Pérdida de células endoteliales después de cirugía de catarata por facoemulsificación

Objetivo: Determinar la pérdida celular endotelial corneal posterior a la cirugía de catarata por técnica de facoemulsificación. Métodos: Se realizó un estudio descriptivo de intervención prospectivo y longitudinal. Se estudiaron 51 ojos operados de catarata por la técnica de facochop. Se les realizó microscopia endotelial pre- y posoperatoria a los tres y seis meses de la intervención. También se estudiaron los parámetros facodinámicos. Resultados: La edad promedio fue de 66,7 ± 11,7 años, predominó el sexo femenino (53,7 %). Se observó una disminución significativa de los valores promedios de densidad celular y hexagonalidad a los tres y seis meses posteriores a la operación de catarata. El porcentaje de pérdida de células endoteliales posterior a la intervención fue de 19,6 ± 0,8 %. El tiempo total de ultrasonido medio fue de 11,8 ± 4,5 seg mientras el tiempo efectivo de facoemulsificación tuvo una media de 0,008 ± 0,001 seg. Conclusiones: El recuento de células endoteliales corneales muestra una disminución significativa de los valores promedios de densidad celular y hexagonalidad a los tres y seis meses posteriores a la operación de catarata, el porcentaje de pérdida de células endoteliales corneales a los seis meses posterior está dentro de los límites normales y se observa relación de dependencia entre el tiempo efectivo de facoemulsificación y el porcentaje de pérdida de células endoteliales.

Objective: To determine the loss of corneal endothelial cell after cataract surgery by the phacoemulsification technique. Methods: A prospective, longitudinal, descriptive and interventional study was conducted. Fifty-one eyes operated on for cataract by the phacoemulsification technique were studied. Preoperative, as well as postoperative endothelial microscopy at three and six months after the cataract surgery, was performed. Phacodynamic parameters were also studied. Results: The mean age was 66.7 ± 11.7 years and there was a predominance of the female sex (53.7%). A significant decrease in the mean values of cell density and hexagonality was observed at three and six months after the cataract surgery. The percentage of endothelial cell loss after surgery was 19.6% ± 0.8%. The mean total ultrasound time was 11.8 ± 4.5 secs, while the effective phacoemulsification time had a mean of 0.008 ± 0.001 secs. Conclusions: The count of corneal endothelial cell shows a significant decrease in the mean values of cell density and hexagonality at three and six months after the cataract surgery; the percentage of corneal endothelial cell loss at six months is within normal limits; and a dependent relationship is observed between the effective phacoemulsification time and the percentage of endothelial cell loss.

Corneal densitometry: an innovative method to quantitatively evaluate corneal changes after phacovitrectomy.

BACKGROUND: To quantitatively investigate corneal changes and the correlation between corneal densitometry (CD) and endothelial parameters after phacovitrectomy. METHODS: Thirty-eight eyes with idiopathic full-thickness macular holes (iFTMHs) and cataracts underwent phacovitrectomy. Examinations were conducted at baseline and Day 1, Day 7, Month 1, and Month 3 postoperatively. CD and central corneal thickness (CCT) were measured using Pentacam. Corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured using specular microscopy. RESULTS: ECD and HEX significantly decreased after surgery and the change in HEX occurred prior to CV. CCT increased immediately after surgery and recovered 3 months postoperatively. CD values increased significantly 1 day after surgery and then gradually decreased. For CD in the 0-2 mm zone, it took 1 month to recover in the central and posterior layers and 3 months in the anterior and total layers. For CD in the 2-6 mm zone, the central layer recovered at Day 7, the anterior and total layers recovered at 1 month, and the posterior layer did not recover until 3 months postoperatively. The CD within all layers in the 0-2 mm zone was positively correlated with CCT. Posterior CD in the 0-2 mm zone was negatively correlated with ECD and HEX. CONCLUSIONS: CD is not only correlated with CCT, ECD, and HEX but also reflects the state of the whole cornea and each layer. CD can be an objective, rapid, and noninvasive tool that reflects corneal health and undetectable edema and monitors the process of lesion repair. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (31/10/2021, ChiCTR2100052554).

Morphology and thickness of corneal endothelial cells in young Sudanese individuals with myopia.

