Manually prepared lamellae for Descemet stripping endothelial keratoplasty (Pachy-DSEK): comparison of four dissection depths / Lamelas manualmente dissecadas para transplante endotelial de córnea (Pachy-DSEK): comparação entre quatro profundidades de dissecção

ABSTRACT Purpose: This study aimed to compare four depths of manual dissection for the preparation of Descemet stripping endothelial keratoplasty lamellae. Methods: Eye bank corneas were randomized into four groups according to dissection depths: Pachy-100 (incision depth = central corneal thickness-safety margin of 100 µm), Pachy-50 (safety margin of 50 µm), Pachy-0 (no safety margin), and Pachy+50 (incision depth = central corneal thickness + 50 µm). All endothelial lamellae were prepared using a standardized method of manual dissection (Pachy-DSEK). The central, paracentral (3.0-mm zone), and peripheral (6.0-mm zone) lamella thicknesses and incision depths were measured by optical coherence tomography. The 3.0-mm and 6.0-mm zone central-to-peripheral thickness ratios were calculated. Results: Endothelial perforation occurred only in the Pachy+50 group (n=3, 30%). Central lamella's thickness in Pachy-100, Pachy-50, Pachy-0, and Pachy+50 groups measured 185 ± 42 µm, 122 ± 29 µm, 114 ± 29 µm, and 58 ± 31 µm, respectively (p<0.001). The overall 3.0- and 6.0-mm C/P ratios were 0.97 ± 0.06 and 0.92 ± 0.14, respectively. Preoperative donor characteristics were not correlated with most thickness outcomes. The planned incision depth correlated significantly with most lamella's thickness parameters (p<0.001). The overall thickness of the lamella negatively correlated with the planned incision depth (p<0.001, r=-0.580). The best outcome was found in the Pachy-0 group, as 75% of the lamellae measured <130 µm and there was no endothelial perforation. Conclusions: By using a standardized method of dissection, most manually prepared lamellae presented a planar shape. Setting the incision depth to the central corneal thickness did not result in endothelial perforation and a high percentage of ultrathin lamellae was achieved.

RESUMO Objetivo: Comparar quatro profundidades de dissecção manual usadas no preparo de lamelas para transplante endotelial. Métodos: Córneas humanas de treinamento disponibilizadas foram randomizadas em quatro grupos: Pachy-100 (profundidade de incisão = espessura corneana central - margem de segurança de 100 µm), Pachy-50 (margem de segurança de 50 µm), Pachy-0 (sem margem de segurança) e Pachy+50 (profundidade de incisão = espessura corneana central + 50 µm). Todas as lamelas foram dissecadas através um método padronizado e já publicado (Pachy-DSEK). As espessuras das lamelas (centro, zona de 3,0mm e zona de 6,0mm) foram medidas com tomografia de coerência óptica. A razão de espessura centro-periferia foi calculada aos 3,0 e 6,0 mm de diâmetro. Resultados: Perfuração endotelial ocorreu apenas no grupo Pachy+50 (n=3, 30%). A espessura central da lamela nos grupos Pachy-100, Pachy-50, Pachy-0 e Pachy+50 foi de 185 ± 42 µm, 122 ± 29 µm, 114 ± 29 µm, e 58 ± 31 µm, respectivamente (p<0,001). As razões C/P aos 3,0 e 6,0 mm foram de 0,97 ± 0,06 e 0,92 ± 0,14, respectivamente. Os parâmetros de características do doador não se correlacionaram com os resultados de espessura de lamela. A profundidade planejada de incisão se correlacionou com a maioria dos parâmetros de espessura de lamela (p<0,001). A espessura de lamela se correlacionou negativamente com a profundidade planejada da incisão (p<0.001, r=-0,580). O melhor resultado foi observado no grupo Pachy-0, em que 75% das lamelas mediram abaixo de 130 µm e não houve perfuração endotelial. Conclusão: Através de um método padronizado de dissecção, a maioria das lamelas endoteliais apresentou uma configuração planar. O planejamento de profundidade de incisão igual à espessura corneana central resultou em alta porcentagem de lamelas ultrafinas sem ocorrência de perfuração.

Comparison of efficacy of small incision extracapsular excision or phacoemulsification in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effects of small incision extracapsular excision and phacoemulsification on the number of corneal endothelial cells, macular thickness and surgically induced corneal astigmatism in cataract patients.METHODS: Retrospective research. A total of 296 age-related cataract patients(296 eyes)admitted to our hospital from May 2019 to February 2023 were selected. They were divided into a small incision extracapsular excision group(144 eyes)and a phacoemulsification group(152 eyes)according to surgical method. The uncorrected visual acuity, best corrected visual acuity, numbers of corneal endothelial cells, macular thickness, surgically induced corneal astigmatism and postoperative complications between the two groups of patients at 7d, 1 and 3mo after surgery were compared.RESULTS: The uncorrected visual acuity and best corrected visual acuity of patients in the small incision extracapsular excision group after 7d of surgery were better than those of the phacoemulsification group, the number of corneal endothelial cells after 7d and 1, 3mo of surgery were higher than that of the phacoemulsification group, the macular thickness after 7d and 1mo of surgery was lower than that of the phacoemulsification group, and the incidence rate of postoperative corneal edema and incidence rate of total complications were lower than those of the phacoemulsification group(all P&#x003C;0.05). Furthermore, there was no statistical significance in the values of surgically induced corneal astigmatism after 1, 7d and 1, 3mo of surgery compared with phacoemulsification group(P&#x003E;0.05).CONCLUSION: Compared with phacoemulsification, the changes in the number of corneal endothelial cells and thickness of the macular area after small incision extracapsular excision are relatively small, visual recovery is faster, and the complications reduced.

