Changes In Endothelial Cell Density Research Articles

Effect of Intravitreal Injection of Ranibizumab (Lucentis®) on Corneal Endothelial Cell Density and Morphology

Abstract Background VEGF has an essential role in initiating wound and inflammation-related neovascularization. Several studies have demonstrated that VEGF is an important mediator of blood– retinal-barrier breakdown, leading to fluid leakage below the macula and inducing the development of macular edema and choroidal neovascular membranes. Anti-VEGF agents interfere with its receptor binding, thus inhibiting VEGF’s signal, which results in inhibition of abnormal blood vessel formation and decreasing vascular permeability. Aim of the Work This study aimed is to report early changes in the corneal endothelial cell density (ECD) and morphology in patients undergoing intravitreal anti-VEGF injections (ranibizumab) for treatment of macular edema. Patients and Methods This prospective study included 22 eyes of 22 DME patients indicated for IVI of Ranibizumab, with mean age 57.1±7.4 years, ranging from 42.0 years to 70.0 years. The majority of them were females (77.3%). Results Cell density (endothelial cell count) at baseline (2601.8±220.0) didn’t show statistically significant difference than that at one month (2598.9±198.1) after IVI. Coefficient variant was not significantly changed at month-1 as compared to baseline. Coefficient variant at baseline was 29.8±4.0, ranging from 22.0 to 39.0. and at one month was 31.3±5.4, ranging from 21.0 to 48.0. Hexagonal cells (HEX) were not significantly changed at one month as compared to baseline. Hexagonal cells at baseline were 68.9±3.2, ranging from 63.0 to 75.0 and after one month, it was 67.8±4.1, ranging from 60.0 to 76.0. Pachymetry was not significantly changed at one month as compared to baseline. The corneal thickness (pachymetry) at baseline was 538.8±40.1 ranging from 448.0–587.0 to 447.0–597.0. after one month of IV ranibizumab it was 536.3±42.1 0.183. Conclusion A single IV injection of Ranibizumab in phakic and otherwise normal eyes with DME showed no change in ECD and pachymetry but a statistically non-significant increase in CV and decrease in HEX 1-month after injection.

Assessment of the Predictive Ability of Theranostics for Corneal Cross-linking in Treating Keratoconus: A Randomized Clinical Trial

PurposeTo validate the ability of theranostic imaging biomarkers in assessing the propensity of corneal cross-linking (CXL) in flattening the maximum keratometry (Kmax) index. DesignProspective, randomized, multicenter, masked clinical trial (NCT05457647). ParticipantsFifty patients with progressive keratoconus. InterventionParticipants were stratified to undergo epithelium-off (epi-off; 25 eyes) and epithelium-on (epi-on; 25 eyes) CXL protocols using UV-A medical device incorporating theranostic software module. The device used controlled UV-A light both for performing CXL and for estimating the corneal riboflavin concentration (riboflavin score) and assessing treatment effect (theranostic score) in real time. A 0.22% riboflavin formulation was applied onto the cornea for 15 minutes and 20 minutes in epi-off and epi-on protocols respectively. All eyes underwent 9 minutes UV-A irradiance at 10 mW/cm2. Main Outcome MeasuresThe primary outcome measure was validation of the combined use of theranostic imaging biomarkers through measurement of their accuracy (proportion of correctly classified eyes) and precision (positive predictive value) to correctly classify eyes and positively predict a Kmax flattening at 1 year after CXL. Other outcome measures were the change of Kmax, endothelial cell density, uncorrected and corrected distance visual acuity, manifest spherical equivalent refraction, and central corneal thickness one year after CXL. ResultsAccuracy and precision of the combined use of theranostic imaging biomarkers in predicting eyes that had more than 0.1 diopter (D) Kmax flattening at 1 year were 91% and 95% respectively. The Kmax value significantly flattened by a median of -1.3 D (IQR: -2.11, -0.49 D; P < 0.001); both the uncorrected and corrected distance visual acuity improved by a median of -0.1 LogMAR (IQR: -0.3, 0.0 LogMAR; P < 0.001 and IQR: -0.2, 0.0 LogMAR; P < 0.001 respectively). There were no significant changes in endothelial cell density (P = 0.33) and central corneal thickness (P = 0.07) 1 year postoperatively. ConclusionsThe study demonstrated the efficacy of integrating theranostics in a UV-A medical device for the precise and predictive treatment of keratoconus with epi-off and epi-on CXL protocols. The concentration of riboflavin and its UV-A light mediated photo-activation in the cornea are the primary factors determining CXL treatment efficacy.

Corneal Endothelial Morphology and Ocular Biometric Indexes in Premature Children With and Without Retinopathy of Prematurity.

The purpose of this study was to analyze human corneal endothelial cells (HCECs) morphology and ocular biometrics in premature (PM) children with or without retinopathy of prematurity (ROP). Retrospective data on patient demographics, HCECs status, and ocular biometrics with at least 2 visits between 2016 and 2021 were reviewed. The main outcomes were endothelial cell density (ECD), coefficient of variation (CV), hexagonal cell ratio (HEX), central corneal thickness (CCT), axial length, anterior chamber depth, keratometry, corneal diameter, pupil diameter, and refraction status. Generalized estimating equation was used to evaluate the differences between PM no-ROP and ROP groups. We also analyzed the trend of ECD, CV, HEX, and CCT change with age between groups. The study included 173 PM patients without ROP and 139 patients with ROP. A total of 666 and 544 measurements were recorded in the PM no-ROP and ROP groups, respectively. The ROP group had higher spherical power, myopic spherical equivalent (SE), and steeper steep keratometry (K; P < 0.05). The ROP group had higher CV (P = 0.0144), lower HEX (P = 0.0012) and thicker CCT (P = 0.0035). In the HCECs parameters, the ROP group had slower ECD decrement (P < 0.0001), faster CV decrement (P = 0.0060), and faster HEX increment (P = 0.0001). A difference in corneal morphology changes between the ROP and PM no-ROP groups were prominent in patients with lower gestational age (GA) in the subgroup analysis. Worse HCECs morphology and higher myopic status were initially observed in patients with prior ROP but not in PM patients with no-ROP. ECD and HCECs morphology improved with age, especially in patients with low GA.

