Glaucoma neovascular. A propósito de un caso / Neovascular glaucoma. A case report

Se presenta un paciente masculino de 60 años de edad, con antecedentes de padecer diabetes mellitus tipo II complicada con retinopatía diabética, así como glaucoma neovascular de tórpida evolución en el ojo izquierdo. Acude a consulta de glaucoma en el Centro Oftalmológico del Hospital Universitario Clínico- Quirúrgico «Arnaldo Milián Castro» de Villa Clara por presentar visión borrosa y molestias oculares en su ojo derecho. Al examen oftalmológico de dicho ojo se observa: disminución de la visión, sangramiento activo proveniente de vaso iridiano, edema corneal, rubeosis iridiana, hipertensión ocular y al fondo de ojo retinopatía diabética; se realizan complementarios hemáticos que muestran cifras de glicemia elevada (20 mmol/l). Se plantea el diagnóstico de glaucoma neovascular del ojo derecho en el curso de una diabetes mellitus tipo II descompensada. Se le indica tratamiento médico - quirúrgico y se logra una evolución favorable.

We present a 60-year-old male patient with a history of type II diabetes mellitus complicated by diabetic retinopathy, as well as neovascular glaucoma of torpid evolution in his left eye. He came to the glaucoma consultation in the Ophthalmological Center at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara due to blurred vision and ocular discomfort in his right eye. Decreased vision, active bleeding from the iris vessel, corneal edema, iris rubeosis, ocular hypertension was observed in such eye at ophthalmological examination and diabetic retinopathy at eye fundus; blood tests were performed showing elevated glycemia figures (20 mmol /l). The diagnosis of neovascular glaucoma of the right eye is stated in the course of a decompensated type II diabetes mellitus. Medical and surgical treatment is indicated and a favourable evolution is achieved.

The effect of different thickness scleral lens on corneal parameters in eyes with keratoconus

Purpose: To investigate the impact of different?thickness scleral lenses (SLs) on corneal thickness, curvature, and fluid reservoir thickness in keratoconic eyes. Methods: Schiempflug imaging and AS?OCT was captured before and immediately following 6 h of SL wear. Different?thickness lenses were used while keeping the other parameters the same. The timing of the measurement for day 1 and day 2 was matched to allow for the control of the confounding influence of diurnal variation. Results: Immediately after 6 h of lens wear, no statistically significant difference (P > 0.05) was noted in corneal edema in any region and quadrants between thin? and thick?lens wearers. The calculated percentage of corneal edema was also within the range of overnight closed eye physiological swelling. Pentacam measured higher central corneal thickness compared to AS?OCT in both baselines and after 6 h of lens wear. The current investigation reported minimal but not statistically significant (P > 0.05) flattening in anterior and steepening in posterior curvature parameters in both thin and thick SLs. The mean reduction in the fluid reservoir thickness was 80.00 ± 3.99 and 79.36 ± 3.84 microns after 6 h of thin? and thick?lens wear, respectively, which was not statistically significant (P > 0.05). A statistically significant positive correlation (r = 0.67, P = 0.02) was found between lens thickness and change in anterior steep k with thick?lens wear. Conclusion: Central lens thickness of 200–400 ?m did not cause any significant change in corneal curvature and fluid reservoir thickness and did not induce clinically significant corneal edema after short?term SL wear.

