Changes In Endothelial Cell Count Research Articles

Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes - A prospective interventional study.

To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes. A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT). Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively. FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS.

Five-year follow-up of a posterior chamber phakic intraocular lens with a central hole for correction of myopia

PurposeTo evaluate intermediate and long-term visual outcomes and safety of a phakic intraocular posterior chamber lens with a central hole (ICL V4c) for myopic eyes.MethodsRetrospective, consecutive case study of patients that uneventfully received a ICL V4c for myopia correction, with a 5-year postoperative follow-up. Department of Ophthalmology, Goethe University Frankfurt, Germany.ResultsFrom 241 eyes that underwent ICL implantation, we included 45 eyes with a mean age at surgery of 33 years ± 6 (18–48 years), with a 5 years follow-up. CDVA improved from 0.05logMAR ± 0.15 CDVA preoperatively to − 0.00 ± 0,07 at 5 years and did not change significantly from 3 to 5 years’ time (p = 0.266). The mean spherical equivalent (SE) improved from -10.13D ± 3.39 to − 0.45D ± 0.69. The change in endothelial cell count showed a mean decrease of 1.9% per year throughout the follow-up. Safety and efficacy index were 1.16 and 0.78, respectively. Cataract formation was seen in 2 of 241 eyes (0.8%), but in none of the 45 eyes that finished the 5-year follow-up.ConclusionsOur data show a good intermediate and long-term stability, efficiency, and safety of ICL V4c phakic lenses in myopic eyes comparable to other known literature.

Assessment of Endothelial Cell Count Changes Post-Yttrium Aluminium Garnet Laser for Posterior Capsular Opacification

Objective: The study aimed to assess the effect of Neodymium : Yttrium Aluminium Garnet laser (ND:YAG laser) on endothelial cell count loss and anterior segment elements. Study Design: Quasi-experimental. Place and Duration Of Study: Armed Forces Institute of Ophthalmology, Rawalpindi from Jul 2021 to Feb 2022. Methodology: A total of 60 patients with a history of posterior capsular opacities planned for Neodymium: Yttrium Aluminium Garnet laser posterior capsulotomy were included. Specular microscopy was done pre and post-laser to study and parameters such as central corneal thickness, endothelial cell count, intra-ocular pressure was noted. Data were analyzed by using the Statistical Package for the Social Sciences version 23 software Result: After four weeks of Neodymium : Yttrium Aluminium Garnet laser, there was no significant change in the intraocular pressure (p=0.334), however, the visual acuity improved from 0.6±0.3-0.05±0.1 (p&lt;0.001) along with a decrease in endothelial cell count 2101±485-1919±427 (p&lt;0.001) and central corneal thickness 0.504±0.03-0.502± 0.03 (p=0.010). A similar trend of changes in the parameters was observed for lower (1.0-1.2MJ) and higher energy (2.1-2.5MJ) in the sample for posterior capsulotomy. Conclusion: Our study concluded that the corneal structural changes occur post-Neodymium: Yttrium Aluminium Garnet posterior capsulotomy, including changes in endothelial cell count. However, there is no significant disturbance in the intraocular pressure after the procedure.

A comparative study: Changes in endothelial cell count in phacoemulsification with temporal clear corneal incision vs superior scleral incision in grade II &amp; III cataract

Endothelial cell loss is a key indicator of the quality of anterior segment surgery like cataract surgery. The amount and integrity of corneal endothelial cells are the two most essential factors determining corneal transparency.Aim of this study was to compare the endothelial cell loss between the superior scleral tunnel incision and the temporal clear corneal incision for phacoemulsification.Prospective observational study. This prospective observational study included 50 patients with grade II and III cataracts undergoing phacoemulsification with a temporal clear corneal incision and 50 patients with a superior scleral tunnel incision. Specular microscopy was used to count ocular endothelial cells before and one month after the surgery.The mean endothelial cell loss was significantly higher with temporal clear corneal incision (14.91% ± 5.13%) in comparison to the superior scleral tunnel incision group (6.58% ± 2.06%). A superior scleral tunnel incision is associated with less postoperative endothelial cell loss as compared to a temporal clear corneal incision and could provide a better visual outcome.

