Evaluation of striate keratopathy after manual small-incision cataract surgery and its final outcomes in a tertiary hospital

Purpose: To study the demographic profile, contributing and precipitating factors, the severity of striate keratopathy and its relation with endothelial cell count, and evaluate the final treatment outcome of striate keratopathy. Methods: This observational analytical cohort study was conducted on 75 patients developing striate keratopathy after MSICS in the immediate postoperative period. Demographic profile, preoperative risk factors, and intraoperative complications were evaluated retrospectively. Postoperatively, slit-lamp grading of striate keratopathy was done, and specular microscopy of both eyes was taken. Treatment of striate keratopathy was initiated, and patients were followed up for 6 to 10 weeks for improvement. Results: Striate keratopathy was most commonly associated with surgeries performed by resident surgeons (92%), longer duration of surgery, associated predisposing factors, and intraoperative or postoperative complications. On postoperative day 1, the majority of patients had moderate and severe striate keratopathy (66% and 32%, respectively). It was associated with significant endothelial cell loss (ECL) at the final follow-up (P = 0.0016). Striate keratopathy resolved in 97.3% of patients, irrespective of the treatment with hypertonic saline. At 6 to 10 weeks, 92% of patients achieved a BCVA of ?6/9. Conclusion: A careful preoperative evaluation, adequate training of resident surgeons, meticulous surgical technique, and prompt management of postoperative complications can lead to a decrease in the incidence of striate keratopathy in the majority of cases. The use of hypertonic saline eye drops does not change the final outcome, and most cases resolve spontaneously during follow-up

Short-term endothelial cell density changes after gonioscopy-assisted transluminal trabeculotomy / Alterações de curto prazo na densidade celular endotelial associadas à trabeculotomia transluminal assistida por gonioscopia

ABSTRACT Purpose: To investigate the reduction in corneal endothelial cell density associated with gonioscopy-assisted transluminal trabeculotomy (GATT) in a short-term follow-up period. Methods: A retrospective analysis of the medical charts of patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy isolated or combined with phacoemulsification (phaco-gonioscopy-assisted transluminal trabeculotomy) was conducted. Patients who underwent phacoemulsification alone were included as controls. The endothelial cell density data (assessed using a specular microscope) before and at the first month after operation were collected and then compared. Results: Sixty-two eyes previously treated with gonioscopy-assisted transluminal trabeculotomy (gonioscopy-assisted transluminal trabeculotomy, n=39 eyes; phaco-gonioscopy-assisted transluminal trabeculotomy, n=23 eyes) fulfilled the inclusion criteria. The mean age of the study patients was 61.3 ± 18.4 years in the stand-alone gonioscopyassisted transluminal trabeculotomy group and 60.4 ± 11.9 in phaco-gonioscopy-assisted transluminal trabeculotomy group. Men comprised 66.6% of the patients in the isolated gonioscopyassisted transluminal trabeculotomy group and 56.5% of those in the phaco-gonioscopy-assisted transluminal trabeculotomy group. The mean visual field defects (mean deviation index) were -13.9 ± 9.2 and -10.3 ± 7.7 dB in the isolated gonioscopy-assisted and phaco-gonioscopy-assisted transluminal trabeculotomy groups, respectively. The patients in the former group presented a mean endothelial cell density reduction of 28.8 cells/mm² (1.31%; p=0.467). In the latter group, the mean endothelial cell density loss was 89.4 cells/mm² (4.36%; p=0.028). The control eyes (23 patients) presented a mean endothelial cell density change of 114.1 ± 159.8 cells/mm² (4.41%; p=0.505). The endothelial cell density reduction in the phaco-gonioscopy-assisted transluminal trabeculotomy group was not significantly different from that in the controls (p=0.81). Conclusions: Gonioscopy-assisted transluminal trabeculotomy appears to be a safe procedure for the corneal endothelial cell layer when performed either isolated or combined with cataract extraction in a short-term follow-up period.

