Central Endothelial Cell Count Research Articles

Suture Technique for Descemet Stripping and Endothelial Keratoplasty

To describe a suture technique for Descemet stripping and endothelial keratoplasty (DSEK). The technique was performed in 2 eyes of 2 patients with Fuchs endothelial corneal dystrophy. A double-armed 10-0 prolene suture on a CIF-4 needle was used to pull the donor corneal button into the recipient's anterior chamber without the use of forceps to hold the button. The suture was also used to unfold the lenticule in the eye without marking the stroma with gentian violet, to center the lenticule and to secure that in place. No intraoperative problems occurred in either case. The suture technique was successfully used to pull the donor button into the host's eye and to unfold and center the button. Both lenticules were well centered and had minimal corneal edema. At 6 months, the central endothelial loss was 8% in the first case and 10% in the second. This suture technique for DSEK avoids the use of forceps and allows less traumatic donor button manipulation. It may be an effective alternative with low endothelial damage; further follow-up will determine the long-term effect on the central endothelial cell count.

Topical plus subconjunctival anaesthesia: foldable intraocular lens implantation in eyes without capsule support through a self‐sealing incision

To evaluate the clinical outcomes of topical plus subconjunctival anaesthesia for secondary implantation of foldable intraocular lens (IOL) (Ophtec PC 425Y) in eyes without capsule support through a self-sealing incision. We reviewed the medical records of 22 patients (22 eyes) who received topical plus subconjunctival anaesthesia for scleral fixation of a foldable IOL through small incision. The scleral incision technique was used for IOL scleral fixation. Twelve eyes had traumatic cataract, seven had postphacoemulsification complications and three were aphakic. We studied visual outcome, intraoperative complications and perioperative pain. Autorefractometry and keratometry measurements and central endothelial cell counts were evaluated 1 day preoperatively and 4 months postoperatively. The level of intraoperative pain was scored on a scale of 1-10, where 1 = no pain and 10 = severe pain. Nineteen patients (86%) tolerated the procedure well, giving pain scores of 1-3, and none required supplemental anaesthesia. The mean age of the patients was 60 years. The postoperative best-corrected visual acuity (BCVA) ranged between 20/100 and 20/25. Four months postoperatively, the mean myopic shift by autorefractometry was -1.25 dioptre (D) and the mean postoperative astigmatism was 1.75 D. The mean central corneal endothelial loss at 4 months was 12.24% (range 4.5-17.2%). Five microscopic hyphaema occurred intraoperatively. Four cystoid macular oedema and four peripheral anterior synechia were the only complications, each occurring at the final follow-up. Topical plus subconjunctival anaesthesia and scleral fixation of foldable IOL (Ophtec PC 425Y) was safe, quick, required a small incision, led to favourable visual outcomes and minimized the risk of intraoperative and postoperative complications in eyes without capsule support. However, a long-term study of a large population is required to confirm these findings.

Torsional mode versus conventional ultrasound mode phacoemulsification: Randomized comparative clinical study