Deviations in corneal endothelium morphology and thickness may indicate corneal abnormalities and could be associated with myopia development. This study aimed to evaluate corneal endothelial cell morphology and central corneal thickness in young individuals with myopia. A prospective study was conducted at Al-Neelain University Eye Hospital between January 2019 and January 2020, including 160 patients with myopia (320 eyes). Data was gathered through clinical assessment of visual acuity, refractive error, and corneal endothelial cells. Results showed that 60% of participants with myopia were female, with a mean age of 21.99±2.8 years and a mean equivalent sphere of -3.19±2.67D. There was a significant difference in endothelial cell degeneration between myopia groups (P<0.001). Corneal guttata occurred in 9.1% of eyes with low myopia and 68.2% with moderate myopia, whereas polymegathism and polymorphism were more prevalent in high myopia. The mean central corneal thickness was 500.50±38.94 µm in low myopia, 497.02±36.23 µm in moderate myopia, and 477.87±43.625 µm in high myopia (P=0.007). The mean endothelial cell number in low myopia was 107.86±21.12, 106.0±24.03 in moderate myopia, and 101.23±18.49 in high myopia (P<0.05). The mean difference in endothelial cell density, coefficient of variation, and hexagonality in low, moderate, and high myopia was not significant (P>0.05). However, Pearson's correlation revealed a significant negative correlation between the degree of myopia and central corneal thickness (r= -0.174, P=0.002) as well as endothelial cell number (r= -0.124, P=0.026). The study concluded that central corneal thickness and endothelial cell number significantly decreased with an increase in the degree of myopia. Corneal guttata was the most common form of endothelial cell degeneration observed in cases of high myopia.

Qualitative and Quantitative Evaluation of Donor Corneal Tissue by Slit Lamp and Specular Microscopy.

Background In India, donor eye collection and promotion of eye banking are insufficient to meet the needs. By adequately evaluating donor corneas, eye banks can maximize the number of viable corneas for transplantation. This study evaluated donor corneal tissue based on age, lens status, and cause of death by their morphology and endothelial cell count via slit lamp and specular microscopy. Methods We conducted a prospective observational study of all eye bank donor corneas indicated for eye donation at a tertiary hospital and research center in Western Maharashtra between September 2019 to December 2021. We evaluated the corneoscleral discs by slit-lamp microscopy specular microscopy. We analyzed donor corneas quantitatively and qualitatively and graded them accordingly. We also collected blood samples for serological testing and the donor's behavioral and family medical histories. Results We collected 94 eyes from 47 donors; the mean age of the donor population was 48.2 years, and most donors were aged 41 to 80 years. Thirty-one donors (65.96%) were male, and 16 were female (34.04%. For preservation, we used Cornisol (Aurolab, Madurai, India) in 36 cases (77%) and McCarey-Kaufman medium in 11 cases (23%). We found a mean endothelial cell density (ECD) of 2214.40/mm2, with hexagonality of 53.05%, and a coefficient of variation of 38.01. Further, we observed that ECD and hexagonality of cells in phakic donors were significantly greater than that of pseudophakic (PP) donors. Moreover, ECD and hexagonality significantly decreased in donors with the chronic disease compared to those who had a sudden, unexpected death. Conclusion Corneal grafts from younger donors, phakic donors, and donors who experienced an acute cause of death were qualitatively and quantitatively significantly better than those of older donors, PP donors, and donors who experienced sudden, unexpected death. Therefore, eye bank specular examination can improve tissue utilization and transplantation success. Therefore, we strongly recommend that eye bank personnel evaluate their donor tissue with a specular microscope to enhance the quality of eye care.

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

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

Qualitative Alterations on Corneal Endothelial Cell Morphometry and Hexagonality After Cataract Surgery.

AIM: To deeply analyze quantitative and qualitative changes of corneal endothelium after longitudinal phacoemulsification. METHODS: In this prospective interventional case series study, 50 eyes with age-related cataract have been evaluated preoperatively, intraoperatively and postoperatively. The measured parameters were surgically induced endothelial cell loss (ECL), average endothelial cell area (AVG) and hexagonality (HEX). RESULTS: The relationship among the measured parameters and the energy dissipated during the two phases of phacoemulsification, sculpting and quadrant removal, has been analyzed with regard to the 5-score harm scale, a new method suggested to categorize cataracts. Two phases of phacoemulsification are linearly related (r = 1.5, P < 0.001, r2 = 79%). Plus, a quadratic model described the correlation between the percentages of ECL and AVG (P < 0.0001), while there was no specific model for the correlation between ECL and HEX. CONCLUSION: The 5-score harm scale allows to predict the mean changes in percentages of ECL, AVG and HEX of endothelial cells after longitudinal phacoemulsification. Also, this study confirms that the main damage on corneal endothelium is due to the energy delivered in the second phase of phacoemulsification.