RESUMO Objetivo: Investigar a redução na densidade celular endotelial corneana associada à trabeculotomia transluminal assistida por gonioscopia (GATT) em curto prazo. Métodos: Análise retrospectiva de prontuários médicos de pacientes com glaucoma de ângulo aberto que foram submetidos à trabeculotomia transluminal assistida por gonioscopia isolada ou combinada com facoemulsificação. Pacientes que foram submetidos à facoemulsificação isolada foram incluídos como controles. Dados da densidade celular endotelial corneana (avaliada através de microscópio especular) pré-operatória e ao primeiro mês pós-operatório foram coletados e comparados. Resultados: Sessenta e dois olhos que foram submetidos à trabeculotomia transluminal assistida por gonioscopia (trabeculotomia transluminal assistida por gonioscopia=39 olhos; faco com trabeculotomia transluminal assistida por gonioscopia=23 olhos) passaram pelos critérios de inclusão. A idade média dos pacientes estudados era 61,3 ± 18,4 anos no grupo trabeculotomia transluminal assistida por gonioscopia isolada e 60,4 ± 11,9 anos no grupo faco com trabeculotomia transluminal assistida por gonioscopia. Homens eram 66,6% do grupo trabeculotomia transluminal assistida por gonioscopia isolada e 56,5% do grupo faco com trabeculotomia transluminal assistida por gonioscopia. O defeito perimétrico médio (Mean Deviation) era -13,9 ± 9,2 dB e -10,3 ± 7,7 dB nos grupos trabeculotomia transluminal assistida por gonioscopia isolada e faco com trabeculotomia transluminal assistida por gonioscopia respectivamente. O grupo que fora submetido à trabeculotomia transluminal assistida por gonioscopia isolada apresentou redução média da densidade celular endotelial corneana de 28,8 células/mm² (1,31%; p=0,467). No grupo faco com trabeculotomia transluminal assistida por gonioscopia, a redução média da densidade celular endotelial corneana foi de 89,4 células/mm² (4,36%; p=0,028). Olhos controle (23 olhos) apresentaram redução média da densidade celular endotelial corneana de 114,1 ± 159,8 células/mm² (4,41%; p=0,505). A redução na densidade celular endotelial corneana no grupo faco com trabeculotomia transluminal assistida por gonioscopia não foi significativamente diferente do grupo controle (p=0,81). Conclusões: A trabeculotomia transluminal assistida por gonioscopia parece ser segura para a camada endotelial corneana em um curto prazo quando realizada de forma isolada ou combinada com cirurgia de catarata.

Comparison of effective phacoemulsification time and corneal endothelial cell loss using three different ultrasound frequencies: A randomized controlled trial

Purpose: Comparison of three ultrasound (US) frequencies for phacoemulsification of hard cataracts to determine a frequency that makes phacoemulsification more efficacious and safer. Methods: A randomized controlled trial was undertaken at a medical college and hospital. In total, 207 patients with grade 5.6� 6.9 (LOCS III) senile cataract were randomized into three groups. Group I underwent phacoemulsification with 28?kHz frequency, group II with 42?kHz frequency, and group III with 53?kHz frequency. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial cell parameters were analyzed for 6 months. Results: The groups were matched for age (P = 0.467), gender (P = 0.497), nuclear grade (P = 0.321), and anterior chamber depth (P = 0.635). The EPT and EFU were significantly lower in group III, compared to group II and group I, with P < 0.0001 and P < 0.0001, respectively. Postoperatively, the endothelial cell density (ECD) was significantly higher in group III at 1 month (P < 0.0001), 3 months (P < 0.0001), and 6 months (P < 0.0001). The percentages of ECD loss were also significantly lower in group III; the difference was statistically significant (P < 0.0001) up to 6 months postoperatively. Conclusion: Higher frequency ultrasound was associated with a lower EPT and EFU as well as better endothelial preservation than lower frequencies in hard cataracts

Clinical evaluation of femtosecond laser-assisted phacoemulsification in the treatment of cataract with shallow anterior chamber / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the therapeutic effect of femtosecond laser-assisted cataract surgery(FLACS)in eyes with shallow anterior chamber depth.<p>METHODS: Totally 60 eyes of 55 cataract patients with shallow anterior chamber who received cataract phacoemulsification in Tangshan eye hospital from November 2020 to February 2021 were selected, and divided into two groups according to the surgical methods on patient's subjective willingness: Patients who received FLACS were assigned to the FLACS group(28 patients, 30 eyes), and patients who received conventional Phaco(27 patients, 30 eyes)were assigned to the Phaco group. Preoperative general conditions, cumulative dissipated energy(CDE), effective phacoemulsification time(EPT), postoperative best corrected visual acuity(BCVA), uncorrected visual acuity(UCVA), endothelial cell loss rate(ECL), central macular thickness(CMT)and complications were compared and analyzed.<p>RESULTS:There was no significant difference in preoperative general data between the two groups(<i>P</i>>0.05). In both groups, UCVA at 1d, 1wk and 1mo after surgery and BCVA at 1wk and 1mo after surgery were better than those before surgery, and at 1d after surgery, UCVA in FLACS group was better than that in Phaco group, the difference was statistically significant(<i>P</i><0.05). In the FLACS group, CDE, EPT, ECL at 1wk and 1mo after surgery, and the incidence of corneal edema at 1d and 1wk after surgery were all lower than those in the Phaco group(all <i>P</i><0.05). There was no significant change in CMT in either the intragroup comparison or the intergroup comparison(<i>P</i>>0.05).<p>CONCLUSION:FLACS is safe and effective in patients with shallow anterior chamber cataract, which can significantly reduce the rate of endothelial cell loss, quickly restore vision, reduce the incidence of complications, and has no significant effect on macula.

Long-term influence of donor graft thickness and size on corneal endothelial cell density of Descemet stripping automated endothelial keratoplasty / 中华实验眼科杂志

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.