To compare the intraoperative and short-term postoperative outcomes of cataract surgery performed with torsional mode and conventional ultrasound mode using the Infiniti Vision System (Alcon Laboratories). Cataract Service, Zhongshan Ophthalmic Center, Sun-Yat-Sen University, Guangzhou, China. In this randomized comparative study, 525 eyes were assigned to phacoemulsification by torsional mode or conventional ultrasound (US) mode. The surgery was performed by an experienced surgeon, and the outcomes were evaluated by an examiner who was masked to treatment assignments. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), and surgical complications. Patients were seen 1, 7, and 30 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA) and the change in corneal clarity, central corneal thickness (CCT), and endothelial cell count. The US group had 262 eyes and the torsional group, 263 eyes. All patients completed the follow-up visits. In the eyes with nucleus density grades of 1, 2, 3, and 4, the mean UST was 10.25 seconds +/- 7.4 (SD), 25.14 +/- 5.5 seconds, 36.45 +/- 8.3 seconds, and 61.44 +/- 17.8, respectively, in the US group and 8.32 +/- 6.8 seconds, 18.45 +/- 7.2 seconds, 29.48 +/- 12.4 seconds, and 48.39 +/- 20.3 seconds, respectively, in the torsional group (P<.001); the mean CDE was 1.25 +/- 0.5, 4.18 +/- 1.2, 8.59 +/- 6.5, and 16.51 +/- 9.6, respectively, in the US group and 0.94 +/- 0.3, 3.13 +/- 2.7, 7.47 +/- 12.6, and 14.08 +/- 8.3, respectively, in the torsional group (P<.001). At 1 day and 7 days, the mean BCVA was 0.23 +/- 0.12 logMAR and 0.00 +/- 0.10 logMAR, respectively, in the US group and 0.18 +/- 0.11 logMAR and -0.08 +/- 0.05 logMAR, respectively, in the torsional group (P<.001). At 30 days, the mean BCVA was -0.10 +/- 0.07 logMAR and -0.12 +/- 0.06 logMAR in the US group and the torsional group, respectively (P>.01). At 1 day and 7 days, the mean CCT was 625 +/- 80 microm and 568 +/- 37 microm, respectively, in the US group and 601 +/- 35 microm and 559 +/- 40 microm, respectively, in the torsional group (P<.001). At 30 days, the mean CCT was 531 +/- 30 microm in the US group and 529 +/- 39 microm in the torsional group (P>.01). At 7 days and 30 days, the mean central corneal endothelial cell count was 2135 +/- 858 cells/mm(2) and 2084 +/- 527 cells/mm(2), respectively, in the US group and 2004 +/- 656 cells/mm(2) and 1953 +/- 615 cells/mm(2), respectively, in the torsional group (P<.001). The torsional mode may provide more effective lens removal with a lower level of phacoemulsification time and energy.

Corneal endothelial damage after cataract surgery: Microincision versus standard technique

To compare corneal endothelial changes after phacoemulsification performed with a standard technique versus a bimanual microincision cataract surgery (MICS) technique. University ophthalmology department. Eighty patients scheduled for routine cataract surgery were randomized into 2 groups; 40 eyes had standard stop-and-chop phacoemulsification (standard group) and 40 eyes had stop-and-chop phacoemulsification with microincision surgery (MICS group). Central corneal endothelial cell counts, coefficient of variation in cell size, hexagonality, and pachymetry were assessed preoperatively and 1 and 3 months postoperatively. The mean preoperative cell count in the entire sample was 2245 cells/mm2 +/- 37 (SE). The mean decreased by 102 cells at 1 month (95% confidence interval [CI], -133 to -71; P < .001) and by 144 cells at 3 months (95% CI, -187 to -102; P < .001). The difference between the standard group and the MICS group was 25 cells at baseline (95% CI, -169 to 120 cells; P = .739), 19 cells at 1 month (95% CI, -163 to 126; P = .799), and 19 cells at 3 months (95% CI, -164 to 125; P = .793). There were no changes in the coefficient of variation or morphology in the overall sample, and the pattern of change did not differ between the 2 groups. Corneal thickness increased by 10.2 microm in the overall sample (95% CI, +4.5 to +16.0; P < .001) and approached baseline values by 3 months with an increase of 3.4 microm (95% CI, -4.1 to 10.8; P = .372). There was no difference in corneal thickness between the groups. No significant differences in corneal endothelial cell loss or endothelial morphology were found between MICS and standard incision techniques.

Long-Term Complications of Iris-Claw Phakic Intraocular Lens Implantation in Weill-Marchesani Syndrome