Effect of mitomycin-C on corneal endothelial cell parameters after refractive surface ablation procedures.

Background: The effect of mitomycin-C (MMC) on the reduction of endothelial cell count in the cornea remains controversial. We aimed to evaluate the effect of MMC on corneal endothelial cell parameters after refractive surface ablation procedures, including photorefractive keratectomy (PRK) and laser epithelial keratomileusis (LASEK). Methods: In this interventional, comparative, follow-up study, 342 eyes of 171 patients were followed up for 6 months. Patients undergoing PRK or LASEK were included and were divided into two groups: group one (188 eyes of 94 patients) with an ablation depth of ≥ 65 µm and who received intraoperative 0.02% MMC for 30 s, and group two (154 eyes of 77 patients) with an ablation depth of < 65 µm and who received balanced salt solution for 30 s. Changes in endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation (CV), and hexagonality values were compared between the groups at 3 and 6 months after surgery. Results: The mean (standard deviaiton [SD]) age of the patients was 28.11 (6.56) years. The mean (SD) ECD did not change significantly in either group between the baseline and at 3 and 6 months postoperatively. The baseline mean ECD was significantly higher in group one than that in group two (P < 0.001) and remained so at 3 (P = 0.002) and 6 months (P = 0.022) postoperatively. The baseline hexagonality value was lower in group one (P = 0.173), with a gradual decrease during the postoperative follow-up as compared with that in group two (P = 0.016 and 0.001 at 3 and 6 months postoperatively, respectively). Group one had a significantly lower CCT at 3 and 6 months postoperatively (both P < 0.001) and a higher mean CV (3 months: P = 0.028; 6 months: P = 0.328). Conclusions: A single intraoperative application of MMC for 30 s as prophylaxis for corneal haze development during refractive surface ablation procedures had no significant effect on ECD up to 6 months postoperatively. Future studies with a contralateral-eye design (to neutralize factors specific to the individual patient), a larger sample size, and longer follow-up are necessary to confirm or disprove our observations.

Correlation between ocular biometric parameters and corneal endothelium in a sample of young Egyptian adults.

Background: To evaluate the normative values of corneal endothelial cell parameters within a group of healthy young Egyptian adults using specular microscopy and to examine any correlations between endothelial parameters and refractive or biometric parameters. Methods: In this cross-sectional study, specular microscopy was used to study the right eyes of 150 healthy young volunteers and evaluated endothelial cell parameters, including cellular density, hexagonality (HEX), and coefficient of variation (CV) at 15 different points on the back corneal surface, which were later grouped into the central zone and either four quadrants or three annular zones. The same eyes underwent refractive and biometric assessments. Results: Hundred fifty healthy adults were examined, and the age ranged from 20 to 30 years, with a median of 23 (interquartile range, 21‒27) years. The mean (standard deviation) of central cell density was 2902.7 (270.7) cells/mm2. The superior paracentral area had the lowest mean density (2895.8 cells/mm2), but the highest mean HEX (67.7%), while the inferior peripheral area had the highest mean density (3100.5 cells/ mm2) but the lowest mean HEX (64%). The difference in cell density among the three annular zones was not statistically significant (P = 0.365). However, HEX and CV in the central and paracentral zones differed statistically significantly from those of the peripheral zone (P < 0.001 and P = 0.014, respectively). Weak but non-significant correlations were detected between endothelial cell density and all measured refractive and biometric parameters. Conclusions: The findings of this study provided useful normative biometric and specular data in a specific age group and a specific population, and could be useful in planning intraocular surgery in young Egyptian adults. However, future longitudinal studies with a larger sample could refine more endothelial cell parameter specifications over time.

[Corneal endothelial evaluation of diabetic patients after phacoemulsification]. / Évaluation endothéliale cornéenne des patients diabétiques après une phacoémulsification.

PURPOSE: To determine whether phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients compared to non-diabetic patients. MATERIALS AND METHODS: This study compared the endothelial status in 32 diabetics with good glycemic control and 32 non-diabetic patients before and after uneventful phacoemulsification. Central corneal thickness (CCT), central corneal endothelial cell density (CD), hexagonal cell percentage (HEX), and percent coefficient of variation (% CV) were measured using a specular microscope. RESULTS: Data were matched by age and sex. Diabetics showed a significantly higher loss of endothelial cells compared to non-diabetics. After 3 months, there was a decline of 165 endothelial cells (SD 97) in the diabetic group and 114 (SD 45) in the control group. This was statistically significant (P=0.0065). In addition, diabetics showed a slower recovery trend of endothelial healing as evidenced by a lower CV variation. The CV change was 4.7 in the control group and 3.2 in the diabetic group, which was statistically significant (P=0.023). A significant correlation was found between the energy used and the change in endothelial count as well as the CV in both groups. CONCLUSION: Despite good glycemic control, diabetics have significantly more endothelial damage compared to non-diabetics with a similar nuclear classification and phacoemulsification energy used. This justifies a more careful use of phacoemulsification energy in diabetics.