Risk factors of corneal endothelial cell injury caused by phacoemulsification / 中国辐射卫生

Objective To identify the risk factors of corneal endothelial cell injury caused by phacoemulsification, so as to provide the evidence for formulating interventions for prevention of corneal endothelial cell injury among cataract patients. Methods A total 248 eyes from 212 cataract patients that underwent phacoemulsification were selected as study subjects. The associations of subjects’ age, gender, left/right eye, pupillary diameter, grades of lens nucleus hardness, duration of phacoemulsification, total ultrasound energy, total infusion fluid amount with endothelial cell loss were evaluated using univariate analysis, and the independent risk factors for corneal endothelial cell injury caused by phacoemulsification were identified using multiple linear regression analysis. Results The density of endothelial cells was (2282.4 ± 412.16) cells/mm2 prior to phacoemulsification and (1921.77 ± 125.46) cells/mm2 months after phacoemulsification in 239 affected eyes, and the proportion of endothelial hexagonal cells was (54.41 ± 7.22)% prior to phacoemulsification and (45.62 ± 3.58)% months after phacoemulsification (χ2 = 5.43, P < 0.05). The incidence of corneal endothelial cell injury was 15.5% in 239 affected eyes. Univariate analysis showed that advanced age, small pupillary diameter, long duration of phacoemulsification, high grades of lens nucleus hardness and high total ultrasound energy were associated with endothelial cell loss, while gender and surgical eyes (left or right eye) were not associated with endothelial cell loss. Multiple linear regression analysis revealed that high grades of lens nucleus hardness, high total infusion fluid amount, long duration of phacoemulsification and high total ultrasound energy were independent risk factors for endothelial cell loss. Conclusions Lens nucleus hardness, high totalinfusion fluid amount, long duration of phacoemulsification and high total ultrasound energy are independent risk factors for endothelial cell loss caused by phacoemulsification.

Corneal structure and endothelial morphological changes after uneventful phacoemulsification in type 2 diabetic and nondiabetic patients / Alterações da estrutura e endotélio da cornea após facoemulsificação sem complicações em pacientes diabéticos tipo 2 e não diabéticos

ABSTRACT Purpose: The aim of this study was to compare corneal structure and endothelial morphological changes after uneventful phacoemulsification cataract surgery between type 2 diabetic and nondiabetic patients and to determine the preoperative and intraoperative factors that may predict greater endothelial cell density loss. Methods: Forty-five diabetic pa­tients (45 eyes) and 43 controls (43 eyes) with age-related cataract were enrolled in this prospective observational study. Corneal (thickness and volume) and anterior segment parameters were measured by Scheimpflug tomography; endothelial cell density and morphology (coefficient of variation of cell size, hexagonal cells) were recorded using noncontact specular microscopy. Patients were evaluated preoperatively and at one and six months after surgery. Univariate and multivariate linear regression analyses were performed to evaluate the relationship between demographic, clinical, ocular, and intraoperative parameters and postoperative endothelial cell density changes at six months. Results: Significant postoperative endothelial cell loss occurred one month after surgery in both groups (p<0.001), which remained stable until month 6; there were no differences between patients with and without diabetes mellitus at any time point. The mean postoperative central corneal thickness at one and six months did not change significantly from the mean preoperative value in either group (p>0.05). Multivariate linear regression analysis showed that older age (p=0.042) and higher cataract grades (p=0.001) were significantly associated with greater endothelial cell density reduction at six-month follow-up. Conclusion: This study showed that older age and denser cataracts might be associated with greater endothelial cell density reduction after cataract surgery. Other factors, such as diabetes mellitus and preoperative anterior segment parameters, did not influence postoperative changes in endothelial cell density.

RESUMO Objetivo: Comparar a estrutura da córnea e as alterações mor­fológicas endoteliais após cirurgia de catarata por facoemulsificação sem intercorrências entre pacientes com diabetes mellitus tipo 2 e não diabéticos; e determinar quais fatores pré e intra-operatórios relacionados com a maior redução da densidade celular endotelial. Métodos: Quarenta e cinco diabéticos (45 olhos) e 43 (43 olhos) controlos com catarata relacionada à idade foram incluídos neste estudo observacional prospectivo. Os parâmetros da córnea (espessura e volume) e do segmento anterior foram medidos pela tomografia Scheimpflug; a densidade e morfologia celular endotelial (coeficiente de variação do tamanho das células, células hexagonais) foram registrados usando microscopia especular não contato. Os pacientes foram avaliados no pré-operatório, 1 e 6 meses após a cirurgia. Foi realizada uma análise de regressão linear uni e multivariada para avaliar a relação entre os parâmetros demográficos, clínicos, oculares e intra-operatórios com a redução da densidade celular endotelial aos 6 meses. Resultados: Nos dois grupos houve uma perda significativa de células endoteliais ao 1º mês pós-ope­ratório (p<0,001), que permaneceu estável até ao 6º mês; sem diferenças estatisticas entre os grupos diabetes mellitus e não diabetes mellitus em qualquer avaliação. A espessura média da córnea no pós-operatório central aos 1 e 6 meses não mudou significativamente em relação ao valor médio pré-operatório nos dois grupos (p>0.05). A análise de regressão multivariada linear mostrou que a idade avançada (p=0.042) e os graus mais elevados de catarata (p=0.001) foram significativamente associados à maior redução densidade celular endotelial aos 6 meses de seguimento. Conclusão: Este estudo mostrou que a idade avançada e as cataratas mais densas podem predispor a uma maior redução densidade celular endotelial após a cirurgia de catarata. Outros fatores, como diabetes mellitus e parâmetros pré-operatórios do segmento anterior, não influenciaram significativamente as alterações pós-operatórias da densidade celular endotelial.

