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Purpose: To evaluate and compare endothelial cell changes in phacoemulsification and manual small- incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts. Methods: This was a prospective, tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors. Results: Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05). Conclusion: Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification
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Purpose: To evaluate and correlate corneal endothelium parameters with the severity of primary glaucoma. Methods: This prospective case?control study was conducted on 150 eyes of 80 newly diagnosed primary open?angle glaucoma (POAG), chronic primary angle?closure glaucoma (cPACG), and normal?tension glaucoma (NTG) patients in a tertiary care center. Endothelial parameters including endothelial cell count (ECC), percentage of hexagonal cells, and coefficient of variation of cell size were analyzed. Glaucoma cases were further sub?grouped into early, moderate, and severe glaucoma and compared for endothelial parameters. Chi?square, Fischer’s exact test, independent sample t?test, and analysis of variance were performed using IBM® SPSS® Statistics version 28. Results: The ECC was markedly reduced in cases (2281 cells/mm2) versus controls (2611 cells/mm2) (P < 0.001). The POAG (2251 cells/mm2) and cPACG (2287 cells/mm2) eyes had significantly a lower ECC compared to healthy controls (P < 0.001), whereas NTG eyes had a lower mean ECC (2538 cells/mm2), but it was not statistically significant (P > 0.05) when compared with controls. The ECC decreased with an increase in severity as patients with early glaucoma had an ECC of 2284 cells/mm2, moderate 2261 cells/mm2, and severe 2086 cells/mm2, and the difference was statistically significant. Conclusion: A significant decrease in corneal ECC was observed in POAG and cPACG patients when compared with healthy controls of the same age group. Mechanical damage following an elevated intra?ocular pressure for a longer duration may be attributed to morphological and consequent functional damage to endothelial cells.
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Purpose: To compare the clinical outcomes of endonucleation chop (EC) versus conventional crater (CC) chop techniques in phacoemulsification of hard nuclear cataracts. Methods: In this Prospective, longitudinal, randomized controlled study with double?blinding. Hundred consecutive eyes with uncomplicated cataracts (nucleus grades 3 and 4) were equally divided into Group A (EC) and Group B (CC). Intraoperative effective phacoemulsification time (EPT) and balanced salt solution (BSS) volume used was noted. Postoperative central corneal thickness (CCT), endothelial cell density (ECD), uncorrected Visual Acuity (UCVA), best?corrected visual acuity (BCVA), and IOP were recorded at days 1, 7, 30, and 90 postoperatively. The Chi?square test (categorical data), Mann–Whitney U test, and t?tests for other parameters were done. Results: The mean EPT in Groups A and B were 6.6 and 14.25 s, respectively (P < 0.001). The BSS volume used was 105.9 and 221.7 mL, respectively (P < 0.001). At 3 months, the ECD loss was 4.35 and 8.6%, respectively (P = 0.025). The?first day CCT was significantly increased in Group B but was the same in both groups at 3 months. A significant improvement in BCVA was noted in both groups. This new technique significantly reduces EPT, the BSS used, and ECD loss. Conclusion: Compared with the CC chop technique, the EC technique for phacoemulsification of hard nuclear cataracts conserved phacoemulsification energy and minimized exposure to the intraocular irrigating solution, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation
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Background:Corneal endothelial cells are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients due to stressful events. Present study was aimed to evaluate corneal endothelial density, hexagonality and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at early postoperative period and 1 month after phacoemulsification.Material And Methods:Specular microscopy examinations prior to phacoemulsification and at early postoperative period and 1 months after phacoemulsification were performed on diabetic and non-diabetic groups in grade 2 and grade 3 nuclear sclerosis. Laterthe changes in endothelial density, the percentage of hexagonality, and Central corneal thickness were evaluated.Result:Mean age of 120 study sample was 58.45 years (standard deviation –8.498 years), with the highest 74 years and lowest 43 years. Therewere 53 (44%) females and 67 (56%) males in the study. 42 (35%) samples were from 51-60 years age group followed by 37 (30.83%) subjects in 61-70 years age group. Mean corneal endothelial cell density decreases after cataract surgery in comparison with pre-operative density among study samples. Mean pre-operative corneal endothelial cell density was lower in diabetics in comparison with non-diabetics, and the difference was statistically significant. Cell density count decreases after cataract surgery inboth groups with significant difference between two groups. Mean corneal endothelial cell morphology (hexagonal cell percentage) decreases after cataract surgery in comparison with pre-operative density among study sample s. Central corneal thickness increases in early postoperative period followed by normalisation at day 30.Conclusion:Diabetic group showed greater hexagonality decrease compared to non-diabetic group at 1 month after phacoemulsification. It is suggested that diabetic corneal endothelium requires additional care and protective measures during cataract surgery to minimize surgical trauma. There were no statistically significant differences in the endothelial loss and Central corneal thickness changes between the diabetic and non-diabetic group at 1 month follow up after phacoemulsification.