Effect of Nondominant Left-Handed Phacoemulsification Surgery on Corneal Endothelium.

To evaluate the effect of phacoemulsification surgery performed with the nondominant left hand on the corneal endothelium. The study included 160 patients who were followed up for at least six months after uneventful cataract surgery. Seventy-seven patients who underwent nondominant left-handed phacoemulsification were evaluated as Group 1 and 83patients who underwent dominant right-handed phacoemulsification were evaluated as Group 2. In all the patients, preoperative axial length (AL), aqueous depth (AD), anterior chamber depth (ACD), and lens thickness (LT) were evaluated. All phacoemulsification procedures were undertaken with the same device by two surgeons using the same technique, and the intraoperative cumulative dissipated energy (CDE) value, effective phacoemulsification time, and total operative time were recorded. Corneal endothelial cell density (ECD), coefficient of variation (CV) percentage, hexagonal cell percentage (HCP), and central corneal thickness (CCT) measurements were evaluated by specular microscopy preoperatively and at the postoperative first and sixth months. The two groups had a similar age and gender distribution and did not significantly differ in terms of the preoperative AL, AD, ACD, LT, intraoperative CDE, effective phacoemulsification time, and total operative time with similar age and gender distribution (p > 0.05 for all). The preoperative and postoperative first- and sixth-month specular microscopy measurements of ECD, CV, HCP, and CCT ​​were also similar in the groups (p > 0.05 for all). In this study, it was observed that nondominant left-handed phacoemulsification resulted in similar changes in endothelial cell count and morphology to those obtained from dominant-handed phacoemulsification.

Five-year follow-up of corneal endothelial cell density after transscleral ab interno glaucoma gel stent implantation

PurposeThis study investigates the course of the endothelial cell density over a period of 5 years after XEN45 implantation (XEN45µm, Allergan Plc., USA) with or without combined cataract surgery.MethodsThis is a prospective, cross-sectional, monocentric, non-randomized clinical trial with the intention to treat a population of the University Eye Clinic Glaucoma Service Salzburg. One hundred and fifty-five eyes with preoperative central corneal endothelial cell counts were subjected to XEN45 implantation with (combined surgery group) or without (solo surgery group) combined cataract surgery. Endothelial cell density was measured at 3 corneal positions. XEN45 location parameters were determined with anterior segment OCT and gonioscopy.ResultsIn the combined surgery group, a significant reduction of central endothelial cell count was found at years 2 and 4 when compared to baseline (p = 0.001 and p = 0.02, n = 86), whereas at years 1, 3, and 5, no change was detected (all p > 0.09). The median reduction of endothelial cell count was − 79 (95% CI: − 183 to − 9) and − 93 (95% CI: − 220 to 23) cells at years 2 and 4, respectively. In the solo surgery group (n = 69), no significant change in endothelial cell counts was detected at any time during the 5-year evaluation period (all p > 0.07). Explorative data analyses revealed that XEN45 location parameters did not significantly influence the course of endothelial cell count over time.ConclusionsEndothelial cell loss after XEN45 implantation seems to be low. The present data suggest no impact on the position of the implant with regard to central endothelial cell counts in this study.

State of refractive surgery with Visian ICL posterior chamber phakic lens in Spain