Comparison of corneal endothelial cell analysis in patients with uveitis and healthy subjects.

PURPOSE: The aim of this study is to investigate the effect of uveitis in corneal endothelial cell number and morphology by non-contact specular microscopy. METHODS: Our cross-sectional study was performed on 56 eyes of uveitis patients and 53 eyes of healthy subjects. Non-contact specular microscopy was performed to all subjects. The cell density (CD), coefficient of variation, cell minimum area (Min) and cell maximum area (Max), the average of cell size (AVG), percent of hexagonality (HEX%), central corneal thickness (CCT), intraocular pressure (IOP) during uveitis and during remission were measured and compared between two groups. RESULTS: The mean endothelial cell analysis of the patients was 2540 ± 619 cells/mm2, and the mean endothelial cell analysis of the control group was 2834 ± 413 cells/mm2. The difference was statistically significant between the groups (p = 0.01). There was a statistically significant difference between two groups in terms of Max, Min, AVG, and HEX values. However, there was no difference in terms of CCT between two groups. There was a significant negative correlation between CD and IOP during uveitis attack. There was a significant negative correlation between the anterior chamber cell value and CD. CONCLUSION: Our results suggested that uveitis affected endothelial cell density, cell size and shape but not the corneal thickness without being influenced by the duration and number of attacks. Increased IOP during uveitis and anterior chamber cell value had an important role on CD in patients with uveitis.

Corneal endothelial cells and corneal thickness in congenital cataract patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Corneal endothelial cell density and morphology in rabbits' eyes using contact specular microscopy / Densidade celular e morfologia das células do endotélio da córnea de coelhos obtidas com microscopia especular

ABSTRACT: The goal of this study was to describe the normal values of corneal endothelial cell density and hexagonality in healthy rabbits' eyes using contact specular microscopy. Both eyes of 18 rabbits, males and females, of different ages were evaluated. The eyes were divided into three groups of 12 each according to the age range of the animals: G1 (6 months old), G2 (12 months old), and G3 (48 months old). Parameters studied included mean endothelial cell density and hexagonality. For Group I, the mean cell density was 2307 cells per mm2. For GII, the mean cell density was 1895 cells per mm2. For G III, the mean cell density was 1818 cells per mm2. Cell density decreased significantly with aging (P<0.001) among the three groups. Pleomorphism in the rabbits of GI was 74.33±10.08. In the rabbits of GII it was 71.83±11.38. In the rabbits of GIII it was 64.02±28.80. Significant differences (P<0.001) were evident between GI and GIII and GII and GIII but not between Groups I and II. The results showed a decrease in number of cells and hexagonality with aging. Corneal endothelium of rabbits suffers changes due to advancing age both in terms of cell density and morphology.

RESUMO: Objetivou-se avaliar a densidade celular e a hexagonalidade do endotélio da córnea de coelhos saudáveis usando um microscópio especular de contato. Os dois olhos de 18 coelhos, machos ou fêmeas, de diferentes idades foram avaliados. Os olhos foram separados em três grupos de 12 olhos cada em função da idade: G1 (6 meses de idade), G2 (12 meses de idade) e G3 (48 meses de idade). Os parâmetros estudados incluíram a densidade celular e a hexagonalidade. Para o Grupo I, a densidade celular média foi de 2307 células por mm2. Para GII, a densidade celular média foi de 1895 células por mm2. Para G III, a densidade celular média foi de 1818 células por mm2. A densidade celular diminuiu significativamente com o envelhecimento (P<0,001) entre os três grupos. O pleomorfismo nos coelhos de GI foi de 74,33±10,08. Nos coelhos do GII foi 71,83±11,38. Nos coelhos de GIII foi de 64,02±28,80. Diferenças significativas (P<0,001) foram evidentes entre GI e GIII e GII e GIII, mas não entre os Grupos I e II. Os resultados revelaram diminuição da densidade celular e da hexagonalidade com o avanço da idade. O endotélio da córnea de coelhos sofre alterações devido ao avanço da idade tanto na densidade celular e quanto na morfologia.