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AIM: To systematically evaluate the effects of femtosecond laser-assisted cataract surgery and conventional ultrasound cataract surgery(CUCS)on corneal endothelial cells.METHODS: Databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, CBM, VIP and WanFang Data were searched for randomized controlled trials(RCT)from the establishment of the database to November 2021 on the effects of femtosecond laser cataract surgery and conventional ultrasound cataract surgery on corneal endothelial cells. Language is limited to Chinese or English. The literatures were evaluated by the Manual of Systematic Evaluation of Cochrane Interventions and the modified Jadad Scale. Stata 15.0 software was used for statistical analysis.RESULTS: A total of 13 RCT were included, including 1 446 eyes in the FLACS group and 1 472 eyes in the CUCS group. The Meta-analysis results showed that the cumulative dissipated energy(CDE)in FLACS group was obviously lower than that in CUCS group [WMD=-3.84, 95%CI (-6.30, -1.38), P=0.002]. The effective phacoemulsification time(EPT)in the FLACS group was obviously lower than that in the CUCS group [WMD=-3.03, 95%CI(-4.00, -2.05), P<0.001]. The density of corneal endothelial cells in both the FLACS group after surgery at 1 and 3mo was higher than that in CUCS group [WMD=121.76, 95%CI(79.31, 164.20), P<0.001; WMD=76.04, 95%CI(19.25, 132.82), P=0.009]; The thickness of the central cornea in the CUCS group was significantly thicker than that in the FLACS group at 1wk after the surgery [WMD=-9.89, 95%CI (-18.60, -1.18), P=0.026]; The incidence of postoperative corneal edema in the FLACS group was less than that in the CUCS group [RR=0.46, 95%CI(0.32, 0.66), P<0.001]. There were no differences in the percentage of hexagonal cells and coefficient of variation of corneal endothelial cells between the two groups.CONCLUSION: Compared with conventional ultrasound cataract surgery, femtosecond assisted cataract surgery can significantly reduce the phacoemulsification energy and the duration of the phacoemulsification energy, and significantly reduce the loss of corneal endothelial cells in the early postoperative period, while reducing the occurrence of postoperative corneal edema.
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Objective:To explore the long-term influence of donor central graft thickness (CGT) and donor graft size on corneal endothelial cell density (ECD) after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods:An observational case series study was conducted.One hundred and forty-four eyes of 134 patients who underwent DSAEK in Peking University Third Hospital from January 2013 to December 2017 with at least 24-month follow-up were enrolled.Preoperative donor ECD was evaluated by specular microscopy, and ECD was determined by in vivo confocal microscopy at 1, 3, 6, 12, and 24 months postoperatively.Donor CGT was measured by anterior segment optical coherence tomography.According to the 3-month postoperative donor CGT, the subjects were divided into thinner graft group (45 eyes with CGT<100 μm), medium-thick graft group (66 eyes with CGT≥100-<150 μm) and thicker graft group (33 eyes with CGT≥150 μm). According to the donor trephination size, the subjects were divided into smaller graft group (31 eyes with trephination size≥7-<8 mm) and larger graft group (113 eyes with trephination size≥8-<9 mm). The changes of the donor CGT and corneal endothelial cell loss rate were compared at different time points after surgery.The relationships between 24-month postoperative ECD and donor ECD, donor graft size and donor CGT were analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University Third Hospital (No.IRB00006761-2008025). Written informed consent was obtained from each subject prior to any medical examination. Results:The donor CGT was 129.0 (90.8, 160.8), 115.5 (93.0, 146.0), 115.5 (89.0, 151.0), 112.5 (94.3, 146.8) and 114.0 (89.0, 144.5) μm at 1, 3, 6, 12 and 24 months after surgery, showing a statistically significant difference ( H=37.369, P<0.001). There was a statistically significant difference between 1-month and 3-month postoperative CGT ( P<0.001). There was no statistically significant difference in the endothelial cell loss rate among the three different donor CGT groups and between the two different donor graft size groups at any postoperative time points (all at P>0.05). Spearman correlation analysis showed that the 24-month postoperative ECD was strongly positively correlated with the preoperative donor ECD( rs=0.783, P<0.001), which was not associated with donor graft size and donor CGT ( rs=0.141, P=0.093; rs=-0.044, P=0.600). Conclusions:Larger postoperative ECD is correlated with larger preoperative ECD of donor graft.Lower long-term corneal endothelial cell loss rate after DSAEK is associated with thinner and larger diameter of donor graft.