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

Reticular epithelial corneal edema as a novel side-effect of Rho Kinase Inhibitors: An Indian scenario

Purpose: To describe clinical course, characteristics, and outcome of reticular epithelial corneal edema (RECE) occurring as a not?so?infrequent adverse effect of a novel drug, Rho?kinase inhibitors (ROCK?I)? netarsudil (0.02%) and ripasudil (0.4%). Methods: This was a retrospective observational non?randomized study. In this study, 12 eyes of 11 patients presenting at a tertiary eye care center between April 2021 and September 2021 were included. All 12 eyes developed a distinctive honeycomb pattern of RECE after starting topical ROCK?I. All patients were subjected to detailed ophthalmic examinations. Results: Eight patients were started on netarsudil (0.02%) and three on ripasudil (0.4%). Five eyes had a prior history of corneal edema. The remaining seven had the presence of ocular comorbidities predisposing to corneal edema. The average time for RECE occurrence was 25 days for netarsudil and 82 days for ripasudil. Visual acuity decreased in two eyes, remained unaffected in four eyes, and could not be quantified in four eyes due to preexisting profound visual impairment. Five eyes had symptoms of ocular surface discomfort associated with bullae. Symptoms and bullae resolved in all eyes in whom ROCK?I was stopped. The average time to resolution of RECE was 10 days for netarsudil and 25 days for ripasudil. Conclusion: RECE after ROCK?I occurs with the use of both netarsudil and ripasudil, although the characteristics differ. The presence of corneal edema and endothelial decompensation seem to be a risk factor, and cautious use is warranted in these patients. Four clinical stages of RECE are described. ROCK?I act as a double?edged sword in patients with endothelial decompensation. Large?scale studies are required to know the exact incidence, pathophysiology, and long?term consequences of the aforementioned side?effect.

Unnoticed metallic foreign body in the camerular angle inducing chronic uveitis / Corpo estranho metálico não notado em ângulo camerular induzindo uveíte crônica

ABSTRACT We report the case of an eight-year-old male patient with a four-month history of unilateral anterior chronic uveitis, associated with a pigmented lesion surrounded by fibrinoid material in the inferior camerular angle and with a fibrotic lesion in the extreme periphery of the inferior retina. The patient had no history of trauma or any other clinical symptoms. Although the patient was suspected of having toxocariasis, serological tests were negative. Partial symptomatic improvement was achieved using both orally and topically administered corticosteroids. In addition, a decrease in fibrinoid material around the pigmented camerular lesion revealed it to be regular and cylindric. Computed tomography of the orbits revealed a metallic foreign body in the topography of the inferior camerular angle. The patient underwent removal of the foreign body through a corneal incision and photocoagulation around the inferior retinal traction. Excellent visual and anatomical results were obtained.(AU)

RESUMO Os autores relatam o caso de paciente do sexo masculino, 8 anos de idade, com história de uveíte crônica anterior unilateral há quatro meses, associada a lesão pigmentada envolvida por material fibrinóide em ângulo camerular inferior e a lesão fibrótica em extrema periferia de retina inferior. Não havia histórico de trauma ou outros sintomas clínicos. A hipótese de toxocaríase foi afastada diante de testes sorológicos negativos. Melhoria sintomática parcial foi alcançada com administração de corticosteróide vias oral e tópica. Ademais, redução na quantidade de material fibrinóide ao redor da lesão camerular a revelou regular e cilíndrica. Foi realizada tomografia computadorizada de órbitas, permitindo a detecção de corpo estranho metálico na topografia de ângulo camerular inferior. O paciente foi submetido a remoção do corpo estranho através de incisão corneana e a fotocoagulação ao redor da tração retiniana inferior. Excelentes resultados visual e anatômico foram obtidos.(AU)

Analysis on influencing factors of corneal edema after phacoemulsification and intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the risk factors of corneal edema after phacoemulsification and intraocular lens implantation in patients with cataract. <p>METHODS: The clinical data of 623 patients with cataract(957 eyes)who underwent phacoemulsification and intraocular lens implantation in our hospital between March 2018 and September 2020 were retrospectively analyzed. Patients with corneal edema observed at any time within the first three days after surgery were included in corneal edema group(82 cases, 82 eyes), and patients without corneal edema were enrolled as non-corneal edema group(541 cases, 875 eyes). The preoperative, intraoperative and postoperative related indexes of the two groups were collected and included in Logistic regression model to screen the high-risk factors. <p>RESULTS: Logistics regression analysis showed that age(<i>OR</i>=1.162), Emery lens nuclear hardness grading(<i>OR</i>=1.301)and perfusion time(<i>OR</i>=1.172)were independent risk factors for corneal edema after phacoemulsification and intraocular lens implantation, and the anterior chamber depth(<i>OR</i>=0.651)were independent protective factors avoiding occurrence(<i>P</i><0.05).<p>CONCLUSION:The factors involved in corneal edema after phacoemulsification and intraocular lens implantation are complicated in patients with cataract. It is necessary to be vigilant for high-risk patients in clinical practice and take preventive measures during perioperative period so as to promote rapid recovery of prognosis and visual function.