Inhibidores de la Rho quinasa y su rol en la disfunción endotelial corneal / Rho Kinase Inhibitors and their Role in Corneal Endothelial Dysfunction

El endotelio corneal es su capa más interna y, a pesar de ser una monocapa de células, es capaz de preservar la transparencia del tejido con dos funciones fundamentales: de barrera y de bomba endotelial sodio-potasio (Na-K). Las células endoteliales tienen muy poca capacidad de regeneración, por lo que cualquier lesión endotelial es compensada por la expansión y migración de las células residuales adyacentes. La disfunción endotelial corneal se caracteriza por un edema de la córnea que puede llevar hasta el transplante de este tejido. Nuevas terapias farmacológicas con inhibidores de Rho-Kinasa y terapias basadas en ingeniería tisular se han propuesto recientemente. Se realizó una búsqueda automatizada sobre los principales avances en estas terapias utilizando la plataforma Infomed, específicamente la Biblioteca Virtual de Salud. La información se resumió en el informe final. Concluimos que existe un progreso significativo en el entendimiento de la patogénesis, y en el desarrollo de los nuevos tratamientos(AU)

The corneal endothelium is its innermost layer and, despite being a monolayer of cells, is able to preserve tissue transparency with two fundamental functions: barrier and endothelial sodium-potassium (Na-K) pump. Endothelial cells have very little regenerative capacity, so any endothelial injury is compensated by the expansion and migration of adjacent residual cells. Corneal endothelial dysfunction is characterized by corneal edema that can lead to corneal tissue transplantation. New pharmacologic therapies with Rho kinase inhibitors and tissue engineering-based therapies have recently been proposed. An automated search on the main advances in these therapies was performed using the Infomed platform, specifically the Virtual Health Library. The information was summarized in the final report. We conclude that there is significant progress in the understanding of pathogenesis, and in the development of new treatments(AU)

Comparison of corneal endothelial changes following phacoemulsification in diabetic and non-diabetic patients

Purpose: To study corneal endothelial changes post phacoemulsification in diabetic and non?diabetic patients. Methods: A comparative, prospective, observational study was conducted on 100 diabetic and 100 non?diabetics who underwent phacoemulsification. All patients were operated by the same surgeon by using the phaco chop technique to exclude any surgeon?related bias. Endothelial cell count, CCT, and coefficient of variance (CV) were measured with a specular microscope along with BCVA preoperatively and at 1 week, 4 weeks, and 3 months postoperatively. For statistical analysis, data were analyzed by using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA). Data were summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Chi square test, independent sample T test, and paired T test were used to compare the data. P ? 0.05 was considered statistically significant. Results: Postoperatively at 1 week, 4?week, and 3 months follow?up intervals, the mean endothelial cell count and coefficient of variance were significantly higher, and the mean percentage of hexagonal cells was significantly lower in non diabetic as compared to the diabetic group. A significant difference in mean central corneal thickness of the two groups was observed at 1?week and 4?weeks postoperative intervals; at both these intervals, the mean value was significantly higher in non diabetic as compared to the non?diabetic group. However, at 3?months post?operative interval, the difference between the two groups was not significant statistically. Mean BCVA values were significantly higher in diabetic as compared to the diabetic group at all three follow?up intervals. Conclusion: The findings of the present study show that endothelial cell characteristics are adversely affected in diabetic eyes as compared to non?diabetic patients undergoing phacoemulsification; this might also have an effect on the visual outcomes.

Effects of different viscoelastic agents on corneal endothelium of patients after phacoemulsification and foldable IOL implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effects of dual viscoelastic agents DisCoVisc and sodium hyaluronate on corneal endothelium of patients after phacoemulsification and foldable intraocular lens(IOL)implantation.METHODS: A total of 247 patients(285 eyes)with cataract treated in Jingmen Aier Eye Hospital between June 2017 and December 2019 were selected, and they were divided into DisCoVisc group(123 cases, 141 eyes)and sodium hyaluronate group(124 cases, 144 eyes)by random number table method. Both groups were treated with phacoemulsification and foldable IOL implantation. DisCoVisc and 1.7% sodium hyaluronate were used as viscoelastic agents in DisCoVisc group and sodium hyaluronate group, respectively. The two groups were compared in terms of intraoperative ultrasound time(UST), cumulative dissipated energy(CDE), time for aspiration of viscoelastic agents after IOL implantation, corneal edema at 1d, 1wk, 1 and 3mo after operation, corneal endothelial cell density(ECD)and ECD loss rates before operation and at 3mo after operation, coefficient variation of corneal endothelial cell size(CV), percentage of corneal hexagonal endothelial cells(6A), intraocular pressure, the proportions of patients with uncorrected visual acuity ≥0.5 and central corneal thickness(CCT)values before and after operation at 1d, 1wk and 1mo.RESULTS:There was no statistically significant difference between the two groups in UST, CDE, aspiration time of viscoelastic agents(P &#x003E;0.05)or corneal edema both rate on day 1 after operation(P&#x003E;0.05). Corneal edema disappeared at 1 wk after operation. The ECD loss rate in DisCoVisc group was significantly lower than that in sodium hyaluronate group at 3mo after operation(P&#x003C;0.05). Intraocular pressure, the proportion of patients with uncorrected visual acuity ≥0.5 and CCT values showed no statistically significant differences between the two groups before and after operation at 1d, 1wk and 1mo(P &#x003E;0.05).CONCLUSION: DisCoVisc, as the viscoelastic agent in phacoemulsification and foldable IOL implantation for patients with Emery-Little grade Ⅱ-Ⅲ lens nucleus hardness, can better protect the patients' corneal endothelium.