ObjectivesTo analyse the state of refractive surgery with Visian ICL phakic lens implantation in Spain, indicating the mean ranges of implanted powers, visual and refractive outcomes obtained and safety and efficacy indices. MethodThis is a population-based, cross-sectional, descriptive, analytical, retrospective, multicentre study in which each co-author collected data from at least the last 10 patients (up to a maximum of 30) with Visian ICL phakic lens implantation. One eye from each subject was randomly selected for study inclusion, and the variables analysed were: age, gender, visual acuities with and without correction pre and post-surgery, preoperative and residualrefraction, keratometry, endothelial cellular density, anterior chamber depth from endothelium, central corneal pachymetry, intraocular pressure, white-white, implanted lens (power and size), expected and achieved spherical equivalent (SEQ) post-surgery at one month after surgery. ResultsA sample of 140 eyes was obtained from 140 patients with a mean age of 31.35 ± 7.28 years. Mean preoperative SEQ was −6.33 ± 3.69D, mean CDVA was 0.96 ± 0.16, ACD was 3.30 ± 0.29 mm, WTW 12.02 ± 0.40 mm, CCT 535.03 ± 37.68 µm, ECD 2684.37 ± 313.74 cels/mm2 and IOP 14.84 ± 2.59 mmHg. 66.4% of the implanted lenses were spherical ICLs and 33.6% toric, with a mean power of −7.81 ± 4.09D and a mean cylinder of 2.27 ± 1.23D. 5.7% of the implanted lenses were hypermetropic. The mean SEQ target selected was +0.04 ± 0.27D. 48.92% of the implanted lenses were of size 13.2 mm, with the remaining 36.69, 10.79 and 3.60% being of sizes 12.6, 12.1 and 13.7 mm, respectively. At one month after surgery a residual SEQ of −0.01 ± 0.31D was obtained. The efficacy and safety indices were 1.06 ± 0.18 and 1.10 ± 0.19, respectively. The mean central vault was 508.80 ± 201.04 µm. The accuracy between the calculated SEQ and the obtained SEQ was 99.3% for spherical lenses and 88.2% for Cyl correction. The mean ECD at 1 month after surgery was 2805.53±273.30céls/mm2, which was a difference from preoperative of 0.11% (p = 0.922), similarly, the mean IOP was 13.98 ± 2.57 mmHg, which was a difference of −0.92 ± 2.80 mmHg. ConclusionsICL phakic lens surgery is an effective, safe and predictable procedure. There were no significant changes in endothelial cell count or intraocular pressure measurement one month after surgery.

Illuminated Chop Using an Illuminated Chopper in Cataract Surgery: on the Way to Minimal-energy Phacoemulsification

Purpose: To minimize ultrasound power use and surgical phaco time in illuminated chop cataract surgery.Methods: The charts of patients who underwent senile cataract surgery by a single surgeon were reviewed retrospectively. A conventional intracameral endoilluminator was used in a Stop &amp; Chop group (n = 45), while an illuminated chopper was used in an illuminated chop (I-Chop) group (n = 71). EFX, a unitless value that roughly correlates with ultrasound energy during phacoemulsification, surgical phaco time, and changes in endothelial cell count were compared between the two groups and the ratio of zero phacoemulsification in the I-Chop group was evaluated.Results: EFX of the Stop &amp; Chop and I-Chop groups was 18.08 ± 16.15 and 0.82 ± 3.53, respectively (&lt;i&gt;p&lt;/i&gt; = 0.001), while the surgical phaco time was 185.08 ± 41.42 and 162.04 ± 49.65 seconds (&lt;i&gt;p&lt;/i&gt; = 0.01). However, the endothelial loss did not differ in the two groups (7.03 ± 7.89 vs. 7.13 ± 9.47%, &lt;i&gt;p&lt;/i&gt; = 0.76). In the I-Chop group, 56 (86%) eyes had zero phaco energy and patients with EFX &gt;1 (n = 6) had more severe nuclear sclerosis grading (2.90 ± 0.71 vs. 4.5 ± 1.0; &lt;i&gt;p&lt;/i&gt; = 0.001).Conclusions: The I-Chop group had lower EFX and shorter surgical phaco time than the Stop &amp; Chop group. Illuminated chop using an illuminated chopper is one way to attain minimal phacoemulsification.

Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus.

Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus.