Comparison of press-and-chop and Nagahara phaco-chop phacoemulsification nucleotomy techniques / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the advantages of press-and-chop technique compared with Nagahara phaco-chop technique.<p>METHORDS: Totally 70 patients(70 eyes)with age-related cataract were randomly divided into 2 groups, press-and-chop technique group(35 patients 35 eyes), phaco-chop technique group(35 patients 35 eyes). In all cases, surgery began with a clear corneal incision, capsulorhexis and hydrodissection. In the press-and-chop technique group, the superficial cortex and epinucleus were aspirated by the phaco tip, then press the center of the lens front surface with the phaco tip. The Nagahara chopper was set around the lens equator, then the phaco tip was driven into the nucleus from the main incision, pull the Nagahara chopper toward the phaco tip. The two instruments were then separated laterally to produce a complete fracture of the nucleus. In phaco-chop technique group, the phaco tip was buried in the center of the endonucleus. The Nagahara chopper was brought through the side-port incision and the equator of endonucleus was engaged by the chopper under the lower edge of the capsulorhexis and pulled toward the phaco tip. The 2 instruments were then separated laterally to produce a complete fracture of the nucleus. The U/S time, preoperative and postoperative corneal endothelial cell density, corneal endothelium loss rate, corneal edema at 1d, 7d, best corrected visual acuity before and after surgery were recorded.<p>RESULTS: The U/S time of press-and-chop technique group was lower than phaco-chop technique group [12.76(8.76,16.76)s <i>vs</i> 22.87(18.36, 27.38)s, <i>P</i><0.01]. The corneal endothelial cells density in press and chop technique group was higher than that in phaco-chop technique group 1mo after operation(2133.44±348.58/mm² <i>vs</i> 1957.94±280.54/mm², <i>P</i><0.05), and the variation rate of corneal endothelial cells in press-and-chop technique group was lower than that in phaco-chop technique group 1mo after surgery [0.15(0.08,0.22)<i>vs</i> 0.22(0.16, 0.28), <i>P</i><0.01]. The corneal edema in press-and-chop technique group was lighter than that in phaco-chop technique group on the first day after surgery(<i>Z</i>=13.195, <i>P</i>=0.004), and corneal edema in both groups subsided on the 7d after surgery. There was no significant difference between two groups in BCVA on the first day after surgery(<i>Z</i>=-0.48, <i>P</i>=0.63).<p>CONCLUSION: Compared with Nagahara phaco-chop technique, press-and-chop technique is simple and safe with less complications.

Facoemulsificación y edema corneal en pacientes con córnea guttata / Phacoemulsification and corneal edema in cornea guttata patients