Microscopia endotelial manual y automatizada: estudio comparativo en adultos sin alteraciones corneales / Manual and automated endothelial microscopy in adults without corneal alterations

Objetivo: Comparar los resultados de los parámetros morfológicos y morfométricos del endotelio corneal a través de la microscopia especular a partir de la utilización del conteo manual y automatizado. Métodos: Se realizó un estudio descriptivo, observacional, de corte transversal de serie de casos en adultos sin alteraciones corneales, en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido de enero de 2019 a enero de 2020. Se estudiaron un total de 50 adultos (100 ojos), de los cuales 50 fueron ojos derechos y 50 ojos izquierdos. Se emplearon los porcentajes y los números absolutos para resumir las variables cualitativas. En el caso de las cuantitativas, se utilizó la media con su desviación estándar. Resultados: El 46 por ciento fue del sexo femenino y el 54 por ciento del sexo masculino. Los parámetros morfométricos, como la paquimetría central, fue igual en ambos conteos. A su vez, se obtuvieron mayores valores de densidad endotelial con el conteo automatizado. En los parámetros morfológicos se registró que la hexagonalidad fue superior en el conteo manual y el coeficiente de variabilidad en el conteo automatizado. Las diferencias más marcadas resultaron en el tamaño mínimo, en el máximo y en el promedio de las células endoteliales corneales, con variaciones entre los dos conteos. Conclusiones: Queda demostrado que tanto el conteo manual como el automatizado para el estudio del endotelio corneal pueden ser aplicados en la práctica oftalmológica(AU)

Objective: Compare the results of morphological and morphometric parameters of the corneal endothelium using specular microscopy with manual and automated counting. Methods: A cross-sectional observational descriptive study was conducted of a case series of adults without corneal alterations attending the Refractive Surgery Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2019 to January 2020. A total 50 adults were studied (100 eyes: 50 right and 50 left). Percentages and absolute numbers were used to summarize qualitative variables, whereas quantitative variables were evaluated with means and standard deviations. Results: Of the patients studied, 46 percent were female and 54 percent were male. Morphometric parameters such as central pachymetry were the same in both countings. Automated counting yielded higher endothelial density values. Morphological parameters showed that hexagonality was greater in manual counting, whereas the coefficient of variability was greater in automated counting. The most obvious differences were observed in minimum size, maximum size and average corneal endothelial cells, with variations between the two countings. Conclusions: It was shown that both manual and automated counting may be used for examination of the corneal endothelium in ophthalmic practice(AU)

Um estudo de correlação entre a contagem endotelial da córnea em pacientes com diferentes estágios de ceratocone usando a microscopia especular / A correlation study between a corneal endothelial count in patients with different stages of keratoconus using specular microscopy

RESUMO Objetivo: Avaliar a contagem endotelial da córnea em pacientes com ceratocone (KCN) por microscopia especular e correlacionar com o estágio do ceratocone. Métodos: Noventa e três olhos de 61 pacientes com KCN foram incluídos neste estudo transversal. Os olhos foram classificados nos estágios 1 a 4 de KCN de acordo com a classificação de Amsler-Krumeich utilizando ceratometria obtida pela topografia de córnea e leituras de paquimetria obtidas pela microscopia especular. Resultados: A idade variou de 12 a 43 anos, média ± (desvio padrão) 22,1 ± 6,7 anos. A ceratometria média variou de 42,25 a 71,4 D (53,0 ± 6,1 D). A paquimetria variou de 350 a 606 µm, (461,7 ± 47,1 µm). Em relação a classificação, 23 pacientes (24,7%) apresentavam estágio 1, 24 (25,8%) estágio 2, 5 (6,5%) estágio 3 e 41 pacientes (44,1%) estágio 4. Não foi observada correlação linear entre ceratometria média e contagem de células endoteliais (Coeficiente de correlação de Pearson = -0,05). Nos estágios iniciais a moderados de KCN, a média da contagem de células endoteliais foi 2738,3 ± 285,4 cel/mm2, enquanto no grupo de KCN avançado (estágios 3 e 4) foi 2670,6 ± 262,7 cel/mm2, p= 0,24. Conclusões: Não há correlação entre a contagem de células endoteliais e o estágio do KCN.

ABSTRACT Objective: To evaluate the corneal endothelial count in patients with keratoconus (KCN) by specular microscopy and correlate with the stage of keratoconus. Methods: Ninety-three eyes from 61 patients with KCN were included in this cross-sectional study. The eyes were classified into KCN stages 1 to 4 according to the Amsler-Krumeich classification using keratometry obtained by corneal topography and pachymetry readings obtained by specular microscopy. Results: Age ranged from 12 to 43 years, mean ± (standard deviation) 22.1 ± 6.7 years. The average keratometry ranged from 42.25 to 71.4 D, (53.0 ± 6.1 D). Pachymetry ranged from 350 to 606 µm, (461.7 ± 47.1 µm). Regarding the Amsler classification, 23 patients (24.7%) had stage 1, 24 (25.8%) stage 2, 5 (6.5%) stage 3 and 41 patients (44.1%) stage 4. No linear correlation was observed between mean keratometry and endothelial cell count (Pearson's correlation coefficient = -0.05). In the early to moderate stages of KCN, the mean endothelial cell count was 2738.3 ± 285.4 cell / mm2, while in the advanced KCN group (stages 3 and 4) it was 2670.6 ± 262.7 cell / mm2 , p = 0.24. Conclusions: No correlation was found between the endothelial cell count and the KCN stage.