This study was designed to report the long-term complications of iris-claw phakic intraocular lens implantation in a patient with Weill-Marchesani syndrome. Case report and literature review. A 26-year-old man with a history of glaucoma had bilateral phakic lens implantation for high myopia 10 years previously. Two years later, the left implant dislocated and was repositioned. Slit-lamp examination of both eyes revealed phakic implants of the iris-claw variety. There were moderate iridocorneal adhesions in the areas in which the lens haptics pinched the iris in both eyes and moderate epithelial and stromal edema over the temporal one-third of the left cornea. The crystalline lenses were clear with 3+phacodonesis OU. Dilated fundus examinations revealed bilateral severe optic nerve cupping. Crystalline lens diameters were measured at 7.5mm in the right eye and 8 mm in the left. Anterior chamber depths were 2.63 mm OD and 2.40 mm OS. Specular microscopy revealed central endothelial cell counts of 1133 and 587 cells/mm OD and OS, respectively. Axial lengths were 23.3 mm OD and 25 mm OS. Gonioscopic examination revealed bilateral angle closure with marked peripheral anterior synechiae. Based on our findings of short stature, shortened and thickened fingers, relatively normal axial length, microspherophakia, high myopia, and glaucoma, we diagnosed the patient with Weill-Marchesani syndrome. Iris claw-lens phakic lenses may be an effective surgical alternative to correct high myopia in select patients; however, it may produce long-term complications in eyes with specific features.

Pterygia with deep corneal changes.

To report a series of patients with pterygia associated with deep corneal marks at the level of the endothelium and Descemet membrane previously unreported. Clinical presentations of 7 patients (11 eyes) with pterygia and underlying deep corneal changes were reviewed for age, duration of pterygium, size of pterygium, and location of pterygium. Slit-lamp photos were obtained. Specular microscopy was performed on both eyes of 6 of these patients to evaluate the central endothelium and measure central corneal pachymetry. All patients were elderly (mean age 75 years, range 64-91) with long-standing nasal pterygia (average duration 43 years). The average size of the pterygium was 2.3 mm (range 0.75-4.25 mm). All patients had significant ultraviolet-B exposure based on outdoor employment or hobbies. None of the patients had a family history of pterygia. Slit-lamp photos document marks at the level of the endothelium and Descemet membrane. All the deep corneal changes were underlying or directly adjacent to the pterygium. Pachymetry measurements of the central involved corneas averaged 531 +/- 41 microm. Central endothelial cell counts of the 9 eyes with endothelial changes averaged 1580 +/- 412 cells/mm2. Long-standing nasal pterygia in elderly patients may rarely induce deep corneal changes at the level of the endothelium and Descemet membrane. Endothelial cell density may be lower in eyes with pterygia with deep corneal changes.

Effect of cataract surgery on the corneal endothelium: Modern phacoemulsification compared with extracapsular cataract surgery

Purpose To investigate whether modern phacoemulsification surgery results in more damage to the corneal endothelium than extracapsular cataract extraction (ECCE), and to examine which preoperative, operative, and postoperative factors influence the effect of cataract surgery on the endothelium. Design Randomized controlled trial. Participants Five hundred patients 40 years or older were randomized into 2 groups (ECCE, 249; phacoemulsification, 251). Methods Central corneal endothelial cell counts, coefficient of variation of cell size, and hexagonality were assessed before surgery and up to 1 year postoperatively. Main outcome measure Endothelial cell count. Results Four hundred thirty-three patients completed the trial. The initial preoperative mean cell count for the entire sample was 2481 (standard error [SE]: 18.6), reduced at 1 year postoperatively to 2239 (SE: 23.5). An average 10% reduction in cell count was recorded by 1 year postoperatively. There was no such change in hexagonality or in the coefficient of variation. There was no significant difference in overall percentage cell loss between the 2 treatment groups. Factors associated with excessive cell loss (≥15% by 1 year) were a hard cataract (odds ratio [OR]: 2.1, 95% confidence limits: 1.1–4.1; P = 0.036), age (OR: 1.04, P = 0.005), and capsule or vitreous loss at surgery (OR: 2.38, P = 0.106). Phacoemulsification carried a significantly higher risk (OR: 3.7, P = 0.045) of severe cell loss in the 45 patients with hard cataracts relative to ECCE (52.6% vs. 23.1%; chi-square test, P = 0.041), with both procedures achieving similar postoperative visual acuity outcomes. Conclusions No significant difference in overall corneal endothelial cell loss was found between these 2 operative techniques. The increased risk of severe cell loss with phacoemulsification in patients with hard cataracts suggests that phacoemulsification may not be the optimal procedure in these cases, and that ECCE should be preferred.