RESUMEN Objetivo: Relacionar la severidad del edema corneal posfacoemulsificación en pacientes con córnea guttata, sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, con la dureza del cristalino y los parámetros facodinámicos. Métodos: Se realizó un estudio descriptivo, prospectivo, de 42 pacientes con córnea guttata, sin riesgo o bajo riesgo de edema posquirúrgico según densidad celular, sometidos a facoemulsificación por el mismo cirujano en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", desde abril del año 2016 a abril de 2017. Se relacionó la severidad del edema corneal con la dureza del cristalino y los parámetros facodinámicos. Resultados: Predominaron los pacientes con 70 años o más (52,4 por ciento) y el sexo femenino (64,3 por ciento). A las 24 horas de operados, el edema corneal estuvo ausente en el 54,8 por ciento y se presentó leve (26,2 por ciento) o mínimo (19,0 por ciento). A los 7 días, el 71,4 por ciento tenía la córnea transparente. Fue más frecuente en la periferia y en la zona paracentral temporal (36,8 por ciento). Aquellos con dureza de cristalino NO2 NC2 no presentaron edema corneal. A los 7 días solo el 11,9 por ciento mantenía edema leve, asociado a cristalinos NO4 NC4 o superior. El edema corneal se presentó asociado al grupo en el que se usó un poder de ultrasonido entre 10 y 20 (36,0 por ciento). Conclusiones: La mayoría de los pacientes con córnea guttata, considerados sin riesgo o bajo riesgo de edema posquirúrgico según la densidad celular, no presentan edema posfacoemulsificación(AU)

ABSTRACT Objective: Determine the relationship between the severity of corneal edema in cornea guttata patients undergoing phacoemulsification considered to be at no risk or low risk for postsurgical edema in terms of cell density, and crystalline lens hardness and phacodynamic 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 phacoemulsification performed by the same surgeon at Ramón Pando Ferrer Cuban Institute of Ophthalmology from April 2016 to April 2017. Corneal edema severity was related to crystalline lens hardness and phacodynamic parameters. Results: A predominance was found of patients aged 70 years and over (52.4 percent) and the female sex (64.3 percent). Twenty-four hours after surgery corneal edema was not observed in 54.8 percent and where it was present it was either mild (26.2 percent) or minimum (19.0 percent). At 7 days 71.4 percent of the patients had a transparent cornea. It was more common on the periphery and in the temporal paracentral area (36.8 percent). Patients with NO2 NC2 crystalline lens hardness did not have corneal edema. At 7 days only 11.9 percent had mild edema associated to NO4 NC4 or higher crystalline lenses. Corneal edema was associated to the group in which an ultrasound power level between 10 and 20 (36.0 percent) was used. Conclusions: Most cornea guttata patients considered to be at no risk or low risk for postsurgical edema in terms of cell density do not develop postphacoemulsification edema(AU)

Intraoperative optical coherence tomography-guided release of lenticulo-corneal adhesion and lens aspiration in anterior dislocation of lens with corneal edema

Purpose: To describe the outcome of microscope integrated optical coherence tomography (MiOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of the crystalline lens and corneal edema. Methods: MiOCT-guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal edema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MiOCT. Results: In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication such as Descemet tear or worsening in corneal edema. Improvement in visual acuity was noted in all cases with resolution in corneal edema by 1 week. Conclusion: MiOCT-guided ILLA can be extremely useful in cases of lenticulo-corneal adhesion especially in cases with corneal edema.

Actualización terapéutica de la queratopatía bullosa pseudoafáquica / Therapeutic update on pseudophakic bullous keratopathy

RESUMEN La queratopatía bullosa pseudoafáquica o edema corneal crónico pseudoafáquico del paciente operado por cataratas con implante de lente intraocular es un proceso en el que la córnea se edematiza y pierde su función óptica, con síntomas dolorosos e irritativos de lagrimeo, ojo rojo, probabilidad de inflamación y ulceración corneal por infección secundaria. Se observan en esta afección multicausal dos grupos de pacientes. En uno de ellos el daño estructural corneal y ocular ha sido excesivo y no existe expectativa de mejora visual. El otro grupo aún conserva la potencialidad de recuperación de la agudeza visual. En el intento de solucionar esta afección se han empleado diversos tratamientos con fundamentos diferentes y resultados acordes con el desarrollo técnico y científico en que fueron aplicados. Es propósito de esta actualización describir y adecuar las posibilidades que los oftalmólogos puedan aplicar como terapéutica en sus respectivos niveles de actuación(AU)