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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.
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Humans , Male , Female , Child , Adolescent , Adult , Endothelial Cells , Keratoconus/diagnosis , Microscopy , Endothelium, Corneal , Cell Count , Cross-Sectional Studies , Corneal Topography , Corneal PachymetryABSTRACT
Purpose: To study the outcomes of rebubbling for graft detachment after Descemet's stripping endothelial keratoplasty (DSEK) or Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods: From 2260 eyes that underwent DSEK or DSAEK from July 2008 to June 2015, 80 eyes of 80 patients developed graft detachment and were retrospectively reviewed. Host-related, surgery-related and donor-related factors that have a bearing on graft adhesion were looked at retrospectively, and eventual outcomes after rebubbling procedure were studied. Results: Successful attachment was observed in 77 (96.25%) eyes and clear grafts were achieved in 55 (68.75%) eyes, while 25 (31.25%) eyes had graft failure. The uncorrected and best-corrected distance visual acuities significantly improved from 1 month to 3 months post-operatively and remained stable till 12 months of follow-up. Three lenticules that failed to attach with the first rebubbling procedure underwent a second rebubbling, two underwent a repeat DSEK with good outcomes and four underwent penetrating keratoplasty. On evaluating possible risk factors for graft failure, lower donor endothelial cell density was found to be a significant factor (P = 0.03). The median graft survival following rebubbling was 30 months. Conclusion: Rebubbling procedure in detached grafts after DSEK or DSAEK can reattach the lenticule in 96% of eyes in immediate post-operative period and the majority of the grafts remained clear on long-term follow-up with a median graft survival period of 2.5 years.
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PURPOSE: We compared and analyzed central corneal thickness (CCT) measurements according to the corneal thickness obtained with noncontact specular microscopy (NCSM) and ultrasound pachymetry (USP). METHODS: CCT was measured in the order of NCSM and USP by a single optometrist in 120 eyes of 120 healthy subjects. The measurements were compared between the devices and the measurement agreements and correlations between the devices were analyzed. To determine if the measurements differed depending on the thickness of the cornea, the patients were divided into three tertile groups from the thinnest patient by CCT measurement using USP, and then the differences in CCT measured by the two devices were analyzed. RESULTS: The CCT measurements using NCSM and USP were 548.25 ± 4.64 µm and 533.09 ± 35.96 µm, respectively. NCSM measurements were found to be thicker, showing statistically significant differences between the measurements (p < 0.001). The two examinations showed a high degree of correlation (r = 0.878; p < 0.01). In the three groups, the differences in CCT measurements between NCSM and USP were 12.93 ± 21.88 µm, 16.85 ± 15.89 µm, and 15.70 ± 20.46 µm, respectively, but the differences between the three groups were not statistically significant (p = 0.655). CONCLUSIONS: Our results show that although the differences in CCT measurements using NCSM and USP were consistent regardless of the corneal thickness, the CCT measurements by NCSM and USP were highly correlated.