Comparative Evaluation of Corneal Endothelium in Diabetic Patients Undergoing Phacoemulsification.

PURPOSE: To determine if phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetics. MATERIALS AND METHODS: This study compared the endothelial status in 60 diabetics with good glycemic control and 60 nondiabetics before and after uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality and percentage coefficient of variation (%CV) were measured using a specular microscope. RESULTS: Data were age and sex matched. Diabetics showed significantly higher loss in endothelial cell count as compared to nondiabetics. At the end of 3 months, there was a decline of 157 endothelial cell (standard deviation [SD] 90) in the diabetic group and 121 (SD 50) in the control group. This was statistically significant (P = 0.008). Furthermore, the diabetics showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the %CV. The change in %CV was 4.5 in the control group and 3.1 in diabetic group which was statistically significant (P = 0.016). Significant correlation was found between energy used and change in endothelial count as well as %CV in nondiabetics only. CONCLUSION: In spite of good glycemic control, diabetics have significantly more endothelial damage in comparison to nondiabetics with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in diabetics.

Measurements of central corneal thickness and endothelial parameters with three different non-contact specular microscopy devices.

We aimed to compare the measurements of central corneal thickness (CCT) and endothelial parameters with three different non-contact specular microscopy (SM) devices. Fifteen eyes of 15 healthy individuals (6 males; 9 females) were enrolled in the study. Mean age was 37.93 ± 15.13 years. Endothelial parameters and CCT were measured with Nidek CEM-530, Topcon SP-3000P, and Tomey EM-3000 SM devices by the same physician. Endothelial parameters included endothelial cell count (ECC), maximum, minimum, and average endothelial cell size. and hexagonality ratio. There were no statistically significant differences in ECC, CTT, and average endothelial size (AES) between the devices (p > 0.05). The measurement of maximum endothelial size (MES) was different between Nidek SM and Topcon SM devices (p = 0.001), but there was no difference in MES between Nidek SM and Tomey SM (p = 0.058), and between Topcon SM and Tomey SM (p = 0.081). There was no difference in minimum endothelial size (MinES) between Nidek SM and Topcon SM (p = 0.794); however, there was a significant difference in MinES between Tomey SM and Nidek SM (p < 0.001), and between Tomey SM and Topcon SM (p < 0.001). Comparison of hexagonality ratio showed statistically significant difference between the devices (p < 0.001). No significant differences in the measurements of ECC, CCT, and AES were detected between different SM devices, whereas a statistically significant difference in hexagonality ratio was detected between the devices. These devices should not be used alternatively in the endothelial morphology assessment in patient's follow-up.

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.

Modificaciones del endotelio corneal en el paciente adulto mayor / Changes of the corneal endothelium in the older adult

OBJETIVO: describir las características del endotelio corneal en pacientes adultas mayores internadas en el Hogar de ancianos Hermanas Giralt. MÉTODOS: se estudiaron 120 ojos de 60 pacientes mujeres, adultas mayores, en una investigación de tipo descriptiva y transversal realizada entre abril y septiembre de 2013. Se realizó biomicroscopia y microscopia endotelial. Se analizaron las imágenes y se evaluaron la densidad celular, el coeficiente de variabilidad, la hexagonalidad celular y la paquimetría. RESULTADOS: la densidad celular media fue de 1 926 cel/mm2 entre 60 y 69 años, la cual disminuyó progresivamente hasta 1 495 en pacientes mayores de 90 años. El coeficiente de variabilidad se incrementó con la edad, con valores de 0,37 para las edades 60-69 y 70-79 años, y en mayores de 91 años fue de 0,41. La hexagonalidad fue mayor en los grupos de 70-79 años (49 por ciento) seguida de las edades 80-89 (48 por ciento). Se observó una disminución del 13 por ciento entre los grupos de 60-69 (43 por ciento) y 90 y más (30 por ciento), con significación estadística. La densidad celular, el coeficiente de variabilidad y la paquimetría no tuvieron diferencias significativas con la edad. CONCLUSIONES: a medida que se incrementa la edad se produce un aumento de la variabilidad celular y una disminución de la densidad celular y la hexagonalidad, así como un incremento de la paquimetría(AU)