ABSTRACT Pseudophakic bullous keratopathy or chronic pseudophakic corneal edema in patients undergoing cataract surgery with intraocular lens implantation is a process in which the cornea edematizes and loses optical function, with painful and irritating lacrimation symptoms, red eye, probable inflammation and corneal ulceration due to secondary infection. Sufferers of this multicausal condition are divided into two groups: In one of them structural corneal and ocular damage has been extreme and no visual improvement is expected, whereas in the other visual acuity recovery is still possible. In an attempt to heal this condition various treatments have been used with different rationales and results according to the scientific and technological development of the setting where they were applied. The present update is aimed at describing and adjusting the possible therapies that ophthalmologists may use in their respective fields of activity(AU)

Protective effect of Dexamethasone combined with hypertonic solution on corneal endothelium in rabbit eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the protective effect of dexamethasone combined with hypertonic solution on corneal endothelial cells of rabbit eyes. <p>METHODS: We made four groups of rabbits for different treatments with dexamethasone and hypertonic solution. All groups were treated with low-permeability solution for 10min to maintain anterior chamber perfusion. Group A was treated with 0.2mL dexamethasone subconjunctival injection, and hypertonic glucose eye drop immediately after surgery. Group B(control group)was subjected to 0.2mL of 0.9% saline subconjunctival injection, and balanced salt solution eye drop immediately after surgery. In group C, 0.2mL dexamethasone subconjunctival injection, and hypertonic glucose eye drop were given on the second day of surgery and in group D(control group), 0.2mL of 0.9% saline through subconjunctival injection and balanced salt solution eye drop were given on the second day of the surgery. The edema degree of cornea was observed with slit lamp before the operation and on the 1, 3, 5 and 7d after operation. The cornea were also examined by anterior segment OCT, and the corneal thickness was measured by A-scan ultrasonography.<p>RESULTS: In group A, during the entire experimental observation period, the cornea had no edema or only mild edema, the thickness of the central cornea hardly increased, and the number of corneal endothelial cells did not change significantly. There was no significant difference compared with(control group B)before modeling(<i>P</i>>0.05). In groups B, C, and D, corneal edema and corneal thickness increased after the rabbit eyes were modeled. There was a significant difference compared with group A(<i>P</i><0.05). The number of corneal endothelial cells in the rabbit eyes of groups B and D could not be measured during the observation period due to corneal edema. The number of corneal endothelial cells can be measured in group C up to the 7d after modeling. The number of corneal endothelial cells in group C was significantly reduced as compared with group A(<i>P</i><0.05), which before modeling and the 7d after modeling.<p>CONCLUSION: Dexamethasone combined with hypertonic glucose solution has a good protective effect on rabbit corneal endothelial cells. And early application can effectively prevent rabbit corneal edema and this method can also prevent the progression of corneal endothelial decompensation.

Investigate the clinical application of anterior segment OCT indescemet's membrane detachment after intraocular surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical application value of anterior segment OCT(AS-OCT)in diagnosis and treatment of descemet's membrane detachment(DMD)after intraocular surgery. <p>METHODS: Totally 23 eyes of 21 patients with corneal edema after intraocular surgery in our hospital from June 2016 to April 2019 were analyzed retrospectively. The degree of corneal edema and the descemet's membrane detachment(DMD)were observed by AS-OCT. The patients with mild or above descemet's membrane detachment were treated with anterior chamber gas tamponade, the patients with other corneal edema were treated with drug conservative treatment, and the corneal edema and adhesion of descemet's membrane were observed.<p>RESULTS: In this study, 21 patients(23 eyes)had corneal edema of different degrees, 14 eyes with descemet's membrane detachment,11 eyes with mild or above descemet's membrane detachment were re-examined by AS-OCT one day after anterior chamber gas tamponade. 10 eyes had good adhesion, 1 eye had poor adhesion, and the adhesion was good after anterior chamber gas tamponade again. After 1mo follow-up, the cornea of all the patients recovered to be transparent and their vision recovered well.<p>CONCLUSION:AS-OCT can timely and accurately diagnose and evaluate descemet's membrane detachment and its therapeutic effect.