Effect of the vault on corneal endothelial cells after microincision ICL V4c implantation without viscoelastic / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the effect of the vault on corneal endothelial cells after implantation of central hole implantable lens(ICL)V4c without viscoelastic microincision.<p>METHODS: Prospective non-randomized controlled study. A total of 70 patients(137 eyes)with myopia who underwent ICL V4c implantation in our hospital from November 2017 to February 2018 were divided into low vault group(100μm<vault≤250μm, 37 eyes), medium vault group(250μm<vault≤750μm, 69 eyes)and high vault group(750μm<vault≤900μm, 31 eyes)according to the size of postoperative vault. After 1a of follow-up, the changes of corneal endothelial cell count and anterior chamber parameters were observed.<p>RESULTS:At 1wk after operation, the anterior chamber depth, anterior chamber volume and anterior chamber angle of the three groups were all decreased compared with those before operation(<i>P</i><0.05). There was no significant difference in corneal endothelial cell count among the three groups at different time points before and after surgery. The loss rate of corneal endothelial cells in the low vault group at 1wk, 3mo and 1a after surgery were about 1.2%, 1.5% and 1.7%, respectively. The loss rate of corneal endothelial cells in the middle vault group were about 0.5%, 0.7% and 1.0%, respectively. The loss rate of corneal endothelial cells in the high vault group were about 1.1%, 1.3% and 1.4%, respectively.<p>CONCLUSION:The vault in early period after ICL V4c implantation without viscoelastic microincision had no significant effect on corneal endothelial cells.

Clinical outcomes of micro incision prechop phacoemulsification in patients with nuclear cataract / 中国医师进修杂志

Objective:To study the therapeutic effect of 1.8 mm micro incision prechop phacoemulsification (PE) in patients with nuclear cataract.Methods:The clinical data of 120 patients with nuclear cataract from June to December 2018 in Ningbo Medical Center Lihuili Hospital were retrospectively analyzed. Among them, 60 patients were treated with 1.8 mm micro incision prechop PE (prechop group), and 60 patients were treated with 1.8 mm micro incision PE (non-prechop group). The effective ultrasonic time and ultrasonic energy were recorded. The changes of optimum corrected vision, astigmatism degree and related indexes of corneal endothelial cells 1 d before operation and 1 d, 1 week, 1 month, 3 months, 6 months, 12 months after operation were compared between 2 groups.Results:The effective ultrasonic time and ultrasonic energy in prechop group were significantly lower than those in non-prechop group: (44.04 ± 8.93) s vs. (59.03 ± 9.98) s and (11.29 ± 1.08)% vs. (14.15 ± 1.16)%, and there were statistical differences ( t = 4.139 and 5.289, <0.05). No serious complications occurred in both groups. There was no statistical difference in optimum corrected vision 1d before operation and 1 d after operation between 2 groups ( P>0.05); the optimum corrected vision 1 week, 1 month, 3 months, 6 months, and 12 months after operation in prechop group was significantly better than that in non-prechop group, and there was statistical difference ( P<0.05). There was no statistical difference in astigmatism degree before and after operation ( P>0.05). The density of corneal endothelial cells and the proportion of hexagonal cells after operation in prechop group were significantly higher than those in non-prechop group, the area of corneal endothelial cells and variation coefficient were significantly lower than those in non-prechop group, and there were statistical differences ( P<0.05). Conclusions:The 1.8 mm micro incision prechop PE to treat nuclear cataract can effectively reduce astigmatism degree after operation and damage corneal endothelial cells in lower degree. And it is better to patients′ postoperative visual recovery.

Corneal endothelial cell changes in diabetics versus age group matched nondiabetics after manual small incision cataract surgery

Purpose: To assess and compare the endothelial cell changes after manual small incision cataract surgery (SICS) in diabetic patients versus age group matched non-diabetic patients. Methods: This comparative prospective observational follow-up study included 54 diabetic patients and 52 control patients without diabetes who underwent manual SICS. Preoperative, one day, one week, one month and three months post-surgery assessments of corneal endothelial cell changes were done using specular microscopy. Data analysis was performed using SPSS software (version 20.0, SPSS, Inc.). Mann朩hitney U test was used to compare the data between the test group and control group. Results: There was drop in the endothelial density in both the groups postoperatively, with the mean percentage of endothelial loss at three months post- surgery being 27.5% in diabetics and 18.3% in controls. There was also a significant increase in central corneal thickness and coefficient of variance in diabetics as compared to controls at every follow up one day, one week, one month and three months. The percentage of hexagonality was statistically significant at post-operative three months. Conclusion: The diabetic endothelium was found to be under greater metabolic stress and had less functional reserve after manual SICS than the normal corneal endothelium.

Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study

Purpose: To compare the outcomes of active-fluidics based torsional phacoemulsification in diabetics and nondiabetics using a balanced tip. Methods: Two hundred and forty-eight patients undergoing senile cataract surgery using torsional phacoemulsification on an active-fluidics-based platform from December 2016 to August 2017 were included in this prospective, nonrandomized, interventional cohort study; of the 248 patients, 54 were controlled diabetics and 194 were nondiabetics. Intraoperative parameters such as cumulative dissipated energy (CDE), total ultrasound time, torsion usage time, torsion amplitude, aspiration time, and fluid usage were documented and compared. Endothelial cell loss (ECL) and central corneal thickness (CCT) were evaluated at 1 month postoperatively. Results: Diabetics and nondiabetics did not differ in CDE, total ultrasound time, torsion amplitude, aspiration time, fluid usage, endothelial cell count, and CCT. ECL on Day 1 (10.2 ± 8.0%) and Day 30 (11.05 ± 8.3%) were significantly higher in diabetics (P = 0.025 and P = 0.045, respectively). There was an increase in CCT on Day 1 (P = 0.018), which settled by Day 30. Grade 4 cataracts in diabetics had significantly higher CCT at Day 1 (P = 0.032) and Day 30 (P = 0.007). In the diabetic subgroup, Grades 3 and 4 cataracts required lower CDE (P < 0.001) and Grade 4 cataracts showed higher ECL than others till 1 month of follow-up (P < 0.05). Conclusion: Intraoperative and postoperative parameters after torsional phacoemulsification are comparable in diabetics and nondiabetics. Endothelial changes and pachymetry may be related to the grade of cataract in diabetics.

A Case of Corneal Chemical Injury by High-dose Ethanol during Orbital Wall Fracture Repair

PURPOSE: To report a case of chemical injury of the cornea caused by high-dose ethanol during orbital wall fracture repair. CASE SUMMARY: A 56-year-old male presented with pain after blowout fracture repair surgery. During the surgery, 2% hexethanol solution (2% chlorhexidine and 72% ethanol mixture), which was used for disinfection of the face, flowed into the left eye. Conjunctival injection in the left limbus, a large corneal epithelial defect, and severe stromal edema were subsequently observed. The patient was treated with topical antibiotics, steroids, and autologous serum eye drops. After 1 week, the corneal epithelial defect was improved, but at the second month of therapy, recurrent corneal erosion with deterioration of the endothelial cell function occurred. Anterior stromal puncture and laser keratectomy were performed. The corneal epithelial defect and erosion improved, but the endothelial cell density was severely decreased. CONCLUSIONS: The 2% hexethanol solution is usually used for preoperative skin disinfection, but it contains a high concentration of ethanol. The surgeon should be aware that high concentrations of ethanol may result in severe corneal damage, including corneal endothelial dysfunction and limbal cell deficiency.

Corneoscleral contact lenses fitting on irregular corneas after laser-assisted in situ keratomileusis / Lentes de contato corneoesclerais adaptadas em córneas irregulares após cirurgia LASIK

ABSTRACT Purpose: We aimed to describe the outcomes of corneoscleral contact lens fitting with multi-aspherical geometry designs in patients with irregular corneas after laser-assisted in situ keratomileusis (LASIK). Methods: This was a retrospective series of 18 patients (age, 26-38 years) selected from an eye clinic database. Participants were required to have unsatisfactory visual acuity with their current contact lenses or spectacles after LASIK for myopia correction. All patients were fitted with corneoscleral contact lenses designed to correct corneal surface irregularities. A diagnostic trial set was used for fitting, and assessments were performed according to a standardized methodology. Subjective comfort, visual acuity, central corneal thickness, endothelial cell count, and corneal-compensated intraocular pressure were evaluated. The follow-up period was one year. Results: Contact lens use was discontinued in 3 patients, thus leaving 24 eyes from 8 females and 7 males for analysis. The fitting characteristics were optimal in terms of lens position and movement. Statistically significant improvements were found in the best spectacle-corrected vision from before fitting to the visual acuity after fitting (p<0.001). Moreover, the patients reported high subjective comfort ratings and usage times (12.98 ± 2.3 hours/day). After one year of wear, visual acuity, subjective comfort, and usage time were maintained. No statistically significant adverse changes developed in the corneas over this period. Conclusion: Corneoscleral contact lenses with a multi-aspherical geometry design provide optimal visual acuity, improved comfort, and prolonged usage times in patients with irregular corneas after LASIK.