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Humans , Cornea , Corneal Pachymetry , Healthy Volunteers , Microscopy , UltrasonographyABSTRACT
@#AIM: To assess corneal endothelial cells and corneal thickness in congenital cataract patients, which contributes to studying the characteristics and mechanism of the disease.<p>METHODS: From August 2014 to December 2018, 141 patients diagnosed with congenital cataract before surgery in our hospital were analyzed retrospectively. Their endothelial cell density(ECD), average size(AVE), standard deviation of size(SD), coefficient of variation(CV), Hexagonality(Hex)and central corneal thickness(CCT)were measured with non-contact specular microscope. The data were statistically analyzed using partial correlation analysis to detect the correlation among patients' ECD, AVE, SD, CV, Hex, CCT and age, and we conducted curve fitting with multiple stepwise regression. We compared male and female patients', bilateral and unilateral cataract's parameters above by covariance analysis.<p>RESULTS: The correlation between patients' ECD, AVE, SD and age was significant, and the fitting curve was obtained with equation ECD=3957.33-306.62×ln(age)、AVE=178.77+27.39×ln(age)and SD=77.13×e0.013×age respectively. CV was significantly greater in female patients than that in male patients(<i>P</i>=0.044). SD and CV was significantly greater in right eyes of bilateral cataract than that in affected eyes(<i>P</i>=0.037, <i>P</i>=0.028 respectively)and healthy eyes(<i>P</i>=0.007, <i>P</i>=0.003 respectively)from unilateral cataract, Hex was significantly less in right eyes of bilateral cataract than that in affected eyes(<i>P</i>=0.006)and healthy eyes(<i>P</i>=0.009)from unilateral cataract, CCT was significantly greater in right eyes of bilateral cataract than that in healthy eyes(<i>P</i>=0.041)from unilateral cataract.<p>CONCLUSION: Congenital cataract may affect corneal endothelial cells and corneal thickness, especially SD, CV, Hex and CCT. Patients' ECD, AVE and SD changes with age. Female patients may have greater CV than male patients.
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Background: Diabetes mellitus is associated with structural changes in corneal endothelial cells and their thickness. The present study was done to compare the endothelial cell density (ECD), central corneal thickness (CCT) and morphology in diabetic and non-diabetic patients.Methods: A cross-sectional study was conducted at Minto Ophthalmic hospital, BMC and RI Bangalore for a period of 20 months (October 2013 - May 2015). A total of 200 study subjects, 100 diabetics and 100 non-diabetic age matched controls were selected, and complete timed ophthalmic evaluation was performed. Specular microscopy was performed on all patients for endothelial cell count assessment and corneal thickness was measured by Pachymeter. The data was analyzed and represented using descriptive statistics. ‘t’ test was used for comparing the two groups.Results: The mean endothelial cell density in diabetic group was significantly lower (2438.73±250.23cells/mm2) compared to non-diabetic group (2599.88±168.16cells/mm2) (p<0.0001). The mean Central corneal thickness in diabetic group was significantly higher (518.40±28.13 μm) compared to control group (490.14±24.31 μm) (p<0.001). The Co-efficient of variation percentage of the diabetics was higher than the non-diabetics but this difference was not statistically significant (P>0.05). The hexagonality percentage was significantly lower in diabetic group compared to the controls suggesting less pleomorphism in the diabetic group.Conclusions: The study concludes that the endothelial cell density was lower and central corneal thickness was higher in diabetic patients compared with the non-diabetics. The altered endothelial morphology was significantly seen in the form of pleomorphism (hexagonality) but polymegathism was not significantly altered.
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AIM:To study the relativity between reject reaction from donation after cardiac death (DCD) and corneal endothelial cell source of corneal graft after penetrating keratoplasty.METHODS:Totally 28 cases of corneal graft rejection after penetrating keratoplasty with cardiac death donor cornea were analyzed using corneal endothelial microscope at less than 1mo,2-3mo,4-6mo,7-12mo after operation.RESULTS:Coefficient variation of corneal endothelial cell of the 28 cases at less than 1 mo,2-3mo,4-6mo and 7-12mo were 38.23％,49.56％,57.18％,65.04％.Corneal endothelial cell density were 2071.15 ± 311.47,1771.33 ± 348.18,1626.59±353.92,1553.14±307.31.The coefficient variation of corneal endothelial cells was positively correlated with rejection (r =0.95,P ＜ 0.05).The postoperative corneal endothelial cell density was negatively correlated with rejection (r=-0.93,P＜0.05).CONCLUSION:The corneal endothelial cell coefficient variation increased gradually and the corneal endothelial cell density decreased gradually after DCD corneal allograft rejection.Corneal endothelial cell coefficient variation and corneal endothelial cell density can be used as indicators of early detection of postoperative rejection.