Comparación de las características de la córnea entre individuos chinos y cubanos / Comparison between corneal features of Chinese and Cuban subjects

Objetivo: Comparar las características de la córnea entre individuos chinos y cubanos adultos sanos. Métodos: Se realizó un estudio observacional, descriptivo, transversal, en 120 ojos de individuos sanos (60 chinos y 60 cubanos), entre 18 y 29 años de edad, entre septiembre del año 2016 y diciembre de 2017 en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Se evaluó la edad, el sexo, la queratometría, la paquimetría y las características del endotelio corneal. Resultados: Predominó el sexo femenino (53,3 por ciento en los cubanos y 66,6 por ciento en los chinos). La edad promedio fue de 24,4 años en ambos grupos. La queratometría promedio resultó mayor en el grupo de estudio de cubanos, con un valor de 44,7 y 44,6 dioptrías en ambos ojos, respectivamente. El espesor corneal fue de 607,3-629,9 en los cubanos y de 575,4-607,2 en los chinos. El coeficiente de variación, la desviación estándar y la densidad celular se diferenciaron mínimamente en ambos ojos para ambas nacionalidades, y resultaron superiores en los ojos izquierdos con un coeficiente de 32,0 (±11,0) en los chinos. La desviación estándar promedio fue de 112,0 (± 36,5) en ambos grupos y en el ojo derecho la densidad celular fue 2 857,1 (± 240,0 cél/mm2) en los chinos y 2 760,0 (± 367,2) en los cubanos. El average de los cubanos estuvo entre 369,0 y 380, y para los chinos entre 352,4 y 358,4 en los ojos derecho e izquierdo. Conclusiones: Existen diferencias significativas en los valores queratométricos. El espesor corneal resulta discretamente más reducido en los chinos. El coeficiente de variación, la densidad celular, el average y la desviación estándar no presentan diferencias estadísticamente significativas(AU)

Objective: Compare the corneal features of Chinese and Cuban healthy adult subjects. Methods: A cross-sectional observational descriptive study was conducted of 120 eyes of healthy 18-29 year old individuals (60 Chinese and 60 Cuban) from September 2016 to December 2017 at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The variables analyzed were sex, keratometry, pachymetry and characteristics of the corneal endothelium. Results: Female sex prevailed (53.3 percent among Cuban and 66.6 percent among Chinese subjects). Mean age was 24.4 years in both groups. Mean keratometry was higher in the Cuban group, with values of 44.7 and 44.6 diopters for both eyes, respectively. Corneal thickness was 607.3-629.9 among Cuban and 575.4-607.2 among Chinese subjects. Variation coefficient, standard deviation and cell density were minimally different between the two eyes in both groups, and were higher in left eyes of Chinese subjects with a coefficient of 32.0 (±11.0). Mean standard deviation was 112.0 (± 36.5) in both groups, whereas right eye cell density was 2 857.1 (± 240.0 cell/mm2) among Chinese and 2 760.0 (± 367.2) among Cuban subjects. Average between right and left eyes ranged from 369.0 to 380 for the Cubans and from 352.4 to 358.4 for the Chinese. Conclusions: Significant differences were found between keratometric values. Corneal thickness was slightly lower among Chinese subjects. Variation coefficient, cell density, average and standard deviation did not show any statistically significant differences(AU)

Application of different phacoemulsification and chopping techniques in hard nuclear cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy of bevel-up phaco chop versus bevel-down phaco drill in the treatment of hard nuclear cataract and the influence on corneal endothelium.<p>METHODS: Between August 2018 and April 2020, 94 patients(104 eyes)with hard(grade Ⅳ-Ⅴ)nuclear cataract treated with phacoemulsification were enrolled in this retrospective study. Among them, 50 eyes treated by bevel-up phaco chop were included in the control group, while 54 eyes treated by phaco drill technique were included in the observation group. The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter in the two groups were recorded. The best corrected visual acuity(BCVA)in 7d, corneal endothelial cell count in 2mo, the proportions of normal hexagonal cells and the degree of corneal edema in 7d were compared between the two groups.<p>RESULTS: The time of using ultrasound, ultrasonic energy and accumulated energy complex parameter of the observation group were shorter and lower than those of the control group(<i>P</i><0.05). The BCVA of both groups increased after operation, and the observation group had higher BCVA than the control group at the same time(<i>P</i><0.05). In 1 and 2mo, the corneal endothelial cell counts and the proportions of normal hexagonal cells in both groups were lower than those before operation. Meanwhile, the corneal endothelial cell count and the proportions of normal hexagonal cells in the observation group were higher than those in the control group(<i>P</i><0.05). Besides, corneal edema was milder in the observation group than in the control group at 24h and 7d after operation(<i>P</i><0.05).<p>CONCLUSION: Compared with bevel-up phaco chop, phaco drill can significantly shorten the time of using ultrasound, reduce ultrasound energy, promote visual recovery, and reduce corneal endothelial cell damage.