OBJECTIVE: to describe the characteristics of the corneal endothelium in older people living in "Hermanas Giralt" home for the elderly. METHODS: one hundred twenty eyes from 60 old women were studied in a descriptive and cross-sectional study performed from April through September 2013. The patients were examined by biomicroscopy and endothelial microscopy. The images were analyzed and the cellular density, the variability coefficient, the cellular hexagonality and the pachymetry were all evaluated. RESULTS: the average cell density was 1 926 cel/mm2 in 60-69 years-old patients, which gradually lowered to 1 495 in patients older than 90 years. The variability coefficient increased with age, showing 0,37 for ages 60-69 years and 70-79 years and it was 0,41 in older than 91 years. Hexagonality was higher in 70-79 years-old agroup (49 percent) followed by the 80-89 years age group (48 percent). In 60-69 years-old (43 percent) and in 90 and over age group (30 percent), there was a 13 percent hexagonality reduction with statistical significance. Cell density, variability coefficient and pachymetry did not show significant differences in relation to age. CONCLUSIONS: the cell density and hexagonality decreased with the age, but variability coefficient and pachymetry increased. The values of corneal endothelium were normal in older adults in our setting(AU)

Modificaciones del endotelio corneal en el paciente adulto mayor / Changes of the corneal endothelium in the older adult

Objetivo: describir las características del endotelio corneal en pacientes adultas mayores internadas en el Hogar de ancianos Hermanas Giralt. Métodos: se estudiaron 120 ojos de 60 pacientes mujeres, adultas mayores, en una investigación de tipo descriptiva y transversal realizada entre abril y septiembre de 2013. Se realizó biomicroscopia y microscopia endotelial. Se analizaron las imágenes y se evaluaron la densidad celular, el coeficiente de variabilidad, la hexagonalidad celular y la paquimetría.Resultados: la densidad celular media fue de 1 926 cel/mm2 entre 60 y 69 años, la cual disminuyó progresivamente hasta 1 495 en pacientes mayores de 90 años. El coeficiente de variabilidad se incrementó con la edad, con valores de 0,37 para las edades 60-69 y 70-79 años, y en mayores de 91 años fue de 0,41. La hexagonalidad fue mayor en los grupos de 70-79 años (49 por ciento) seguida de las edades 80-89 (48 por ciento). Se observó una disminución del 13 por ciento entre los grupos de 60-69 (43 por ciento) y 90 y más (30 por ciento), con significación estadística. La densidad celular, el coeficiente de variabilidad y la paquimetría no tuvieron diferencias significativas con la edad.Conclusiones: a medida que se incrementa la edad se produce un aumento de la variabilidad celular y una disminución de la densidad celular y la hexagonalidad, así como un incremento de la paquimetría(AU)

Objective: to describe the characteristics of the corneal endothelium in older people living in Hermanas Giralt home for the elderly.Methods: one hundred twenty eyes from 60 old women were studied in a descriptive and cross-sectional study performed from April through September 2013. The patients were examined by biomicroscopy and endothelial microscopy. The images were analyzed and the cellular density, the variability coefficient, the cellular hexagonality and the pachymetry were all evaluated. Results: the average cell density was 1 926 cel/mm2 in 60-69 years-old patients, which gradually lowered to 1 495 in patients older than 90 years. The variability coefficient increased with age, showing 0,37 for ages 60-69 years and 70-79 years and it was 0,41 in older than 91 years. Hexagonality was higher in 70-79 years-old agroup (49 percent) followed by the 80-89 years age group (48 percent). In 60-69 years-old (43 percent) and in 90 and over age group (30 percent), there was a 13 percent hexagonality reduction with statistical significance. Cell density, variability coefficient and pachymetry did not show significant differences in relation to age. Conclusions: the cell density and hexagonality decreased with the age, but variability coefficient and pachymetry increased. The values of corneal endothelium were normal in older adults in our setting(AU)

Microscopia especular con corrección manual vs. software automatizado / Specular microscopy with manual correction vs. automated software

