Long-term corneal endothelial cell loss after filtration surgery: analysis using natural language processing.

Purpose

To use automated clinical data extraction to investigate long-term corneal endothelial cell density (ECD) changes and associated risk factors following glaucoma filtration surgery.

Methods

This retrospective study analyzed 136 patients (107 with primary open-angle glaucoma [POAG] and 29 with exfoliation glaucoma [EXG]) who underwent filtration surgery between August 2020 and May 2023. Clinical data from 36,561 consecutive visits were extracted using a BERT (Bidirectional Encoder Representations from Transformers)-based natural language processing system. Mixed-effects regression models evaluated factors associated with ECD reduction, including intraocular pressure (IOP), glaucoma type, surgical technique, inflammation markers, and postoperative duration. ECD reduction was analyzed using 30-day moving averages and linear regression.

Results

ECD decreased linearly at approximately 1% per 100 days over an extended period of 1,500 days postoperatively. Multivariate analysis identified lower IOP (p < 0.001) and longer postoperative duration (p < 0.001) as independent risk factors for ECD reduction. Initial univariate analysis suggested associations with age, medication score, and concurrent cataract surgery, although these associations did not retain significance in multivariate analysis. No significant associations were found between ECD loss and anterior chamber flare, glaucoma type (EXG versus POAG), or surgical technique (trabeculectomy versus Ex-PRESS).

Conclusions

Long-term ECD loss occurs progressively after filtration surgery, with lower postoperative IOP emerging as a risk factor. These findings suggest the need for careful monitoring of corneal endothelial status in patients who maintain low IOPs after filtration surgery. The results also demonstrate the utility of automated data extraction for analyzing long-term surgical outcomes.