Parámetros endoteliares y edema corneal poscirugía de catarata en pacientes con córnea guttata / Endothelial parameters and corneal edema in cornea guttata patients undergoing cataract surgery

RESUMEN Objetivo: Relacionar la severidad del edema corneal poscirugía de catarata en pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, con los parámetros de la microscopia endotelial. Métodos: Se realizó un estudio descriptivo, prospectivo de 42 pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según la densidad celular, quienes fueron sometidos a la cirugía de catarata por el mismo cirujano en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde abril del año 2016 a diciembre de 2017. Se determinó la severidad del edema corneal y se relacionó con el grado de córnea guttata, así como con los parámetros de la microscopia endotelial. Resultados: El 52,4 por ciento fueron mayores de 70 años y el 64,3 por ciento mujeres. No hubo edema en el 54,8 por ciento en las primeras 24 horas, y fue en el 26,2 por ciento leve y en el 19,0 por ciento mínimo, donde predominó la córnea guttata grado 3 y presentaban un bajo riesgo prequirúrgico. Sin embargo, no hubo diferencias en relación con el polimegatismo y el pleomorfismo. Conclusiones: La severidad del edema corneal en pacientes con córnea guttata posfacoemulsificación a los siete días no se asocia con el polimegatismo, ni con el polimorfismo prequirúrgico, pero sí con el conteo endotelial prequirúrgico(AU)

ABSTRACT Objective: Determine the relationship between the severity of corneal edema in cornea guttata patients undergoing cataract surgery considered to be at no risk or low risk for postsurgical edema in terms of cell density, and endothelial microscopy parameters. Methods: A descriptive prospective study was conducted of 42 cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density, who underwent cataract surgery performed by the same surgeon at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to December 2017. Corneal edema severity was determined and related to cornea guttata grade and endothelial microscopy parameters. Results: Of the patients studied, 52.4 percent were aged over 70 years and 64.3 percent were women. Edema was not observed in 54.8 percent in the first 24 hours, whereas it was mild in 26.2 percent and minimum in 19.0 percent. Grade 3 cornea guttata and low presurgical risk prevailed. However, no differences were found in relation to polymegethism and pleomorphism. Conclusions: At seven days, corneal edema severity in cornea guttata patients undergoing phacoemulsification is not associated to polymegethism or presurgical polymorphism, but it as associated to the presurgical endothelial count(AU)

Corneal endothelium in unilateral Fuchs heterochromic iridocyclitis

Purpose: To assess the corneal endothelium in patients with Fuchs heterochromic iridocyclitis (FHI) and compare it with the normal fellow eye. Methods: Retrospective, observational, cross-sectional study of 31 patients seen between Jan 2016 to Dec 2018, with clinical diagnosis of Fuchs heterochromic iridocyclitis, was performed. Specular microscopic examination was documented in both eyes. The affected eyes formed the study group and the fellow healthy eyes served as controls. Results: The mean age of the patients was 29.9 ± 8.2 years. The endothelial cell density (P = 0.0001) was significantly lower, whereas average cell size (P = 0.0001), coefficient of variation (P = 0.004), and maximum cell area (P = 0.01) were significantly higher in the affected eye compared to the control eye. In three patients, the affected eye showed guttae, while the healthy fellow eye revealed a normal specular mosaic. Conclusion: Specular microscopic analysis shows endothelial alterations in the affected eyes in FHI.

Femtosecond laser-assisted cataract surgery <i>vs</i> traditional phacoemulsification in the treatment of patients with different axial length cataracts / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the effectiveness and safety of femtosecond laser-assisted cataract surgery(FLACS)with traditional cataract surgery in cataract patients with different axial lengths.<p>METHODS: Patients with cataract surgery were divided into normal axis group(22mm≤AL<24mm group), medium and long axis group(24mm≤AL <26mm), and long axis group(26mm≤AL)according to the axial length. Each group had 100 eyes. The patients in each group were randomly divided into femtosecond laser group and traditional ultrasonography group. The postoperative changes of best-corrected visual acuity(BCVA), visual quality and corneal endothelial cells were analyzed.<p>RESULTS: The visual acuity of the patients in each group was improved(FLACS: <i>t</i>=8.29, 25.01, 19.23, all <i>P</i><0.01; PHACO: <i>t</i>=19.61, 18.76, 18.23, all <i>P</i><0.01). Visual acuity improvement after FLACS in different axial groups was better than that after PHACO, but there was no significant difference between the groups(<i>P</i>=0.24, 0.25, 0.19). The postoperative strehl ratio value increased after operation in all groups expect for PHACO medium and long axis group, but the increase was significant only in normal axis group(<i>P</i>=0.011, 0.007). The corneal endothelial counts in the FLACS group were significantly lower than those before the operation(<i>P</i><0.01, 0.002, <0.01). The corneal endothelial counts in the PHACO group except for the medium and long axis group were significantly reduced after surgery(<i>P</i><0.01); there was no significant difference in postoperative corneal endothelial count between the FLACS and PHACO groups(<i>P</i>>0.05).<p>CONCLUSION: Both traditional cataract surgery and femtosecond laser-assisted cataract surgery can effectively improve the BCVA in various types of axis. Both surgical methods will cause damage to the corneal endothelium, but the difference is not obvious.

Effect of EX-PRESS miniature glaucoma device implantation on corneal endothelial cell density and intraocular pressure for primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To study the effect of EX-PRESS miniature glaucoma device implantation on corneal endothelial cell density and intraocular pressure for primary open angle glaucoma(POAG). <p>METHODS:This was a prospective clinical study of 38 eyes in 32 POAG patients who underwent EX-PRESS miniature glaucoma device implantation in our hospital from May 2016 to December 2017. The central, nasal, temporal,superior, inferior endothelium cell density, intraocular pressure(IOP), best corrected visual acuity(BCVA)were observed at 24mo after operation. Anterior chamber depth and the position of drainage nail with iris and cornea were also observed. <p>RESULTS: There was no significant difference of the corneal endothelium density in five sites and BCVA between preoperation and postoperation(<i>P</i>>0.05). There was significant difference in IOP between pre-operation and postoperation(<i>P</i><0.05). The complete success rate was 66% and conditional success rate was 21%, the failure rate was 13%. The main cause of failure was filtering bleb scarring. There was no complete disappearance of anterior chamber during the operation and follow-up period. There were 1 eye of shallow anterior chamber, 5 eyes of EX-PRESS contact with iris surface. The position of drainage nail with iris and cornea endothelium was good in the other 32 eyes.<p>CONCLUSION: The EX-PRESS miniature glaucoma device implantation has no effect on corneal endothelial cells in five directions and can effectively control intraocular pressure. It is a safe and effective method for primary open-angle glaucoma.