OBJETIVO: comparar los resultados del análisis del endotelio corneal, obtenidos mediante el software automatizado y la corrección manual. MÉTODOS: se realizó un estudio descriptivo, comparativo y longitudinal de la microscopia endotelial practicada a 20 adultos sanos (40 ojos). Fueron tomadas tres imágenes de cada ojo con el fin de seleccionar la de mejor calidad, para proceder posteriormente a la corrección manual del software en la pantalla del ordenador. La información de la base de datos fue procesada en el programa estadístico SPSS versión 19. Las variables cuantitativas se expresaron según sus respectivas medidas de resumen y se utilizó t Student para medir el grado de asociación entre las variables estudiadas (total de células identificadas, coeficiente variabilidad, densidad celular e índice de hexagonalidad). Se trabajó con un nivel de confianza del 95 % y de error inferior al 0,05 %. RESULTADOS: al trazar los contornos celulares de forma manual, las medidas obtenidas respecto a la densidad celular, el índice de hexagonalidad y el coeficiente de variación coincidieron con lo obtenido en otros estudios. El primer parámetro analizado y comparado fue el número de células que son identificadas por el software, el cual reconoció los límites celulares por el cambio de coloración. La media osciló entre 106,8 para el ojo derecho, con un rango de 121/88 y 105,05 para el izquierdo, con un rango de 121/79; con una desviación estándar de 9,393. Por su parte, al realizar la corrección manual aumentó la media para todos los grupos de edades, de 113,5 en el ojo derecho (rango 151/80) y 112,1 en el ojo izquierdo, (rango de 147/88), con una desviación estándar de 13,657. Como puede apreciarse, se modificó significativamente la cantidad de células contabilizadas para ambos ojos, y pudo constatarse que hubo células que no fueron identificadas y otras que fueron interpretadas como dobles, errores que pueden ser corregidos manualmente y con esto se modifican los valores prestablecidos por el software.CONCLUSIONES: la opción de trazar manualmente los límites celulares en la pantalla del ordenador para el análisis de los parámetros cuantitativos del endotelio corneal resulta efectiva durante la realización de la microscopia especular.

OBJECTIVE: to compare the results of the corneal endothelium analysis through the automated software and its manual correction. METHODS: a longitudinal, comparative and descriptive study of the endothelial microscopy performed on 20 healthy adults (40 eyes). Three images from each eye were taken to select the best quality one in order to later make manual correction of the software on the computer screen. The information from the database was processed by the SPSS statistical program version 19. The quantitative variables were expressed as per their respective summary measures whereas Student's t test measured the level of association among the studied variables (total number of identified cells, variability coefficient, cell density and hexagonality index). The 95% confidence interval and the error below 0,05 % were used. RESULTS: the manual drawing of cell contours yielded cell density, hexagonality index and variation coefficient values similar to those of other studies. The first analyzed and compared index was the number of cells that the software identified by recognizing the cell limits based on color changes. The mean ranged from 106,8 for the right eye with a range of 121/88 to 105,05 for the left eye with a range of 121/79, being the standard deviation of 9,393. On the other hand, the manual correction increased the mean for all the age groups to 113,5 for the right eye (range 151/80) and 112,1 for the left eye (range of 147/88), being the standard deviation of 13,657. As it may be observed, the number of cells for both eyes significantly changed and there were cells which were either unidentified or taken as doubles; these are errors that may be manually corrected, thus changing the set values of the software. CONCLUSIONS: the choice of manually drawing the cell limits on the screen for the analysis of the quantitative parameters of the corneal endothelium proves to be effective during the specular microscopy.

Microscopia especular con corrección manual vs. software automatizado / Specular microscopy with manual correction vs. automated software

Objetivo: comparar los resultados del análisis del endotelio corneal, obtenidos mediante el software automatizado y la corrección manual. Métodos: se realizó un estudio descriptivo, comparativo y longitudinal de la microscopia endotelial practicada a 20 adultos sanos (40 ojos). Fueron tomadas tres imágenes de cada ojo con el fin de seleccionar la de mejor calidad, para proceder posteriormente a la corrección manual del software en la pantalla del ordenador. La información de la base de datos fue procesada en el programa estadístico SPSS versión 19. Las variables cuantitativas se expresaron según sus respectivas medidas de resumen y se utilizó t Student para medir el grado de asociación entre las variables estudiadas (total de células identificadas, coeficiente variabilidad, densidad celular e índice de hexagonalidad). Se trabajó con un nivel de confianza del 95 por ciento y de error inferior al 0,05 por ciento. Resultados: al trazar los contornos celulares de forma manual, las medidas obtenidas respecto a la densidad celular, el índice de hexagonalidad y el coeficiente de variación coincidieron con lo obtenido en otros estudios. El primer parámetro analizado y comparado fue el número de células que son identificadas por el software, el cual reconoció los límites celulares por el cambio de coloración. La media osciló entre 106,8 para el ojo derecho, con un rango de 121/88 y 105,05 para el izquierdo, con un rango de 121/79; con una desviación estándar de 9,393. Por su parte, al realizar la corrección manual aumentó la media para todos los grupos de edades, de 113,5 en el ojo derecho (rango 151/80) y 112,1 en el ojo izquierdo, (rango de 147/88), con una desviación estándar de 13,657. con una desviación estándar de 13,657. Como puede apreciarse, se modificó significativamente la cantidad de células contabilizadas para ambos ojos, y pudo constatarse que hubo células que no fueron identificadas y otras que fueron interpretadas como dobles, ...(AU)