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Background: Myopia is a common pathologic change of the eye, especially in Asian countries undergoing rapid development. It is known that Asian people have a higher prevalence of myopia. High levels of myopia are associated with increased risk of cataract, posterior vitreous detachment, retinal tears and retinal detachment, increased risk of choroidal neovascularization, and myopic macular degeneration. Aim: To describe the corneal endothelial density and morphology in patients of low and moderate myopic in rural south Indian population and the relationship between endothelial cell parameters and other factors. Materials and Methods: Totally 100 patients were included. Noncontact specular microscopy was performed after taking a history and testing the visual acuity, intraocular pressure measurement, Schirmer’s test and routine eye examination by slit lamp microscope. The studied parameters included mean endothelial cell density (MCD), the coefficient of variation (CV), and percentage of hexagonality. Results: In low myopic eyes the MCD was 2892. 0±146.2/mm2 , the mean CV was 38.4± 0.4 and the mean hexagonal appearance of the cell was 53.9± 0.9%. In moderate myopic eyes, the MCD was 35716± 142.0 mm2 , the mean CV was 37.9± 3.4% and mean the hexagonal appearance of the cell was N. Sathish Kumar, D. Sundararajan, S. Veluchamy. Assessment of corneal endothelial cell density and morphology in low and moderate myopic eyes in rural south Indian population. IAIM, 2017; 4(10): 93-96. Page 94 59.83± 3.6. There were statistically significant differences in MCD (p<0.000) and hexagonal appearance of the cell (p<0.005) between low and moderate myopic eyes. Conclusion: The normative data of the corneal endothelium of eyes indicated that statistically, MCD decreased significantly with age. Previous studies have reported no difference in MCD, the percentage of CV, and percentage of hexagonality between genders. Nevertheless, significantly different percentages of CV between genders were presented in this study.
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AIM:To investigate the effect of Ahmed glaucoma drainage valve implantation on corneal endothelial cell density and intraocular pressure in patients with neovascular glaucoma.METHODS:Totally 200 cases (200 eyes) of patients with neovascular glaucoma in our hospital from June 2013 to June 2016 were enrolled in this study.All patients were treated with glaucoma drainage valve implantation.The medical records of the patients were retrospectively analyzed;the evaluation of operation completion was made;intraocular pressure at preoperative and postoperative 1wk,1mo,1a was detected using non-contact tonometry;the corneal endothelial cell density at preoperative and postoperative 1 wk,1mo and 1 a was tested by corneal endothelial microscopy,and visual acuity of patients before operation and at 1 a after operation was recorded.All patients' complications and intervention methods were followed-up and recorded.RESULTS:All patients' complete success rate was 81.0％,the conditional success rate was 92.0％.The proportion of preoperative and postoperative vision without light perception,hand moving to 0.01,0.02-0.05,0.06-＜0.10,≥0.10 had significant difference (P＞0.05).Intraocular pressure before treatment was 42.43±3.43mmHg,and were 13.45 ± 2.34mmHg,15.89 ± 2.67mmHg,16.34±2.88mmHg at 1wk,1mo and 1a after operation respectively,showing significant difference (F=4570.62,P＜ 0.001).Before treatment,corneal endothelial cell density was 2453.67± 342.34/mm2,and were 2216.67-± 332.32/mm2,2087.34 ± 326.45/mm2,1959.67±303.34/mm2 at 1wk,1mo and 1 a after operation respectively,holding significantly different (F=83.42,P＜0.001).There were macular degeneration 20 eyes of hyphema,13 eyes of low pressure,8 eyes of drainage valve displacement and 21 eyes of shallow anterior chamber.CONCLUSION:Ahmed glaucoma drainage valve implantation for neovascular glaucoma can effectively control intraocular pressure but the presence of corneal endothelial cell loss exists,can effectively protect and recover residual vision of patients,relief complications and recover it after simple intervention,it is an effective method for neovascular glaucoma.