​Corneal Complications After Manual Small-Incision Cataract Surgery – A Clinical Study In A Tertiary-Based Hospital

Aims and Objectives: The aim is to study the different corneal complications after manual small-incision cataract surgery(MSICS) and their implication on the final visual outcome in the patients.Design: It is a prospective, hospital-based observational study.Materials and Methods: The present study was done among 100 patients who underwent MSICS with implantation of posteriorchamber intraocular lens implantation. Study was conducted over a period of 3 months between March 2018 and May 2018 inGovernment Medical College, Jammu. All patients with clinically significant visual cataract admitted in Ophthalmology Departmentof Government Medical College, Jammu, during the study period were included. The post-operative corneal complications andbest corrected visual acuity (BCVA) of the enrolled patients were reviewed on the 1st, 7th, 15th, 30th, and 45th post-operative day.Results: 100 eyes of 100 patients consisting of 69 males and 31 females who underwent MSICS with intraocular lens implantationin the Department of Ophthalmology were studied. Majority of the patients belonged to the 60–69 years age group whichconstitutes 35 of the total patients. Out of 100 patients, 26 had corneal complications. 24 patients had striate keratopathy – outof whom 16 patients had mild grade striate keratopathy (<10 Descemet’s membrane folds [DMF]) and 8 patients had severegrade striate keratopathy (>10 DMF). 1 patient had microcystic corneal edema, and 1 patient had Descemet’s membranedetachment. After 6 weeks of post-cataract surgery, it was found that 89 patients achieved a BCVA of 6/9 or better.Conclusions: Corneal complications such as striate keratopathy are transient and resolve usually by the end of 2 weeks.Therefore, it was concluded that detailed pre-operative planning and careful surgery can prevent most of these complications.

Corneal Stromal Edema during Lidocaine Injection for Blepharoplasty

PURPOSE: To report a case of corneal edema caused by an iatrogenic lidocaine injection into the corneal stroma created while performing a local anesthetic (lidocaine) injection into the eyelid for a blepharoplasty procedure. CASE SUMMARY: A 15-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection in the upper blepharon for a blepharoplasty procedure. At the first clinical visit, visual acuity was hand motion and an accurate anterior chamber examination was difficult because of corneal edema. The Seidel test was negative. On corneal optical coherence tomography, the corneal thickness was 1,580 µm without any sign of Descemet's membrane detachment. We prescribed 5% NaCl four times a day and prednisolone acetate eight times a day. On the next day after injury, the corneal edema was significantly improved (central corneal thickness: 660 µm), and Descemet's membrane detachment was still not observed. One week after injury, the naïve visual acuity was 20/20, the central corneal thickness was 560 µm, and the endothelial cell count was 3,260 cells/cm². Three weeks after injury, the corneal edema was fully resolved and only slight temporal corneal haziness remained. After 2 months, the cornea was clear without any subjective discomfort. CONCLUSIONS: Corneal edema without Descemet's membrane detachment can be resolved spontaneously without aggressive treatment such as gas or air injection. However, endothelial cell count and corneal opacity need to be monitored on follow up exam. This clinical experience suggests that severe corneal edema in anterior stromal layer could be spontaneously resolved without severe complication.