Objective: to compare the results of the corneal endothelium analysis through the automated software and its manual correction.Methods: a longitudinal, comparative and descriptive study of the endothelial microscopy performed on 20 healthy adults (40 eyes). Three images from each eye were taken to select the best quality one in order to later make manual correction of the software on the computer screen. The information from the database was processed by the SPSS statistical program version 19. The quantitative variables were expressed as per their respective summary measures whereas Student's t test measured the level of association among the studied variables (total number of identified cells, variability coefficient, cell density and hexagonality index). The 95% confidence interval and the error below 0,05 % were used. Results: the manual drawing of cell contours yielded cell density, hexagonality index and variation coefficient values similar to those of other studies. The first analyzed and compared index was the number of cells that the software identified by recognizing the cell limits based on color changes. The mean ranged from 106,8 for the right eye with a range of 121/88 to 105,05 for the left eye with a range of 121/79, being the standard deviation of 9,393. On the other hand, the manual correction increased the mean for all the age groups to 113,5 for the right eye (range 151/80) and 112,1 for the left eye (range of 147/88), being the standard deviation of 13,657. As it may be observed, the number of cells for both eyes significantly changed and there were cells which were either unidentified or taken as doubles; these are errors that may be manually corrected, thus changing the set values of the software.Conclusions: the choice of manually drawing the cell limits on the screen for the analysis of the quantitative parameters of the corneal endothelium proves to be effective during the specular microscopy(AU)

Caracterización del endotelio corneal en pacientes con indicación de cirugía de catarata / Characterization of the corneal endothelium in patients requiring cataract surgery

Objetivo: describir la morfología del endotelio corneal en pacientes con indicación de cirugía de catarata. Métodos: se estudiaron 200 ojos de 127 pacientes, 86 mujeres y 41 hombres, con indicación de cirugía de catarata en una investigación de tipo descriptiva y transversal realizada entre octubre y diciembre de 2011. Se examinaron los pacientes en lámpara de hendidura buscando alteraciones de la morfología del endotelio y se les realizó microscopia especular con el Topcon SP3000P. Se analizaron las imágenes y se evaluaron la densidad celular, el coeficiente de variabilidad, la hexagonalidad celular y la paquimetría. Resultados: predominó el sexo femenino con 86 pacientes y en los dos grupos la mayoría tenían entre 60 y 79 años. La densidad celular media fue de 2 238,19 cél/mm2, disminuyó significativamente con la edad y no tuvo diferencias con el sexo. El coeficiente de variabilidad, la hexagonalidad y la paquimetría no tuvieron diferencias significativas con la edad, ni con el sexo. Las guttas corneales predominaron en las féminas (103; 76,9 por ciento) con diferencia significativa entre los sexos. Conclusiones: a mayor edad hay disminución de la densidad celular, así como un aumento del coeficiente de variabilidad sin diferencias entre sexos. Se comprueba la estrecha relación entre la disminución de la densidad celular y el aumento de la paquimetría. Además, se muestran los parámetros de normalidad del endotelio corneal en pacientes con indicación de cirugía de catarata en nuestro medio

Objective: to describe the morphology of corneal endothelium in patients requiring cataract surgery.Methods: adescriptive, cross-sectional study was conducted in 200 eyes from 127 patients distributed into 86 females and 41 males, who required cataract surgery. All the patients were examined with slit-lamp method to look for corneal guttas and were performed Topcon specular microscopy SP3000P. Images were analyzed and the cell density, the variability coefficient, the cell hexagonality and pachymetry were all evaluated. Results: females predominated with 86 patients in both groups and most aged 60-79 years. The average cell density was 2238.19 cell/mm2 that significantly decreased with the age increase, and it did not show any differences between the sexes. The average variability coefficient, hexagonality and pachymetry did not show significant differences in terms of age and sex. The presence of corneal guttas predominated in females (103; 76.9 percent.) but the difference between the sexes was significant.Conclusions: as the age increases, the cell density diminishes but the variability coefficient increases and there are no differences between the sexes. The close relationship between the decreased cell density and the increased pachymetry is proved. Additionally, the study presents the normal parameters of the corneal endothelium in patients requiring cataract surgery in our setting