Transscleral fixation of a foldable intraocular lens in aphakic vitrectomized eyes

Purpose: To evaluate the clinical outcomes of transscleral fixation of a foldable intraocular lens (IOL) in eyes that had pars plana lensectomy combined with pars plana vitrectomy for severe vitreoretinal disease. Setting: Seoul National University Hospital, Seoul, Korea. Methods: The medical records of 21 patients who had a transscleral fixation of a foldable IOL after previous vitrectomy combined with lensectomy for severe posterior segment pathology were reviewed. The underlying vitreoretinal diseases were complicated proliferative diabetic retinopathy (n = 9), proliferative vitreoretinopathy (n = 5), traumatic retinal detachment (n = 3), intraocular foreign body (n = 2), and uveitic retinal detachment (n = 2). The postoperative best corrected visual acuity (BCVA) was compared with the preoperative BCVA. Autorefractometry and keratometry measurements and central endothelial cell counts were evaluated 1 day preoperatively and 6 months postoperatively. Results: The mean age of the patients was 54.5 years. The preoperative aphakic period ranged from 2 to 22 months. The visual acuity reached the preoperative BCVA by 2 months after surgery and was better than the preoperative BCVA at 6 months ( P = .006) and at the final visit ( P = .003). Six months postoperatively, the mean myopic shift by cycloplegic autorefractometry was −1.0 diopter (D) and the mean scalar shift in surgically induced keratometric cylinder, 1.0 D. The mean central corneal endothelial loss at 6 months was 6.7% (range 2.4% to 22.2%). The only vitreoretinal complications were a transient vitreous hemorrhage and a reopened macular hole that was reattached after fluid–gas exchange. Conclusion: Transscleral fixation of a foldable IOL was safe and led to favorable visual outcomes in aphakic vitrectomized eyes with previous severe vitreoretinal disease.

Corneal edema resolution after “descemetorhexis”

A 79-year-old woman had left eye phacoemulsification complicated by inadvertent excision of Descemet’s membrane (DM). One day postoperatively, the visual acuity was counting fingers with diffuse corneal edema. The patient was treated medically, with gradual resolution of the corneal edema over a 6-month period. The torn edge of DM could be visualized as the edema cleared, and no endothelial cell count could be obtained centrally. Approximately 1 year postoperatively, the central endothelial cell count was 2114 cells/mm 2 in the right eye and 827 cells/mm 2 in the left eye. The decreased cell count, increased polymegethism, and pleomorphism suggested that endothelial cells migrated to cover the stromal surface area in the absence of DM.

Anterior chamber intraocular lens for high myopia: Five year results

Purpose: To evaluate the effectiveness of the surgical correction of high myopia 5 years after anterior chamber intraocular lens (IOL) implantation and to analyze the lens position and related complications. Setting: Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. Methods: This prospective study comprised 26 eyes that were implanted with an anterior chamber IOL (model ZB5M) and had a minimum follow-up of 5 years. Before and after surgery, manifest and cycloplegic refractions were done; slitlamp examination was performed; anterior chamber depth was measured; and keratometry, ophthalmoscopy, and central corneal endothelial cell count were performed. At the last follow-up, computerized biomicroscopy of the anterior segment was also done. Results: The spherical equivalent decreased from −16.5 diopters (D) ± 4.1 (SD) preoperatively to −0.9 ± 0.9 D postoperatively. At the last examination, 57.7% of eyes had a spherical equivalent refraction within ±1.0 D of emmetropia. Of eyes with a preoperative best spectacle-corrected visual acuity of 20/40 or better, 73.3% had an uncorrected visual acuity of 20/40 or better postoperatively. The mean tilt caused by the IOL was 4.4 ± 2.7 degrees (range 0.5 to 12.2 degrees) and the mean IOL decentration, 0.3 ± 0.2 mm (range 0.02 to 0.8 mm). The mean decrease in the endothelial cell count was 1.5%, with a mean cell density of 2808 ± 305 cells/mm 2 preoperatively and 2765 ± 242 cells/mm 2 postoperatively. Pupillary ovalization was observed in 12 eyes (46.1%). Conclusions: The anterior chamber IOL safely and effectively corrected high myopia.