Concordancia entre los diferentes conteos celulares según los parámetros morfológicos y morfométricos del endotelio corneal / Concordance between different cell counts according to morphologic and morphometric parameters of the corneal endothelium

RESUMEN Objetivo: Estimar los valores morfológicos y morfométricos del endotelio corneal según la cantidad de células y evaluar la concordancia interobservadores para los diferentes parámetros, considerados según los diferentes conteos celulares en adultos sin alteraciones corneales. Métodos: Se realizó una investigación observacional, descriptiva y transversal de serie de casos en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en dos años de estudio. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 200 ojos de 100 pacientes adultos sin alteraciones corneales. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad y coeficiente de variabilidad) y morfométricos (densidad celular), así como el promedio del tamaño celular corneal según cantidad de células evaluadas. Resultados: Según la cantidad de células endoteliales evaluadas, no existieron diferencias significativas de las variables morfológicas y morfométricas (p> 0,05) en ambos ojos. La concordancia entre los diferentes conteos celulares según los valores de los coeficientes de correlación intraclase fueron todos altos. La concordancia interobservadores (excepto para la hexagonalidad) y los coeficientes de correlación intraclase fueron altos. Conclusiones: Los valores morfológicos y morfométricos del endotelio corneal según cantidad de células evaluadas, son similares en todos los conteos celulares. Se demuestra una buena concordancia entre los diferentes conteos celulares estudiados para los diferentes parámetros estimados(AU)

ABSTRACT Objective: To estimate the morphological and morphometric values of the corneal endothelium according to the number of cells and evaluate the interobserver concordance for the different parameters, estimated according to the different cell counts in adults without corneal alterations. Methods: An observational, descriptive and cross-sectional case series research was carried out in the Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology during two years of study. After applying the exclusion criteria, the sample was made up of 200 eyes of 100 adult patients without corneal alterations. Non-contact endothelial microscopy SP-3000P was performed to identify morphological values (hexagonality and coefficient of variability) and morphometric values (cell density), as well as the average corneal cell size according to the number of cells evaluated. Results: According to the amount of endothelial cells evaluated, there were no significant differences between morphological and morphometric variables (p>0.05) in both eyes. The agreement between the different cell counts according to the values of the interclass correlation coefficients (ICC) were all high. The interobserver concordance and ICCs were also high, except for hexagonality. Conclusions: The morphological and morphometric values of the corneal endothelium, according to the number of cells evaluated, are similar in all cell counts. Good concordance between the different cell counts studied for the different estimated parameters is demonstrated(AU)

Comparison of structural integrity and functional status of corneal endothelium stored in Cornisol and Optisol-GS

Purpose: To compare the structural integrity and functional status of the donor corneas stored in Cornisol and Optisol-GS. Methods: Fifteen optical grade corneal donor buttons (6 pairs; 3 individual) obtained from Rotary Aravind International Eye Bank were used for the study. The left eye of the paired sample was preserved in Cornisol and the right in Optisol-GS. The three individual buttons were used for the baseline data. The corneas were assessed with slit lamp and specular microscope before and after storage time (7, 10, or 14 days). They were then immunostained for markers of structural integrity (ZO-1, Phalloidin) and functionality (Na+/K+ ATPase). The images were acquired using confocal microscope and analyzed using ImageJ software. Results: There was no difference in the clinical evaluation of the corneal layers between the two media. No marked variation was observed in the immunostaining data with reference to the storage period. Intact cellular integrity was identified in 91% (51%, 98%) [Median (min, max)] of cells in Cornisol and 94% (38%, 98%) cells in Optisol based on ZO-1 staining, comparable to the baseline data [87% (76%, 97%)]. Stress fibers were detected in 42.5% (1%, 88%) cells in Cornisol stored corneas and in 55% (11%, 94%) in Optisol when stained for actin cytoskeleton, which correlated with the presence of epithelial defect before storage and vacuolated endothelial cells after storage. No difference was observed between the two media based on the staining pattern for Na+/K+ ATPase. Conclusion: Cornisol and Optisol-GS are equivalent in maintaining the structural integrity and functionality of the donor corneas.