A Higher-energy Accelerated Corneal Collagen Cross-linking Method for Keratoconus: A Retrospective, Observational Cohort Study

Introduction: Primary keratoconus is a non-inflammatory corneal ectasia disease with an unknown cause. Nowadays, the most widely used treatment method is corneal collagen crosslinking based on the Dresden protocol. Due to the long surgery time, we have been searching for a new method which cost less time in surgery. Methods: A retrospective, observational cohort study was used. A total of 31 participants (59 eyes) with primary keratoconus were collected. Twelve of them (24 eyes) used the standard Dresden protocol, and the remaining 19 (35 eyes) used a higher-energy accelerated corneal collagen cross-linking method. Application of riboflavin solution to the de-epithelialized cornea for 10 min, then the cornea is UVA irradiated (wavelength, 365 nm and power, 30 mW/cm²) for another 3.55 min, and the total irradiation energy is 6.4J/cm². Participants were followed up for 12 months after surgery and underwent complete examinations at 3, 6, and 12 months in predetermined windows of time. The examinations items include routine ophthalmological examination, uncorrected vision acuity (UCVA), best corrected visual acuity (BCVA), refraction, corneal curvature, the elevation of the thinnest point on front surface and back surface (F Ele Th, B Ele Th), the thickness of the thinnest point of the cornea (CT), and the density of the corneal endothelial cells (ECD). The independent sample t-test method was used to compare the changes of the parameters of the standard Dresden protocol and the higher-energy accelerated corneal collagen cross-linking. Results: In the A-CXL treatment group, the maximum keratometry value decreased by 1.48D from baseline, UCVA improved by an average of 0.07 logarithm of the minimum angle of resolution (logMAR) units, BCVA improved by an average of 0.15 logarithm of the minimum angle of resolution (logMAR) units. All of those are similar to standard Dresden protocol group. There were no significant changes in endothelial cell count and thickness of cornea 1 year after treatment. Conclusions: In this study, we found that accelerated corneal collagen cross-linking under 6.4J energy has a similar surgical effect as corneal collagen cross-linking under the Dresden protocol, and did not cause more adverse events.

A prospective study of endothelial cell count in diabetic and non-diabetic patients after cataract surgery

Introduction: To assess and compare the changes in endothelial cell count in diabetic and non-diabetic patients after routine phacoemulsi?cation and small incision cataract surgery. Materials and Methods: Total 130 eyes of 130 patients was taken in the study were age and sex matched. Out of which 65 eyes of 65 patients of Type 2 diabetes mellitus and 65 eyes of 65 non-diabetic patients of cataract underwent cataract surgery. Out of which 65 patient for phacoemulsification surgery and 65 patients for small incision cataract surgery were evaluated. In all the patients specular microscopy for the corneal endothelial cell count and central corneal thickness was done pre-operatively. And post operatively at one week, six weeks and 12 weeks was done. The variation in the endothelial size and shape and percentage of hexagonal cells were assessed. A Comparative analysis of endotheial cell count and percentage of endothelial cell loss between two groups was performed. Also there was comparison of endothelial cell loss between phacoemulcification and small incision cataract surgery was done. Results: The mean pre-operative endothelial cell count in the Non-diabetic group was higher than the diabetic group (p Conclusions: In diabetic patients there was higher endothelial cell loss when compared with nondiabetic patients after cataract surgery. The changes were seen even in the presence of good glycemic control. Keywords: Cataract surgery, Diabetes mellitus, Endothelial cell loss.

Corneal Endothelial Changes Following Refractive Lens Exchange

Background: clear lens extraction (CLE) by phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in a series of highly myopic and hyperopic eyes was effective and had an acceptable predictability and a low rate of complications especially on corneal endothelium. Aim of the work: to study corneal endothelium changes (number and morphology) following phaco-aspiration in refractive lens exchange procedure (1 month and 6 months postoperatively) Subjects and methods: a non-randomized prospective study was carried out from October 2018 to May 2019 on twenty five eyes of 14 subjects with age (38-48) years old with high myope> 8 D and high hyperopia > 6 D; these patients were not candidate for corneal refractive surgery or phakic IOL procedure. They were selected from outpatient Ophthalmology Clinics of Al-Azhar University Hospitals in Cairo. The patients were examined by specular microscopy before and after refractive lens exchange procedure (1 month and 6 months postoperatively) Results: Log MAR BCVA improved from (0.47) preoperatively to (0.5904) at the end of the 6 th month with P-value 0.35. Changes in endothelial cell count from (2.650) cells/mm2 before surgery to (2.372) cells/mm2 1 month after surgery to (2.358) cells/mm2 6 months after surgery with P-value <0.001. Error of refraction improved from (-14.94) in myope and (7.98) in hyperope preoperatively to (-1.42) in both groups at the end of the 6th month after surgery with p-value <0.001. Conclusion: CLE surgery by phaco-aspiration technique is less harmful to the corneal endothelium because it uses no phaco power.