Phakic anterior chamber lenses for the correction of myopia: A 7-year cumulative analysis of complications in 263 cases

ObjectiveTo perform a prospective, clinical trial to determine the potential cumulative complications of patients implanted with angle-supported phakic intraocular lenses (PIOLs) for the correction of myopia. DesignNonrandomized, prospective, comparative trial. ParticipantsTwo hundred sixty-three eyes of 160 consecutive patients were included. InterventionAngle-supported anterior chamber intraocular lenses were implanted into phakic eyes. Main outcome measuresNight halos and glare were recorded. Central endothelial cell count, postoperative inflammation, applanation tonometry, cataract development, retinal detachment, and pupil ovalization were recorded by the same physician. ResultsNight halos and glare were reported as significant by 20.2% at 1 year and 10% at year 7 of follow-up. This complication was significantly lower in the larger optical zone PIOL (ZSAL-4) than in the ZB5M/ZB5MF group (P < 0.05). Acute postoperative iritis was observed in 4.56% of cases. High intraocular pressure that required antiglaucoma medications appeared in 7.2% of cases. Central corneal endothelial cell density was significantly decreased at postoperative month 3 (P < 0.0001). The percentages of cell loss were 3.76% at month 3 and 1.83% at year 1, and then the percentages decreased by 1.37% more at year 2, 0.72% at year 3, 0.3% at year 4, 0.6% at year 5, 0.4% at year 6, and 0.56% at year 7. The total cumulative loss of central endothelial cells after 7 years was 8.37%. Pupil ovalization was present in 5.9% of cases, although smaller degrees of this complication were observed in another 10.3%. Retinal detachment appeared in 3% of cases. The PIOL explantation was decided in 11 cases (4.18%) because of cataract development (9 cases) and extreme pupil ovalization associated with severe glare (2 cases). The Kaplan-Meier cumulative survival analysis study showed an expected period free from complication of 86.5% for IOP elevation, 98.75% for endothelial cell count inferior to 1500 cells/mm2, 86.97% for pupil ovalization, 95.43% for retinal detachment, and 89.02% for explantation. ConclusionsAngle-supported PIOL appeared to be well tolerated by the corneal endothelium with a low rate of other complications. Pupil ovalization seemed to be a specific problem for this type of PIOL.

Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery

Purpose: To compare topical tetracaine 0.5% alone and with intracameral lidocaine 1% as a local anesthetic agent in phacoemulsification with intraocular lens (IOL) implantation.Setting: The Toronto Hospital—Western Division; Toronto, Canada.Methods: Fifty-trine consecutive patients (60 eyes) having phacoemulsification with implantation of a foldable acrylic IOL (AcrySot) were randomized into 1 of 2 groups: The-intracameral balanced salt solution (BSS) group received topical tetracaine 0.5% plus intracameral BSS;-the intracameral lidocaine group received topical tetracaine 0.5.% with preservabve-free intracameral lidocaine 1%. The patients' subjective experience of pain ,vvas measured at 4 points during surgery using a 4-point pain scale. Patient and surgeon satisfaction with the anesthesia used was measured using a 5-point satisfaction scale. Central endothelial cell counts were obtained preoperatively and 1 month postoperatively. Best corrected visual acuity (BCVA) was measured pfeoperatively and 1 hour, i day, 1 week, and 1 month postoperatively.Results: The mean pain score after phaccemulsfication was significantly higher in the intracameral BSS group than in the intracameral lidocaine group (0.63 ± 0.7 [SD] and 0.23 ± 0.4, respectively,- P < .019). The mean pain score at the end of surgery was also significantly higher. in the intracameral BSS group than in the intracameral lidocaine group (0.60 ± 0.6 and 0.21 ± 0.4, respectively; P < .014). The surgeon satisfaction score was significantly lower for the intracameral BSS group than for' the intracameral lidocaine group (3.90 1.2 and 4.73 ± 0.8, ' respectively; P < .0007). There was no difference in patient satisfaction between the intracameral BSS and intracameral lidocaine groups (4.60 ± 0.6 and 4.70 0.8). Endothelial cell loss 1 month postoperatively was similar between the 2 groups (,6:1% ± 8% and 6.7% ± 6%) Ninety-seven percent of patients (29/30) in each group noted BCVA improvement from preoperatively. The rate of potential visual acuity recovery was similar in both groups.Conclusion: Topical tetracaine 0.5% with intracameral lidocaine was safe and effective in patients having phacoemulsifcation with IOL implantation. The advantage of using intracameral lidocaine 1% over a placebo was a significant decrease in the patients' subjective experience of pain and in the surgeon's satisfaction with the anesthesia used. None of the other parameters measured in this study differed significantly between the 2 groups.