Evaluation of equine corneal endothelium after exposure to 0. 05% brilliant blue - an in vitro study / Avaliação do endotélio corneano de equinos após contato com o corante azul brilhante 0, 05% - estudo in vitro

The aim of this study was to evaluate the immediate effects of 0.05% brilliant blue on corneal endothelium of horses. Thirty-eight corneas of 19 horses, male or female, of different ages were studied. Corneas were randomly divided into two groups. Group 1: Corneal endothelium was covered with 0.3mL of brilliant blue 0.05% for 60 seconds followed by rinsing with a balanced salt solution. Group 2: Corneal endothelium was covered with BSS for 60 seconds. The corneas were excised with an 8mm trephine and prepared to analyze posterior endothelial surface using a light microscope (24 corneas) and a scanning electron microscope (14 corneas). The equine posterior corneal endothelium surface observed by optical microscopy and scanning electron microscopy revealed a continuous layer of polygonal cells of uniform size and shape in both the control and treatment groups. Due to non-normal residuals at ANOVA mean comparison, a generalized linear model was utilized at 5% level of significance. The chi-square test stated that treatment and control group were not different statistically. The 0.05% brilliant blue did not cause damage to equine corneal endothelium.(AU)

Objetivou-se avaliar os efeitos imediatos de uma solução de 0,05% de azul brilhante sobre o endotélio da córnea de equinos. Trinta e oito córneas de 19 cavalos, machos ou fêmeas, de diferentes idades foram estudadas. As córneas foram divididas aleatoriamente em dois grupos. Grupo 1: O endotélio corneano foi perfundido com 0,3mL de azul brilhante 0,05% durante 60 segundos seguido por irrigação com uma solução salina balanceada. Grupo 2: O endotélio corneano foi perfundido com BSS durante 60 segundos. As córneas foram posteriormente excisadas com trépano de 8mm e preparadas para análise endotelial utilizando um microscópio óptico (24 córneas) e um microscópio eletrônico de varredura (14 córneas). A análise da superfície posterior do endotélio da córnea equina observada por microscopia óptica e microscopia eletrônica de varredura revelou uma camada contínua de células poligonais de tamanho e forma uniformes tanto no grupo controle quanto no grupo tratamento. Devido aos resíduos não normais na comparação da média de ANOVA, utilizou-se um modelo linear generalizado com nível de significância de 5%. Evidenciou-se com o teste qui-quadrado que não houve diferença estatística entre o grupo controle e o grupo tratamento. O azul brilhante de 0,05% não causou dano ao endotélio corneano de equinos.(AU)

Efecto de la lente fáquica ACR-128 sobre la tensión ocular y el endotelio corneal en las altas miopías / Effect of the ACR-128 phakic lens on ocular tension and the corneal endothelium in high myopia

RESUMEN Objetivo: Describir los efectos sobre la tensión ocular y el endotelio corneal con el implante de la lente fáquica ACR-128 para la corrección de la alta miopía. Métodos: Se realizó un estudio descriptivo, observacional, longitudinal y prospectivo en 60 ojos de 32 pacientes con miopía corregida con lente fáquica ACR-128. Se determinaron las complicaciones trans y posoperatorias, la presión intraocular, la densidad de las células endoteliales, el coeficiente de variabilidad y la hexagonalidad, así como la posición de la lente. El análisis estadístico se realizó con la Prueba T para datos pareados, con una significación del 95 por ciento. Resultados: La edad media fue de 27,41 ± 5,91 años y el 68,75 por ciento correspondió al sexo femenino. El equivalente esférico preoperatorio promedio fue de -11,54 ± 3,20 dioptrías. Resultó sin complicaciones transoperatorias el 100 por ciento; las posoperatorias inmediatas fueron de 93,33 por ciento y las mediatas y tardías del 95,00 por ciento. No hubo diferencias significativas entre el pre y el posoperatorio en la tensión ocular (p=0,2570); la densidad endotelial fue p= 0,0928; el coeficiente de variación p= 0,889 y la hexagonalidad (p= 0,0957). Conclusiones: El implante de la lente fáquica ACR-128 para la corrección de las altas miopías es un procedimiento seguro, al ofrecer escasas complicaciones y mínimos efectos en la tensión ocular y en el endotelio corneal(AU)

ABSTRACT Objective: Describe the effects of ACR-128 phakic lens implantation for high myopia correction on ocular tension and the corneal endothelium. Methods: An observational descriptive longitudinal prospective study was conducted of 60 eyes of 32 patients with myopia corrected with the ACR-128 phakic lens. Determination was made of intra- and postoperative complications, intraocular pressure, endothelial cell density, variability and hexagonality quotient, and lens position. Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 27.41 ± 5.91 years and 68.75 percent of the patients were female. Mean preoperative spherical equivalent was -11.54 ± 3.20 diopters. Complications were none in the intraoperative period, 93.33 percent in the immediate postoperative period and 95.00 percent mid- or long-term. No significant differences were found between the pre- and postoperative periods concerning ocular tension (p= 0.2570). Endothelial cell density was p= 0.0928, the variability quotient p= 0.889 and hexagonality p= 0.0957. Conclusions: ACR-128 phakic lens implantation for correction of high myopia is a safe procedure causing few complications and minimal effects on ocular tension and the corneal endothelium(AU)

Effects of atracurium besylate on corneal endothelium of chickens: in vitro study / Avaliação dos efeitos do besilato de atracúrio no endotélio corneano de galinhas: estudo in vitro

The aim of this study was to investigate the acute effects of atracurium besylate on cellular damage in corneal endothelium of chickens. Twenty healthy chicken eyes were assigned to the following groups: Group 1 (G1), experimental group (n=10); and Group 2 (G2), control (n=10). Excised corneoscleral buttons were immediately placed on glass microscopy slides with endothelial region faced up. Corneal endothelium of eyes in G1 were covered with AB (0.2mL, 10mg/mL) for 3 min and then rinsed with balanced salt solution (BSS), while the corneal endothelium of eyes in G2 were covered with BBS for 3 min. Corneas from both groups were stained with alizarin red/trypan blue and visualized by light microscopy. Ten random photographs were taken from each cornea. The area of cellular damage was measured by software in all samples and cell loss of each group was averaged and compared. Endothelial area of denudation and Descemet's membrane exposure were higher in G1 than G2. In conclusion, atracurium besylate induced an acute damage on corneal endothelium of chickens.(AU)'