Corneal Endothelial Changes Following Refractive Lens Exchange

Background: clear lens extraction (CLE) by phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in a series of highly myopic and hyperopic eyes was effective and had an acceptable predictability and a low rate of complications especially on corneal endothelium. Aim of the work: to study corneal endothelium changes (number and morphology) following phaco-aspiration in refractive lens exchange procedure (1 month and 6 months postoperatively) Subjects and methods: a non-randomized prospective study was carried out from October 2018 to May 2019 on twenty five eyes of 14 subjects with age (38-48) years old with high myope> 8 D and high hyperopia > 6 D; these patients were not candidate for corneal refractive surgery or phakic IOL procedure. They were selected from outpatient Ophthalmology Clinics of Al-Azhar University Hospitals in Cairo. The patients were examined by specular microscopy before and after refractive lens exchange procedure (1 month and 6 months postoperatively) Results: Log MAR BCVA improved from (0.47) preoperatively to (0.5904) at the end of the 6 th month with P-value 0.35. Changes in endothelial cell count from (2.650) cells/mm2 before surgery to (2.372) cells/mm2 1 month after surgery to (2.358) cells/mm2 6 months after surgery with P-value <0.001. Error of refraction improved from (-14.94) in myope and (7.98) in hyperope preoperatively to (-1.42) in both groups at the end of the 6th month after surgery with p-value <0.001. Conclusion: CLE surgery by phaco-aspiration technique is less harmful to the corneal endothelium because it uses no phaco power.

A study of endothelial cell count pre- and post-neodymium-doped yttrium aluminum garnet laser iridotomy in subacute angle closure using specular microscope.

AIM:The aim of this study was to study the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iridotomy on corneal endothelial cell count in patients with subacute angle closure using specular microscope.MATERIALS AND METHODS:In this prospective study, 50 cases of narrow-angle Grade 1 and Grade 2 (Shaffer gonioscopic grading) visiting the Regional Institute of Ophthalmology, Government Medical College, Amritsar underwent Nd:YAG laser peripheral iridotomy. After obtaining informed written consent, specular microscopy was performed before and after iridotomy at 1 week, 1 month, 3rd month, and at 6th-month follow-up visits. Central, nasal, and temporal endothelial cell counts were evaluated through noncontact specular microscopy.RESULTS:The mean participant age was 51.52 ± 7.9 years, and majority of the participants were females (76%). The mean IOP before the laser was 19.25 ± 1.914 mmHg and it varied from 18.50 ± 1.647 to 18.25 ± 1.699 mmHg (day 1, p = 0.06 and at 6 months, p = 0.04) following laser procedure. The mean corneal endothelial cell count at superotemporal site before laser peripheral iridotomy was 2844 ± 260, and this value decreased to 2807 ± 263, 2699 ± 267, 2656 ± 270, and 2591 ± 275 cells/mm2 at postiridotomy, 1, 3, and 6 months’ follow-up visits, respectively; these differences were statistically significant (p < 0.05). The mean total energy required to produce iridotomy was 14.88 ± 6.71 mJ, ranging from 5 to 37 mJ. The linear regression analysis indicated no statistical correlation between change in endothelial cell count at the treated site and total mean energy used. No significant difference was found between preiridotomy and postiridotomy corneal thickness at any site.CONCLUSION:This study demonstrated a significant endothelial cell loss at the treated site in 6 months’ follow-up and suggested that Nd:YAG laser iridotomy may pose hazard to the corneal endothelium, although corneal decompensation at the treated site or as a whole was not seen.