Corneal Refractive and Endothelial Changes Following THC:YAG (Holmium) Laser Sclerostomy

To determine the effect of THC:YAG (holmium) laser sclerostomy on corneal curvature and endothelial cell counts. One hundred twenty-five cases were reviewed for high postoperative corneal astigmatism (> 5 D) or preoperative and postoperative endothelial cell count measurements in eyes without preoperative evidence of corneal endothelial compromise. Nine patients had keratometry reading at 2 to 3 months with documented corneal astigmatic changes of 5.62 to 12 D (mean 7.27 +/- 2.16 D). Sixteen eyes of 14 patients studied with specular microscopy had central mean endothelial cell count reductions of 6.5% following THC:YAG laser sclerostomy. The total energy applied correlated with the percentage reduction in endothelial cell counts (r = .507, P = .045, n = 16, Spearman correlation). Higher laser energy levels can result in high corneal astigmatism, which in some cases may be persistent, and a reduction in endothelial cell count.

Transscleral fixation of acrylic intraocular lenses in the absence of capsular support through 3.5 mm self-sealing incisions

Purpose: To evaluate the safety and efficacy of transscleral ciliary sulcus fixation of acrylic intraocular lenses (IOLs) through small incisions in the management of secondary IOL implantation.Setting: Department of Ophthalmology, Osaka Rosai Hospital, Osaka, Japan.Methods: This retrospective study consisted of 28 patients (30 eyes) who had transscleral fixation of .acrylic IOLs through 3.5 mm incisions. All patients were followed for a minimum of 6 months in several different clinical settings. Data on visual acuity, keratometry, and central corneal endothelial cell count were evaluated preoperatively and postoperatively. The refractive error achieved and incidence of postoperative complications were determined.Results: Uncorrected visual acuity (UCVA) improved in all eyes. Of the 18 eyes without pre-existing pathology, 11 (61.1%) had a UCVA of 20140 or better from 1 week postoperatively. Best corrected visual acuity was unchanged in 24 eyes (80.0%) and improved by 2 Snellen lines or more in 5 eyes (16.7%) at the final examination. Self-sealing wound adaptation was achieved in 25 eyes (83.3%). The mean scalar shift in keratometric cylinder was 1.25 diopters (D) at 1 day postoperatively, 1,17 D at 1 week, and 1.06 D at 3 months. The rate of central corneal endothelial loss 6 months postoperativelyaveraged 7.84%. No intraoperative complications that were directly associated with acrylic IOL implantation occurred. Postoperative complications that included transient ocular hypertension, slight vitreous hemorrhage, and IOL malposition were found in a small population but resolved spontaneously without further surgical intervention.Conclusions: The good visual outcomes and low incidence of complications achieved in the present study indicate that acrylic IOLs positioned through small incisions might be considered for ciliary sulcus fixation. However, evaluation of this technique in a large population over the long term is required.

Corneal endothelial cell loss from suture fixation of a posterior chamber intraocular lens