RESUMO Objetivo: Descrever os resultados do ajuste de lentes de contato corneoesclerais com geometria multiasférica em pacientes com córneas irregulares após cirurgia de ceratomileuse in situ assistida por laser (LASIK). Métodos: Esta foi uma série retrospectiva de 18 pacientes (idade, 26-38 anos) selecionados a partir de um banco de dados de uma clínica oftalmológica. Os participantes foram escolhidos ao manifestaram acuidade visual insatisfatória com suas lentes de contato ou óculos atuais depois de terem sido submetidos à LASIK para correção de miopia. Todos os pacientes receberam lentes de contato corneoesclerais projetadas para corrigir irregularidades na superficie da córnea. Um conjunto diagnóstico de prova foi usado para a adaptação e as avaliações foram feitas de acordo com uma metodologia padronizada. O conforto subjetivo, a acuidade visual, a espessura central da córnea, a contagem de células endoteliais e a pressão intraocular compensada da córnea foram avaliados. O período de acompanhamento foi de um ano. Resultados: O uso de lentes de contato foi descontinuado em 3 pacientes, deixando 24 olhos de 8 mulheres e 7 homens para análise. As características de adaptação foram ótimas em termos de posição e movimento da lente. Melhorias estatisticamente significativas foram encontradas na melhoria da visão corrigida por óculos antes de se ajustar a acuidade visual após a adaptação (p<0,001). Além disso, os pacientes relataram altos índices subjetivos de conforto e tempo de uso (12,98 ± 2,3 horas/dia). Após um ano de uso, a acuidade visual, o conforto subjetivo e o tempo de uso foram mantidos. Não houve alterações adversas estatisti­camente significativas nas córneas ao longo deste período. Conclusão: As lentes de contato corneoesclerais com projeto geométrico multiasférico proporcionam acuidade visual ideal, maior conforto e tempo de uso prolongado em pacientes com córneas irregulares após o LASIK.

Influence of Preoperative Corneal Endothelial Status on Postoperative Corneal Endothelium Density after Cataract Surgery

PURPOSE: To analyze the influence of preoperative corneal endothelial status on postoperative corneal endothelium density after cataract surgery. METHODS: We evaluated 228 eyes of 158 patients who underwent cataract surgery. Corneal endothelial status and central corneal thickness were measured before surgery and 1 day, 1 month, 3 months and 6 months after surgery. Patients were classified by preoperative endothelial cell density (three groups) and their coefficients of variation and hexagonality (two groups). Clinical parameters, including corneal endothelial cell losses, visual acuity, intraocular pressure, spherical equivalent refraction and central corneal thickness were measured to compare the intergroup indices. RESULTS: There were no significant differences in corneal endothelial cell losses at 1 day, 1 month, 3 months and 6 months after surgery in any of the groups based on corneal endothelial cell density. There were increases in corneal thickness at 1 day and 1 month after surgery that were significantly higher in the low-endothelial cell density group than the 2,000-2,500 cells/mm² cell density group (p < 0.05), but there were no differences after the 3-month time point. There were no significant differences in clinical parameters for the coefficient of variation and hexagonality groups until 6 months after surgery. CONCLUSIONS: We observed reversible corneal edema in the low endothelial group; however, there were no significant intergroup differences in corneal endothelial cell loss due to preoperative corneal endothelial status. Our results suggest that cataract surgery is relatively safe for patients with morphologically abnormal corneal endothelium and/or low endothelial density; the safety is primarily due to improved equipment and surgery techniques.

Quantitative & qualitative analysis of endothelial cells of donor cornea before & after penetrating keratoplasty in different pathological conditions.

Background & objectives: Endothelial cells of the donor cornea are known to be affected quantitatively and qualitatively in different pathological conditions after penetrating keratoplasty (PK) and this has direct effect on the clarity of vision obtained after PK. This study was undertaken to analyze the qualitative and quantitative changes in donor endothelial cells before and after PK in different pathological conditions. Methods: A prospective investigational analysis of 100 consecutive donor corneas used for penetrating keratoplasty between June 2006 and June 2008, was conducted. The patients were evaluated on the first day, at the end of first week, first month, third and six months and one year. Results: A decrease was observed in endothelial cell count in all pathological conditions. After one year of follow up the loss was 33.1 per cent in corneal opacity, 45.9 per cent in acute infective keratitis (AIK), 58.5 per cent in regrafts, 28.5 per cent in pseudophakic bullous keratopathy (PBK), 37 per cent in descemetocele, 27 per cent in keratoconus and 35.5 per cent in aphakic bullous keratopathy (ABK) cases. Interpretation & conclusions: The endothelial cell loss was highest in regraft cases which was significant (P<0.05), while the least endothelial cell loss was seen in keratoconus cases. The cell loss was associated with increase in coefficient of variation (CV), i.e. polymegathism and pleomorphism. Inspite of this polymegathism and pleomorphism, the clarity of the graft was maintained.

Changes in Corneal Endothelial Cell after Ahmed Glaucoma Valve Implantation and Trabeculectomy: 1-Year Follow-up

PURPOSE: To compare changes in corneal endothelial cell density (CECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy. METHODS: Changes in corneal endothelium in patients that underwent AGV implantation or trabeculectomy were prospectively evaluated. Corneal specular microscopy was performed at the central cornea using a non-contact specular microscope before surgery and 6 months and 12 months after surgery. The CECD, hexagonality of the endothelial cells, and the coefficient of variation of the cell areas were compared between the two groups. RESULTS: Forty eyes of 40 patients with AGV implantation and 28 eyes of 28 patients with trabeculectomy were studied. Intraocular pressure in the AGV implantation group was significantly higher than that in the trabeculectomy group (p < 0.001), but there was no significant difference in other clinical variables between the two groups. In the AGV implantation group, the mean CECD significantly decreased by 9.4% at 6 months and 12.3% at 12 months compared with baseline values (both, p < 0.001), while it decreased by 1.9% at 6 months and 3.2% at 12 months in the trabeculectomy group (p = 0.027 and p = 0.015, respectively). The changes at 6 months and 12 months in the AGV implantation group were significantly higher than those in the trabeculectomy group (p = 0.030 and p = 0.027, respectively). In the AGV implantation group, there was a significant decrease in the CECD between baseline and 6 months and between 6 months and 12 months (p < 0.001 and p = 0.005, respectively). However, in the trabeculectomy group, a significant decrease was observed only between baseline and 6 months (p = 0.027). CONCLUSIONS: Both the AGV implantation group and the trabeculectomy group showed statistically significant decreases in the CECD 1 year after surgery. The decrease in CECD in the AVG implantation group was greater and persisted longer than that in the trabeculectomy group.