Corneal Endothelial Cells Changes after Phacoemulsification in Diabetic Patients

Patients and Methods: The study included 40 eyes of 40 patients scheduled for cataract surgeryby phacoemulsification at Al-Azhar University Hospitals. The patients were assigned to 2 groups. Group 1: Twenty patients without diabetes were used as a control group. Group 2: Twenty patients diagnosed with diabetes based on medical history and all were on medical treatment. In this prospective randomized study, preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japa) were performed to evaluate endothelial cell count changes over 6 months. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, BCVA, HEX and CD, the differences between preoperative and postoperative values are statistically significant in both groups. On the other hand, in term of CV, the difference between preoperative and postoperative CV is statistically insignificant in both groups. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical traumaand has a lower capability in the process of repair.

Corneal Endothelial Cells Changes after Phacoemulsification in Diabetic Patients

Patients and Methods: The study included 40 eyes of 40 patients scheduled for cataract surgeryby phacoemulsification at Al-Azhar University Hospitals. The patients were assigned to 2 groups. Group 1: Twenty patients without diabetes were used as a control group. Group 2: Twenty patients diagnosed with diabetes based on medical history and all were on medical treatment. In this prospective randomized study, preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japa) were performed to evaluate endothelial cell count changes over 6 months. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, BCVA, HEX and CD, the differences between preoperative and postoperative values are statistically significant in both groups. On the other hand, in term of CV, the difference between preoperative and postoperative CV is statistically insignificant in both groups. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical traumaand has a lower capability in the process of repair.

Biomechanical changes to Descemet's membrane precede endothelial cell loss in an early-onset murine model of Fuchs endothelial corneal dystrophy

Early-onset Fuchs endothelial corneal dystrophy (FECD) has been associated with nonsynonymous mutations in collagen VIII α2 (COL8A2), a key extracellular matrix (ECM) protein in Descemet's membrane (DM). Two knock-in strains of mice have been generated to each express a mutant COL8A2 protein (Col8a2L450W/L450W and Col8a2Q455K/Q455K) that recapitulate the clinical phenotype of early-onset FECD including endothelial cell loss, cellular polymegathism and pleomorphism, and guttae. Due to abnormalities in ECM protein composition and structure in FECD, the stiffness of DM in Col8a2 knock-in mice and wildtype (WT) controls was measured using atomic force microscopy at 5 and 10 months of age, coinciding with the onset of FECD phenotypic abnormalities. At 5 months, only sporadic guttae were identified via in vivo confocal microscopy (IVCM) in Col8a2Q455K/Q455K mice, otherwise both strains of Col8a2 transgenic mice were indistinguishable from WT controls in terms of endothelial cell density and size. By 10 months of age, Col8a2L450W/L450W and Col8a2Q455K/Q455K mice developed reduced corneal endothelial density, increased endothelial cell area and guttae, with the Col8a2Q455K/Q455K strain exhibiting a more severe phenotype. However, at 5 months of age, prior to the development endothelial cell abnormalities, Col8a2L450W/L450W and Col8a2Q455K/Q455K mice knock-in mice had reduced tissue stiffness of DM that was statistically significant in the Col8a2Q455K/Q455K mice when compared with wildtype controls. These data indicate that alterations in the tissue compliance of DM precede phenotypic changes in endothelial cell count and morphology, and may play a role in onset and progression of FECD.

Treatment Outcomes of Mitomycin C-Augmented Trabeculectomy, Sub-Tenon Injection versus Soaked Sponges, after 3 Years of Follow-up: A Randomized Clinical Trial