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@#AIM:To investigate the effect of small incision non-phacoemulsification cataract surgery on corneal endothelial cell.METHODS:Totally 140 cataract patients (152 eyes) treated in our hospital from August 2013 to March 2016 were selected.All of the patients underwent small incision non-phacoemulsification cataract surgery.Before surgery and at 1wk, 1mo and 3mo after surgery, we measured the corneal endothelium of upper cornea, the central cornea and the lower part of cornea.The proportion and density of hexagonal cells, loss rate and cell area in corneal endothelial cells were calculated and compared.RESULTS:Postoperatively 36 eyes had posterior elastic layer folds, aqueous flare, which disappeared after treatment.After surgery, corneal incision was found to have mild corneal edema.No other complications were found.A total of 128 patients (137 eyes) were followed up for a total of up to 3mo, with a loss of follow-up in 12 patients (15 eyes).After surgery, corneal endothelial cell density of the upper part of the cornea, the central cornea and the lower part of cornea, was statistically significantly different with each other (F=3.526, P=0.031), the difference in different time points was statistically significant (F=4.111, P=0.018).The postoperative corneal endothelial cell loss rate was statistically significant different between the three groups (F=3.526, P=0.031), at different time pionts (F=4.111, P=0.018).There was statistical significance of percentage of hexagonal cells between the three groups (F=4.348, P=0.014), the difference was significantly different between different time points (F=4.964, P=0.008).There was statistical significance of corneal endothelial cell area between the three groups (F=3.180, P=0.044), the difference was significantly different between the time points (F=3.511, P=0.032).CONCLUSION:After small incision non-phacoemulsification cataract surgery, corneal endothelial cell density decreased, hexagonal cell proportion decreased, corneal cell area expanded.
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AIM: To compare the effect of small incision extracapsular cataract extraction and phacoemulsification on corneal endothelial cells and explore the differences between these two most commonly used surgeries for grade Ⅱ-Ⅲ lens nucleus. · METHODS: Retrospective study. We retrospectively evaluated the data of age-related cataract patients who had completed surgery in our hospital between June 2013 and December 2015. There were 84 eyes of 84 patients. The corneal endothelial cell density of all the patients were greater than 2000/mm2 and lens nucleus were gradeⅡ- Ⅲ. The patients were divided into manual small incision cataract surgery ( MSICS ) group and phacoemulsification ( Phaco ) group. MSICS group included 42 cases (42 eyes) and Phaco group included 42 cases ( 42 eyes ) . Postoperative evaluations were performed at 1d, 1wk, 1mo and 6mo and included uncorrected visual acuity ( UCVA ) , corneal endothelial cell density and the proportion of hexagonal cells. · RESULTS: There were no statistically significant differences of the two groups in preoperative basic data, UCVA, corneal endothelial cell density and the proportion of hexagonal cells, nuclear classification. The postoperative UCVA were significantly improved in both groups (x2=148. 01, P0. 05). ·CONCLUSION: Manual small incision cataract surgery and phacoemulsification can indiscriminately improve UCVA and decrease the density of corneal endothelial cells. However, the change of hexagonal cells proportion was not obvious. These two surgeries for cataract patients with corneal endothelial cell density greater than 2000/mm2 , grade Ⅱ-Ⅲ lens nucleus have similar efficacy and safety.
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PURPOSE: To evaluate the long-term changes in cornea endothelial cell density (ECD) after pars plana vitrectomy (PPV) with fragmentation. METHODS: Twenty patients (20 eyes) who underwent PPV with fragmentation and who were followed up for 2 years were enrolled in this retrospective study. The cornea ECD, coefficient of variation (CV), and hexagonality (HA) were calculated using a specular microscopy at 1, 3, 6, 12 months, and 2 years after surgery. RESULTS: The preoperative mean ECD was 1,782 ± 623 cells/mm², and the postoperative mean ECD did not significantly change at 1, 3, 6, and 12 months. Additionally, there were no significant changes in CV or HA. At 2 years after surgery, the mean ECD was 1,722 ± 532 cells/mm², the mean CV was 35.50 ± 3.03%, and the mean HA was 53.00 ± 4.91%. There were no significant changes in ECD, CV, or HA preoperatively and postoperatively at 1, 3, 6, and 12 months. CONCLUSIONS: In this study, the mean ECD did not significantly decrease after PPV with fragmentation at 2 years after surgery. A PPV with fragmentation was an appropriate surgical procedure for patients with low cornea endothelial cell density.