Clinical effects of coaxial 1 . 8 mm microincision phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe and compare clinical effects of coaxial 1. 8mm microincision phacoemulsification and 3. 2mm small incision phacoemulsification. ●METHODS:A total of 117 eyes of 85 patients with age-related cataract in our hospital were divided randomly into two groups:43 patients (59 eyes) in the coaxial 1. 8 mm microincision cataract surgery group ( C - MlCS ) , 42 patients (58 eyes) in the coaxial 3. 2 mm traditional small incision cataract surgery group (C-SlCS). A total of 117 eyes were received phacoemulsification with intraocular lens implantation. Uncorrected visual acuity was recorded preoperatively and postoperatively at 1, 7, 30 and 90d. The effective phacoemulsification time and average ultrasound energy were recorded in surgery. Corneal endothelial cell and corneal topography were recorded preoperatively and postoperatively at 90 d. ●RESULTS:Uncorrected visual acuity ( logMAR) was no overall statistical significance difference between C-MlCS group and C-SlCS group (P>0. 05), but was significant statistical difference in different time-point within both groups(P0. 05). On the 1 day after surgery, uncorrected visual acuity was 0. 16±0. 11 in C-MlCS group and 0. 22±0. 18 in C-SlCS group(P0. 05). EPT was (3. 09±1. 61)s in C-MlCS group and (3. 20±1. 92)s in C-SlCS group (P>0. 05). At 90 d after surgery, corneal endothelial cell loss percentage was (5. 81±2. 28)% in C-MlCS group and (5. 69±2. 38)% in C-SlCS group (P>0.05), SlA was (0.35±0.11) Din C-MlCS group and (0. 61±0. 13) D in C-SlCS group (P ● CONCLUSION: Compared with coaxial 3. 2mm traditional small incision cataract surgery, 1. 8mm coaxial microincision cataract surgery can get earlier visual rehabilitation and significantly reduce SlA. The coaxial 1. 8mm microincision cataract surgery is safe, effective and deserves further clinical applications.

Sudden Loss of Endothelial Cell Density 7 Years after Receiving an Implantable Contact Lens: A Case Report

PURPOSE: To report a case of decreased endothelial cell density 7 years after posterior chamber phakic intraocular lens implantation. CASE SUMMARY: A 45-year-old man with high myopia combined with astigmatism was treated with Toric implantable Collamer Lens (ICL) implantation. The patient's best corrected visual acuity was 0.7 in both eyes before the operation. After the treatment, his uncorrected visual acuity was 0.9 and corrected visual acuity was 1.0 in both eyes, indicating an improvement in visual function. Preoperative endothelial cell density measured 3,063 cells/mm2 in the right eye and 3,126 cells/mm2 in the left eye. At 5 years postoperatively, measurements were 2,897 cells/mm2 in the right eye and 2,974 cells/mm2 in the left, showing little change. However, a 6-year postoperative measurement of 2,198 cells/mm2 in the right eye and 2,803 cells/mm2 in the left showed a slight decrease in endothelial cell density in the right eye, and a follow-up measurement one year later displayed a rapid decline to 1,272 cells/mm2 in the right eye and 2,852 cells/mm2 in the left eye. The Toric ICL lens was removed from the right eye and phacoemulsification and posterior chamber intraocular lens implantation was performed. Two-month postoperative endothelial cell density was 1,257 cells/mm2 and endothelial cell damage from the operation itself was minimal. CONCLUSIONS: ICL implantation may cause complications related to corneal endothelial cells as well as glaucoma. Patients should receive regular follow-up examinations for endothelial cell density.

Ultrasound biomicroscopy after palliative surgical procedures for bullous keratopathy: a descriptive comparative study / Biomicroscopia ultrassônica após procedimentos cirúrgicos paliativos na ceratopatia bolhosa: estudo comparativo descritivo