To report the 3-year outcome of trabeculectomy with mitomycin C (MMC)-soaked sponges versus intra-Tenon injection of MMC in eyes with uncontrolled primary open-angle glaucoma. Randomized clinical trial. Eighty-two consecutive patients with uncontrolled primary open-angle glaucoma. Participants were randomized either to intra-Tenon injection of 0.1 ml of 0.01% MMC (TI group) or 0.02% subconjunctival application of MMC-soaked sponges (TS group). Patients were followed up for 3 years after surgery. The data for 73 eyes were included in the final analysis. The primary outcome measure was the surgical success, defined as intraocular pressure (IOP) more than 5 mmHg and <21 mmHg, and IOP reduction of 20% or more from baseline, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures were IOP, glaucoma medications, best-corrected visual acuity (VA), bleb morphologic features according to the Indiana Bleb Appearance Grading Scale, complications, and endothelial cell count changes. The cumulative probability of success at 3-year follow-up was 72.2% in the TI group and 65.1% in the TS group (P= 0.30). Uncontrolled IOP was the most common reason for failure. The mean preoperative IOP was 22.4±4.6 mmHg with an average of 3.1±1.0 medications. At 3 years, final IOP was 15.3±3.7 mmHg in the TI group and 16.4±3.5 mmHg in the TS group (P= 0.55). Mean glaucoma number of medications was 0.9±1.1 and 1.1±1.1 in the TI and TS groups, respectively (P= 0.54). Blebs tended to be more diffuse (P= 0.032), less vascularized (P= 0.013), and more shallow (P= 0.012) after intra-Tenon injection. Visual outcomes and endothelial cell changes were similar in both groups (P= 0.47 and P= 0.94, respectively). Although the success rate and IOP reduction were comparable with both techniques, bleb morphologic parameters were more favorable after intra-Tenon injection of 0.1 ml of 0.01% MMC.

Corneal Endothelial Changes after Iris-Claw Anterior Chamber Phakic Intraocular Lens Implantation

Background: Compared to other refractive surgeries, implantation of phakic intraocular lenses (pIOL) have more desirable results and are potentially reversible procedures due to the possibility of explanting these lenses. These methods usually do not require expensive or special surgical equipment and most ophthalmologists are able to perform these procedures., however disabilities resulting from pIOL are more severe compared to corneal refractive surgery. Due to the potential risk of damage to anterior segment structures, especially corneal endothelial cell loss, pIOL implantation is subjected to debate. Aim of the Work: To evaluate the endothelial cell count changes in eyes implanted with the iris-claw phakic lens for treatment of moderate to high myopia as regard changes in cell density. Patients and Methods: This study included Ten eyes of patients with moderate to high myopia implanted with The Iris-Claw Anterior Chamber Phakic Intraocular Lens at Al-Hussein University Hospital, In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy (Topcon SP- 1P, Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal ECD and the percentage of corneal endothelial cell loss. Secondary outcome measures were UCVA, BCVA, manifest refraction, and complications. Results: Preoperative mean endothelial cell count was 3198.50 ± 444.67 cells/ mm² (range, 2715.00 – 3846.00 cells/ mm²)., it was 3074.50 ± 410.76 cells/ mm² (range, 2609.00 – 3686.00 cells/ mm²) at 1 month after surgery., 3003.00 ± 411.91cells/ mm² (range, 2532.00 – 3610.00cells/ mm²) at 6 months after surgery. The mean endothelial cell loss was 6.07% at the end of the follow up period with 3.79% at one month postoperative, 2.37% from one to six months postoperative. The mean BCVA improved from 0.27 ± 0.09 preoperatively to 0.44 ± 0.12 postoperatively and the mean UCVA, from 0.02 ± 0.01 to 0.33 ± 0.09 postoperatively, the mean SE was -0.93 ±0.57 D Postoperatively. Conclusion: Artisan phakic IOL had excellent results including., their suitability for high myopes, reversibility, high optical quality, predictability, safety, efficacy, potential gain in visual acuity in myopic patients and did not produce significant corneal endothelial cell loss 6months after surgery.

Corneal Endotheleal Cells Changes after Phacoemulsification in Type II Diabetes Mellitus