Purpose: To evaluate the effect of suture fixation of a posterior chamber intraocular lens (PC IOL) on the corneal endothelium.Setting: Seoul National University Hospital, Seoul, Korea.Methods: Central corneal endothelial cell density was measured in 40 eyes that had planned extracapsular cataract extraction (P-ECCE) with PC IOL implantation and in 40 eyes that had PC IOL implantation by suture fixation (17 eyes with cataracts and 23 aphakic eyes). Central corneal endothelial cell counts were taken 1 day preoperatively and 1 and 3 months postoperatively by contact specular microscopy.Results: One month postoperatively, mean central corneal endothelial cell loss was 10.1% in eyes that had P-ECCE with PC IOL implantation, 10.4% in eyes with cataracts that had PC IOL implantation by suture fixation, and 10.3% in aphakic eyes that had PC IOL implantation by suture fixation. At 3 months, it was 11.2%, 11.6%, and 11.7%, respectively. There was no statistically significant difference in the central corneal endothelial cell loss between the eyes that had PC IOL implantation by suture fixation and those that had P-ECCE with PC IOL implantation.Conclusions: Posterior chamber IOL implantation by suture fixation is a useful and safe method in patients who are aphakic or whose posterior capsule ruptures during cataract surgery.

Comparative study of intraocular lens implantation through 3.0 mm temporal clear corneal and superior scleral tunnel self-sealing incisions

Purpose: To compare the clinical outcome of phacoemulsification and foldable silicone intraocular lens (IOL) implantation through a 3.0 mm temporal clear corneal incision and a 3.0 mm superior scleral tunnel incision.Setting: Department of Ophthalmology, Yodogawa Christian Hospital, Osaka, Japan.Methods: Eighty cataractous eyes of 78 patients with pre-existing against-the-rule (ATR) astigmatism were recruited for this prospective, randomized study. The patients were assigned to one of the two groups. Data on uncorrected and corrected visual acuities, keratometry, flare intensity measurement, and central cornea endothelial cell count were evaluated preoperatively and at 2 days, 1 week, and 1 and 3 months postoperatively.Results: Although the pre-existing keratometric cylinder decreased in the temporal clear corneal incision group and increased in the superior scleral tunnel incision group, the amount of cylinder shift was not significantly different. Mean scalar shift of keratometric cylinder in the corneal incision group was 1.19 diopters (D) at 2 days postoperatively, 0.86 D at 1 week, and 0.56 D at 3 months and in the scleral incision group, 1.09 D at 2 days, 0.76 D at 1 week, and 0.65 D at 3 months. Eighty percent of the eyes in each group achieved an uncorrected visual acuity of 20/40 or better from the second day postoperatively. No statistically significant difference in visual rehabilitation or other parameters was noted between the groups throughout the study. Complications including corneal endothelial cell loss and wound incompetence requiring suturing were observed in the temporal clear corneal incision group.Conclusions: Both incisions offered satisfactory clinical results, but the superior scleral tunnel incision resulted in fewer complications. Minimal corneal keratometric change induced by a 3.0 mm incision was not related to uncorrected visual rehabilitation.

Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision

Purpose: To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters.Methods: Fifty-eight patients had phacoemulsification through temporal, two-step clear corneal tunnel incisions. In Group A (n = 28), a one-piece, plate-haptic, foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color-coded, computer-assisted specular microscopy was used for special cell analysis after 1 year.Results: Collective data showed an ECL of 7.9 ± 4.1 % (mean ± standard deviation) at 2 to 5 days postoperatively, 6.7 ± 2.9% after 6 months, and 7.3 ± 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST ≤1 1/2 minutes, 6.7% with UST ≥ 1 1/2 to 2 1/2 min, and 9.6% with UST > 2 1/2 to 3 1/2 min; in Group B, it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age-related cell parameters 1 year postoperatively.Conclusions: Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.

Donor cornea procurement: six‐year review of the role of the eye bank in South Australia

The Lions Eye Bank of South Australia was established six years ago and has collected corneas from 790 donors. The consent rate is currently 82% of requests made. Two-thirds of donors have been male, with mean donor age/year varying from 54 to 64 years (range two to 93 years). Cardiovascular and respiratory diseases, trauma and haemorrhage account for 80% of all donor deaths. Mean death to enucleation time is five hours. Corneas assessed as being of excellent or very good quality are released preferentially from the bank; those with central endothelial cell counts of less than 1500 cells/mm2 are discarded. Fewer than 1% of donors have returned a positive result for HIV or hepatitis B. Of the 1580 corneas collected by the bank, 863 (55%) have been used for transplantation with a primary non-function rate of 0.46%. The evolving policies, logistics of operation and methodologies employed by the bank are described in detail.