Purpose: To describe quantitative and qualitative features of eyes with advanced bullous keratopathy assessed using ultrasound biomicroscopy, before and after anterior stromal puncture (ASP) or amniotic membrane transplantation (AMT) procedures to relieve chronic pain. Methods: The present descriptive comparative study included 40 eyes of 40 patients with chronic intermittent pain due to bullous keratopathy who were randomly assigned to one of the two treatments (AMT or ASP). Ultrasound biomicroscopy (Humphrey, UBM 840, 50 MHz transducer, immersion technique) was used, and a questionnaire about pain intensity was completed preoperatively and postoperatively at days 90 and 180, respectively. Exclusion criteria were age<18 years, presence of concurrent infection, ocular hypertension, and absence of pain. Results: In a 180-day follow-up, the AMT group exhibited mean central corneal thickness (CCT), 899.4 µm preoperatively and 1122.5 µm postoperatively (p<0.001); mean epithelial thickness (ET), 156.4 µm preoperatively and 247.8 µm postoperatively (p<0.001); and mean stromal thickness (ST), 742.9 µm preoperatively and 826.3 µm postoperatively (p=0.005). The ASP group exhibited mean CCT, 756.7 µm preoperatively and 914.8 µm postoperatively (p<0.001); mean ET, 102.1 µm preoperatively and 245.2 µm postoperatively (p<0.001); and mean ST, 654.6 µm preoperatively and 681.5 µm postoperatively (p<0.999). Correlations between CCT and pain intensity in the AMT group (p=0.209 pre- and postoperatively) and the ASP group (p=0.157 preoperatively and p=0.426 at the 180-day follow-up) were not statistically significant. Epithelial and stromal edema, Descemet’s membrane folds, epithelial bullae, and the presence of interface fluid were frequently observed qualitative features. Conclusion: CCT increased over time in both groups. The magnitude of CCT did not correlate with pain intensity in the sample studied. The presence of interface ...

Objetivo: Descrever as características quantitativas e qualitativas da biomicroscopia ultrassônica (UBM) em olhos com ceratopatia bolhosa avançada, antes e após os procedimentos de punção estromal anterior (ASP) ou transplante de membrana amniótica (AMT) para alívio de dor crônica. Métodos: Estudo comparativo descritivo incluindo 40 olhos de 40 pacientes com dor crônica intermitente devido a ceratopatia bolhosa, randomizados em duas modalidades de tratamento (AMT e ASP). Biomicroscopia ultrassônica (Humphrey, UBM 840, transdutor de 50 MHz, técnica de imersão) foi utilizada, e um questionário de avaliação da intensidade da dor foi aplicado no pré-operatório, e após 90 e 180 dias de pós-operatório. Critérios de exclusão foram: idade abaixo de 18 anos, presença de infecção, hipertensão ocular, e ausência de dor. Resultados: No seguimento de 180 dias, o grupo Transplante de membrana amniótica apresentou: média da espessura corneana central (CCT): 899,4 µm (pré), 1.122,5 µm (pós-operatório) (p<0,001); média da espessura epitelial (ET): 156,4 µm (pré), 247,8 µm (pós-operatório) (p<0,001); média da espessura estromal (ST): 742,9 µm (pré), 826,3 µm (pós-operatório) (p=0,005), e, grupo ASP apresentou: CCT média: 756.7 µm (pré), 914,8µm (pós-operatório) (p<0,001); ET média: 102,1 µm (pré), 245,2 µm (pós-operatório) (p<0,001); ST média: 654,6 µm (pré), 681.5 µm (pós-operatório) (p<0,999). A correlação entre intensidade da dor e espessura corneana central no grupo AMT (p=0,209 pré e pós-operatórios) e no grupo ASP (p=0,157 pré-operatório e p=0,426 aos 180 dias de seguimento) não foi significativa. Edema epitelial e estromal, dobras na membrana de Descemet, bolhas epiteliais, e presença de fluido na interface foram características qualitativas frequentemente observadas. Conclusão: A espessura corneana central aumentou ao longo do tempo em ambos os grupos. A magnitude da espessura corneana central não interfere na intensidade da dor ...

Complications and management in Descemet's stripping endothelial keratoplasty: Analysis of consecutive 430 cases.

Purpose: To analyze the complications and their managements in Descemet’s stripping endothelial keratoplasty (DSEK) in consecutive 430 cases by single surgeon in a tertiary eye hospital. Materials and Methods: 430 eyes of 366 patients with endothelial dysfunctions scheduled for DSEK, were analyzed retrospectively. In all cases donor dissection was performed manually, and ‘Taco’ insertion and unfolding technique was used. Intra-operative and postoperative complications with their managements and outcomes were reviewed retrospectively. Periodic endothelial cell density was analyzed for each patient till the last visit. Follow-up period was between 3 to 60 months (mean 18.7 months). Results: 13 (3.0%) eyes had operative complications during donor dissection and 16 (3.7%) had during recipient procedure. In 7 (1.6%) eyes, donor lenticule was replaced with a new one during the surgery. In early postoperative period, 21 (4.9%) eyes had donor dislocation and 12 (2.8%) eyes had air-induced pupillary block; and they were managed immediately. 2 cases had primary graft failure and in 1 case had postoperative bacterial endophthalmitis requiring evisceration. In late postoperative period, 48 (11.3%) eyes had secondary glaucoma and 14 (3.3%) eyes had late secondary graft failure. Endothelial rejection occurred in 5 (1.2%) cases. Mean endothelial cell loss was 19.7% after 3 months and 54.2% after 5 years. Total graft failure in this series was 31 (7.2%) and in 17 cases re-DSEK was performed successfully. Conclusions: Both operative and postoperative complications do occur in DSEK. Most of these complications can be managed by medical or appropriate surgical means. Some of the complications can be avoided and reduced with experience.