Background: Corneal endothelial cells are responsible for the clarity of the cornea; however, endothelial cells have limited cell division ability. Studies have proven that cornea is more vulnerable to chronic changes affecting endothelial cells in diabetic patients. Cataract extraction by phacoemulsification is one of the most ophthalmic surgeries having a negative effect on the corneal endothelial cells especially in elders. Age of the patient and diabetes mellitus have a negative effect on the outcome of phacoemulsification. The aim of the study is to compare the changes occur in corneal endothelium pre and post cataract extraction by phacoemulsification in diabetic patients in aspects of BCVA, CCT, CD, CV and HEX. Aim of the work: To assess endothelial cells changes following cataract extraction by phacoemulsification and posterior chamber IOL implantation in type II diabetic patients. Methods: The study included 20 eyes of 20 patients scheduled for cataract surgery by phacoemulsification at Al Azhar university hospitals. The patients were assigned to 2 groups. Group 1: Ten patients without diabetes were used as a control group, and a casual blood glucose test and glucose tolerance test were undertaken in accordance with the recommendations of the American Diabetes Association to disclose undetected diabetes. Group 2: Ten patients diagnosed with type II diabetes based on medical history and all were on oral anti-diabetic medication or subcutaneous treatment with insulin. Serum glycosylated hemoglobin (HbA1c) was obtained in all patients with diabetes to evaluate their glycemic status.In this prospective randomized study we did Preoperative specular microscopy and serial postoperative specular microscopy ( Topcon SP- 1P,Topcon Medical Inc., Japan).) were performed to evaluate endothelial cell count changes over 6 months. Endothelial cell images were collected in the central region of the cornea before surgery and 1 and 6 months after surgery. The main outcome measures were central corneal thickness (CCT), cell density (CD), coefficient of variation (CV), hexagonality (HEX) and best corrected visual acuity (BCVA). Results: In term of CCT, in group 1 the CCT mean ±SD in preoperative is 510.7 ±35.13, in 1 month postoperative is 522.1 ±35.91 and in 6 months postoperative is 512 ±34.91, the difference between preoperative CCT and 6 months postoperative is 1.3 ±0.95. In group 2 the CCT mean ±SD in preoperative is 497.45 ±25.82, in 1 month postoperative 515.64 ±26.59 and in 6 months postoperative is 500.18 ±25.5, the difference between preoperative CCT and 6 months postoperative is 2.73 ±1.64. In term of CD, in group 1 the CD mean ±SD in preoperative is 2678 ±390, in 1 month postoperative is 2599 ±378 and in 6 months postoperative is 2571 ±355, the difference between preoperative CD and 6 months postoperative is -107.17 ±15.53. In group 2 the CD mean ±SD in preoperative is 2872 ±335, in 1 month postoperative is 2703 ±326 and in 6 months postoperative is 2441 ±284, the difference between preoperative CD and 6 months postoperative is -430.8 ±50.31. In term of CV, in group 1 the CV mean ±SD in preoperative CV is 34.4 ±2.95, in 1 month postoperative is 35.2 ±3.05 and in 6 months postoperative is 35 ±2.6, the difference between preoperative CV and 6 months postoperative is 0.7 ± 1.34 which is statistically insignificant. In group 2 the CV mean ±SD in preoperative CV is 36 ±3, in 1 month postoperative is 37 ±3.16 and in months postoperative is 36 ±3.2, the difference between preoperative CV and 6 months postoperative is -0.3 ±1.64 which is statistically insignificant. In term of HEX, in group 1 the HEX mean ±SD in preoperative is 34 ±8, in 1 month postoperative 29 ±7 and in 6 months postoperative 28 ±7, the difference between preoperative and 6 months postoperative is -6.2 ±1.55 which is statistically significant. In group 2 the mean HEX mean ±SD in preoperative is 33 ±10, in 1 month postoperative is 25 ±7 and in 6 months postoperative is 24 ±7, the difference between preoperative HEX and 6 months postoperative is -8.7 ±2.58 which is statistically significant. In term of BCVA, in group 1 the BCVA mean ±SD in preoperative is 0.15 ±0.05, in 1 month postoperative is 0.38 ±0.11 and in 6 months postoperative is 0.5 ±0.07, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. In group 2 the BCVA mean ±SD in preoperative is 0.128 ±0.034, in 1 month postoperative is 0.285 ±0.0369 and in 6 months postoperative is 0.392 ±0.093, the difference between preoperative BCVA and 6 months postoperatively is statistically significant. Conclusion: The endothelium in diabetic subjects is more vulnerable to surgical trauma and has a lower capability in the process of repair.