothelial cell density at high risk for corneal endothelial decompensation. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.