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Humans , Cornea , Endothelial Cells , Microscopy , Retrospective Studies , VitrectomyABSTRACT
PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.
Subject(s)
Adult , Animals , Female , Humans , Cataract , Cornea , Endothelial Cells , Hoof and Claw , Intraocular Pressure , Iris , Lens Implantation, Intraocular , Lenses, Intraocular , Myopia , Phakic Intraocular LensesABSTRACT
PURPOSE: To report a case of corneal failure after implantation of the Ahmed glaucoma valve occurring in a patient diagnosed with Fuchs' heterochromic iridocyclitis. CASE SUMMARY: A 53-year-old male who complained of ocular pain and suddenly decreased visual acuity in his right eye visited our clinic. His visual acuity was 0.15 and intraocular pressure (IOP) was 55 mm Hg. The slit-lamp examination revealed edematous cornea, fine round or stellate keratic precipitates connected with fine filaments on the endothelium and depigmentation of the iris. The corneal endothelial cell density was 2,958 cells/mm2. There was no specific finding in his left eye. The IOP did not improve with medical treatment, therefore, an Ahmed glaucoma valve was implanted in his right eye. At every follow-up exam the tube was well positioned and the IOP was maintained between 8 and 13 mm Hg. Eight months postoperatively, the patient complained of decreased visual acuity and the cell density was decreased to 1,408 cells/mm2. Posterior subcapsular cataract opacity was observed as well as progression of depigmentation and distortion of the iris. Seventeen months after the surgery, the cell density was 700 cells/mm2. On follow-up examination, his visual acuity was decreased to FC10 cm with the cataract progressing, therefore cataract surgery was performed. One month postoperatively, his vision improved to 0.1. However, the visual acuity deteriorated due to progression of the corneal edema and penetrating keratoplasty was performed. CONCLUSIONS: Aggravation of the corneal complication after Ahmed glaucoma valve implantation should be considered in patients with Fuchs' heterochromic iridocyclitis-induced glaucoma.
Subject(s)
Humans , Male , Middle Aged , Cataract , Cell Count , Cornea , Corneal Edema , Corneal Endothelial Cell Loss , Endothelial Cells , Endothelium , Follow-Up Studies , Glaucoma , Intraocular Pressure , Iridocyclitis , Iris , Keratoplasty, Penetrating , Visual AcuityABSTRACT
PURPOSE: To compare the survival of corneal grafts and the changes in endothelial cell density in penetrating keratoplasty using domestic or imported corneas. METHODS: Medical records of 236 eyes of 211 patients who underwent penetrating keratoplasty from November 2004 to August 2011 in Seoul National University Hospital and were followedup at least 1 year were retrospectively reviewed. After excluding the patients who received the combined surgeries with other surgeries except cataract surgery, the eyes were divided into 2 groups depending on the origin of donor tissue resulting in a domestic cornea group (108 eyes) and an imported cornea group (128 eyes). Recipient demographics, preoperative diagnosis, donor age, death-to-preservation time, death-to-operation time and pre-and postoperative visual acuities were compared between the 2 groups. Kaplan-Meier survival and changes in endothelial cell density were analyzed at 3, 6 and 12 months and then every year. RESULTS: The most common preoperative diagnoses were regraft and corneal opacity in the domestic and imported cornea groups, respectively, without statistical difference. Death-to-preservation time was 8.9 hours and 8.0 hours in the domestic and imported cornea groups, respectively, without statistical difference. However, death-to-operation time was longer in the imported cornea group (4.98 days) than in the domestic cornea group (2.18 days). There were no differences in pre- and postoperative visual acuities, decrease in annual changes in endothelial densities and survival up to 3 years between the 2 groups. In addition, the survival and decreased annual changes in endothelial densities were not different from each other in penetrating keratoplasty combined with cataract surgery or in penetrating keratoplasty for a corneal edema. CONCLUSIONS: Our study results suggest that clinical outcomes of the penetrating keratoplasty using imported corneas are comparable in efficacy when compared with the clinical outcomes using domestic corneas.