Confocal microscopy features in chronic corneal edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To report <i>in vivo</i> confocal microscopic(IVCM)in corneal edema.<p>METHODS: Twenty-one patients with clinically diagnosed corneal edema were involved. All cases, in addition to control group of five normal eyes, were examined with IVCM. <p>RESULTS: IVCM findings in corneal edema showed that epithelial bullae appeared as dark, round areas with well-defined margins in all of the patients; Subepithelial fibroblasts and scarring; Other IVCM features included absent(57%)or reduced(43%)subbasal nerves in central corneal; Apart from the associated scar tissue, BZ presented a branching pattern of fine, darklines in all of the patients. Furthermore, fine or coarse granularity with avariable degree of reflectivity were noted in the anterior stroma in 13 of the 21 cases(62%); The number of keratocytes in the stroma of corneas was less than that in the normal corneas measured by using confocal microscopy in all of the patients; Endothelial changes with total obscuration of endothelial cell borders were seen in all of the patients. IVCM findings in the control group showed normal patterns.<p>CONCLUSION: This is the study in which IVCM features of corneal edema have been found in detail. Subepithelial fibroblasts, reduced subbasal corneal nerves and stromal keratocyte were well documented in this study. With increasing popularity of endothelial keratoplasty this work supports the role of IVCM in quantitative evaluation of corneal edema in preoperative stages, as well as after surgery.

Study on the examination and follow-up of cataract patients on the day after operation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the necessity of visual acuity, intraocular pressure(IOP)and slit lamp microscope examination on the same day after cataract surgery, and to explore a safe and effective method for postoperative observation.<p>METHODS: We collected cataract patients receiving day surgery from October to November 2018. They underwent phacoemulsification combined with intraocular lens(IOL)implantation. 149 patients(149 eyes)were included. Before the surgery, and 2h, 1d, 1wk after the surgery, we measured and compared their best corrected visual acuity(BCVA)and IOP, observing whether they had the corneal edema, IOL dislocation or other complications with slit lampmicroscope. We also compared the percentage of high IOP, low IOP before and after surgery.<p>RESULTS: BCVA before and 2h after surgery, BCVA 2h and 1d after surgery, and BCVA 1d and 1wk after surgery were statistically different, showing a gradually improving trend(<i>P</i><0.05). There was no significant difference between IOP before surgery and 2h after surgery or 1d after surgery(<i>P</i>>0.05), but the IOP 1wk after surgery was lower than that before surgery, 2h after surgery and 1d after surgery(<i>P</i><0.05). The percentage of high IOP 2h after surgery was significantly higher than that before surgery, 1d after surgery and 1wk after surgery. No ocular complication was found 1wk after surgery.<p>CONCLUSION: The visual acuity, IOP and corneal edema of the patients recovered 1wk after day cataract surgery, and high IOP was easy to happen 2h after surgery. Visual acuity, IOP and slit lamp microscope examination were safe, and corresponding treatment could be given to patients with high IOP.

Comparison of endothelial cell changes by specular microscopy between Ringer's and Ringer's lactate during phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the difference between using Ringer's and Ringer's lactate(RL)solutions as irrigating solutions during phacoemulsification and investigate their effect on corneal endothelium.<p>METHODS: This was a prospective interventional double blinded clinical study that included 100 eyes of 100 patients aged between 50 to 65 years suffering from a visually significant age-related cataract and scheduled for routine uncomplicated phacoemulsification. The included eyes were randomly divided into two equal groups(each group included 50 eyes). Group 1 received Ringer's solution and group 2 received Ringer's lactate as an irrigating solution.<p>RESULTS: The first group with Ringer's solution had a mean age of 57.5±8 years and the second group with RL solution had a mean age of 58.6±9 years. After 3mo, endothelial cell density decreased in group 1 by a mean of 8.5%, and in group 2 by a mean of 3.6%(<i>P</i>=0.013). Additionally, central corneal thickness increased in group 1 by a mean of 6.9% and in group 2 by a mean of 1.5%(<i>P</i>=0.006). By correlating the percentage of change in pachymetry and specular microscopic parameters with volume of irrigation solution used, there was no significant correlation.<p>CONCLUSION: The use of Ringer's lactate as an irrigating solution is associated with less endothelial cell loss postoperatively in comparison to Ringer's solution and also associated with decreased postoperative edema.