Corneal Endothelial Cell Loss, Cystoid Macular Edema, and Iris-supported intraocular Lenses

Endothelial cell loss, persistent cystoid macular edema and a chronic low-grade uveitis may complicate intracapsular cataract extraction combined with iris supported intraocular lenses. Clinical examination of 19 eyes of 17 patients, at 1.1 to 5 years after cataract surgery, and correlation with wide field specular microscopy and fluorescein angiography, documents this problem. The mean central corneal endothelial cell count was 497 cells/mm2 (standard deviation, 119). In ten cases, focal edema was localized to the corneal periphery. Cystoid macular edema was present in all but one case. Intermittent cornea/ implant touch or low-grade intraocular inflammation, possibly from iris/implant contact, may explain the natural history of the endothelial cell loss and cystoid macular edema. Monitoring endothelial cell counts and macular function in patients with iris-supported implants may afford the early recognition of this problem. In such cases, early implant removal may alter the natural history and preserve corneal and macular function.

Three Years Experience with Radial Keratotomy: The UCLA Study

A clinical trial of radial keratotomy was begun under a strict research protocol at the Jules Stein Eye Institute in November 1979. The results after two years of 16-incision keratotomies, as well as more recent eight-incision keratotomies, are reported. The difficulties in obtaining patient compliance at two years is presented and discussed. Thirty-seven eyes (46%) were unavailable for independent examination at two years, and 28 eyes (35%) were not available at all. Of those eyes available for evaluation (16-incision), the mean follow-up was 24.7 (±2) months (range 21–30 months). The mean preoperative myopia for these 52 eyes was −5.20 (±2.11) diopters (D) (range −2.00/−13.50 D), and the mean decrease in myopia was 3.85 (±2.08) D with 50% maintaining an uncorrected visual acuity of 20/40 or better and 33% achieving 20/200 or worse. Uncorrected acuity results were far superior for those patients with preoperative myopia of 5.00 D or less. Two-year central endothelial cell counts on 46 eyes resulted in a +2.0% (±4.3) change in cell density compared with the cell count taken three months after surgery. It appears that long-term endothelial cell loss does not occur. Fourteen eyes (33%) retained a hyperopic cycloplegic refractive error at two years, with four eyes ranging from +2.50 to +5.75 D; thus, this result represents a major complication of 16-incision (3.0 mm optical zone) keratotomy. The microperforation rate of 19% has led to no adverse developments to date. A moratorium from January to June 1981 allowed for evaluation of our results and a change in the protocol to eight-incision keratotomy on patients with less than 6.00 D of myopia and less than 2.00 D of astigmatism. Since that time 63 eyes were operated with a mean follow-up of 9.4 (±6) months (range 2–21 months). The mean preoperative myopia for these eyes was −3.84 (±1.04) D (range −2.00/−6.75 D), and the mean decrease in myopia was 2.85 (±1.05) D, with 65% obtaining an uncorrected visual acuity of 20/40 or better, 13% achieving 20/200 or worse. This was superior to the results with 16-incision keratotomy because of patient selection. Eight-incision surgery achieved 73% of the myopia change achieved with 16-incision surgery. No microperforation occurred in the 62 eyes of the eight-incision series. The complications of glare and variable vision were much less in the eight-incision series than in the 16-incision series, although admittedly based on shorter follow-up. Central endothelial cell counts were obtained in 16 eyes of the eight-incision series at six months after surgery. A mean cell loss of −2.6% (±10.0) was noted that is much less than the 10% loss noted in our three-month evaluation of the 16-incision procedure. The eight-incision surgery lowered the severity of overcorrection myopia dramatically. Thirteen eyes (21%) fell in this range with no eye greater than +2.00 D. While the rate of overcorrection was 29% (15 of 52 eyes) with 16-incision keratotomy and not statistically different (<i>P</i> > 0.7), two eyes were over +4.00 D. One case of incisional bacterial corneal ulcer was treated successfully, leaving a stromal scar and 20/20 unaided acuity. An analysis showed that results were quite similar for three different surgeons.