Objetivou-se avaliar os efeitos agudos do besilato de atracúrio sobre o endotélio corneano de galinhas. Vinte olhos saudáveis de galinhas foram aleatoriamente separados em dois grupos com 10 olhos cada, sendo G1 o grupo controle e G2 o grupo tratamento. Imediatamente após a excisão dos botões corneoesclerais estes foram colocados em lâminas de microscopia de vidro com o lado endotelial voltado para cima. No Grupo 1, o endotélio corneano foi recoberto com 0,2ml de besilato de atracúrio (10mg/ml) durante 3 minutos e depois lavado com solução salina balanceada. No Grupo 2, o endotélio corneano foi recoberto apenas com solução salina balanceada durante 3 min. As córneas de ambos os grupos foram coradas com vermelho de alizarina e azul de tripano e visualizadas com microscópio óptico. Foram obtidas dez fotografias aleatórias de cada amostra. As imagens foram analisadas e com auxílio de um software as áreas com ausência de células endoteliais calculadas. A perda celular endotelial foi significativamente maior no grupo tratamento comparativamente ao grupo controle. Com base nos resultados apresentados foi possível concluir que o besilato de atracúrio induziu dano agudo nas células do endotélio da córnea de galinhas.(AU)

Femtosecond laser-assisted phacoemulsification combined with multifocal intraocular lens implantation in the treatment of cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To probe into the clinical values of femtosecond laser-assisted phacoemulsification combined with multifocal intraocular lens implantation in the treatment of cataract.<p>METHODS: Totally 94 cases(94 eyes)of patients with cataract and who treated from July 2015 to July 2018 were divided into observation group(47 eyes)and control group(47 eyes)by random number table method. The observation group wes received femtosecond laser-assisted phacoemulsification combined with multifocal intraocular lens implantation, while the control group were received traditional phacoemulsification combined with multifocal intraocular lens implantation Then, the operation related indexes, corneal endothelial cell density, visual acuity and complications of two groups were observed.<p>RESULTS:The time of phacoemulsification in the observation group was shorter than that in the control group, and the ultrasound energy, cumulative energy of intraoperative phacoemulsification and anterior chamber flash value after operation for 7d were lower than those in the control group(<i>P</i><0.05). There was no significant difference in corneal endothelial cell density between the two groups before operation(<i>P</i>>0.05). The corneal endothelial cell density after operation for 3mo in the observation group was significantly higher than that in the control group(<i>P</i><0.05). There was no significant difference in the best corrected visual acuity(BCVA)and uncorrected visual acuity(UCVA)between the two groups(<i>P</i>>0.05). The BCVA and UCVA after operation for 3mo in the observation group were better than those in the control group(<i>P</i><0.05).There was no significant difference in complications between the two groups(<i>P</i>>0.05).<p>CONCLUSION: The effects of femtosecond laser-assisted phacoemulsification combined with multifocal intraocular lens implantation in treatment of cataract are significant, which can reduce the cumulative release of ultrasound energy, reduce corneal endothelial damage, and promote visual recovery of patients, thus it is safe and it is worthy to be promoted.

Morphological parameters of corneal endothelium in patients with rhegmatogenous retinal detachment complicated with choroidal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the changes of morphological parameters of corneal endothelial cell in patients with choroidal detachment following rhegmatogenous retinal detachment(RDD-CHD). <p>METHODS: Seventy patients(70 eyes)with RDD-CHD were collected consecutively. In patients with RDD-CHD, thirty-eight cases(38 eyes)not with high myopia were enrolled in group A; 32 cases(32 eyes)associated with high myopia were enrolled in group B. Thirty-six normal controls(36 eyes)were enrolled in group C. We measured the related morphological parameters of corneal endothelial cells in all subjects using corneal specular microscope. The parameters of corneal endothelial cells included minimum size of cell area(S_min), maximum size of cell area(S_max), average size of cell area, standard deviation of cell area(SD), coefficient of variability cell area(CV), cell density of corneal endothelial cells(CD)and hexagonality(HG). <p>RESULTS: There were statistically differences in the CD(<i>P</i><0.001)and hexagonality(<i>P</i><0.001)between the patients with RDD-CHD and normal subjects. There were statistically differences in the CD between groups A and B(<i>P</i><0.05), between groups A and C(<i>P</i><0.05), between groups B and C(<i>P</i><0.001). SD correlated with axis length(<i>r</i>_s=-0.426, <i>P</i><0.01); CV correlated with axis length(<i>r</i>_s=0.494, <i>P</i><0.01), CD correlated with intraocular pressure(<i>r</i>_s=-0.025, <i>P</i><0.05), CD correlated with axis length(<i>r</i>_s=0.368, <i>P</i><0.05), HG correlated with course(<i>r</i>_s=0.552, <i>P</i><0.05). In patients with RDD-CHD, SD correlated with axis length(<i>r</i>_s=0.236, <i>P</i><0.05); CV correlated with axis length(<i>r</i>_s=0.159, <i>P</i><0.05), HG correlated with course(<i>r</i>_s=0.142, <i>P</i><0.05), S_max correlated with intraocular pressure(<i>r</i>_s=-0.314, <i>P</i><0.01).<p>CONCLUSION: The valus of HG and CD of corneal endothelial cells in patients with RDD-CHD were both lower than that of the normal subjects. Axis length, course and intraocular pressure might influence the morphological parameters of corneal endothelium in RDD-CHD patients.