Intraoperative Performance and Early Postoperative Outcomes Following Phacoemulsification With Three Fluidic Systems: A Randomized Trial.

To compare intraoperative performance and early postoperative outcomes following phacoemulsification with two systems using active fluidics and one using gravity-based fluidics. In this prospective randomized trial, 200 eyes were randomized to the traditional and Active Sentry groups (n = 80 eyes each) where the Centurion Vision System was used with traditional or Active Sentry (Alcon Laboratories, Inc) hand-pieces, respectively, or the Infinit group (n = 40 eyes) where the Infiniti Vision System (Alcon Laboratories, Inc) was used. Within the traditional and Active Sentry groups, there were two subgroups with low (30 mm Hg) or high (55 mm Hg) intraocular pressure (IOP) used. Outcome measures compared were: cumulative dissipated energy (CDE), percentage change in central corneal thickness (CCT) at 1 day, 1 week, and 1 month, anterior chamber cells at 1 day and 1 week, rate of rise and fall of IOP following occlusion break, corneal endothelial cell density (ECD), and macular thickness 6 months postoperatively. CDE was significantly lower in group II compared to the traditional group (2.96 ± 1.4 vs 4.14 ± 2.2, P = .001). With 30 mm Hg IOP, the Active Sentry group had significantly less percentage change in CCT at 1 week postoperatively compared to the traditional handpiece group (0.01% vs 0.02%, P = .008). Incidence of anterior chamber cells less than grade 2 on day 1 was significantly higher in the Active Sentry group (82.9% vs 52%, P = .03). Percentage change in ECD was significantly lower in the Active Sentry group (-0.957 vs -0.98%, P = .005). Significantly faster rise of IOP to baseline following occlusion break was seen in the Active Sentry group. The use of Active Sentry handpiece was associated with lower CDE, less postoperative increase in CCT, fewer anterior chamber cells, and faster rise of IOP following occlusion break. [J Refract Surg. 2024;40(5):e304-e312.].

Causes and outcomes of implantable collamer lens explantation in patients with corneal endothelial cell loss.

To investigate the correlated factors of corneal endothelial cell density (ECD) loss and ECD change in implantable collamer lens (ICL) explantation patients. Seoul St. Mary's Hospital, Seoul, South Korea. Retrospective analysis. The study cohort consisted of 93 eyes from 50 patients who underwent ICL explantation. Correlation analysis was performed to assess the ocular parameters associated with ECD loss, while percentage of ECD change (ΔECD%) was monitored up to 6 months postoperatively. Receiver operating characteristic (ROC) curve was used to set cutoff values of ocular parameters to prevent ECD loss after explantation. In multiple regression analysis, high vaulting, high vaulting/anterior chamber depth (ACD), low anterior chamber angle (ACA), and high iris pigmentations are the significant factors of ECD loss. At postoperative 6 months, 14 eyes (15.1%) had decrease (10.5% loss), 47 eyes (51.0%) were stationary, and 32 eyes (34.4%) had increase (12.7% gain) of ECD. The ROC curve analysis showed that vaulting had the highest area under the curve (AUC = 0.822), followed by vaulting/ACD (AUC = 0.821), ECD (AUC = 0.753), and ACA (AUC = 0.723) (all P < .01). Preoperative ECD showed a sensitivity of 77.6% and specificity of 86.7% in preventing ECD loss after explantation, with a cutoff value of 1722 cells/mm 2 , as determined by ROC curve analysis. Our study demonstrated that high vaulting is a significant factor in ECD loss among ICL-inserted patients. To prevent continuous ECD loss in ICL patients, close monitoring of ECD and making appropriate decisions regarding explantation may be necessary.

Phacoemulsification using an active fluidics system at physiologic vs high intraocular pressure: impact on anterior and posterior segment physiology.

Evaluate the impact of high vs low intraoperative intraocular pressure (IOP) during phacoemulsification on anterior and posterior physiology. Private practice in Des Moines, Iowa. Prospective, randomized, paired-eye clinical trial of patients anticipating bilateral cataract surgery. 27 participants randomized at the time of their first cataract surgery to either low IOP or high IOP group. The subsequent cataract surgery was performed under the alternate condition. During phacoemulsification and cortex removal, IOP was maintained either at low (≤28 mm Hg) or at high (≥55 to 60 mm Hg) levels. The primary outcome was fluid usage, with secondary outcomes of central corneal thickness, foveal avascular zone area, foveal and macular thickness, endothelial cell density (ECD), and postoperative inflammation. Surgery with low IOP settings used less fluid (40.0 mL vs 55.6 mL, P < .0001). Corneal thickness changes were smaller in low IOP eyes at 1 day and 1 week (3.0% vs 8.1%, P = .01; 3.1% vs 4.4%, P = .01) but were similar by 1 and 3 months. ECD dropped less in low IOP eyes at 1 and 3 months (-1.7% vs -12.3%, P = .001, 2.1% vs -8.9%, P = .0003.) IOP remained a significant predictor of ECD change when relationship was controlled for fluid use and phacoemulsification energy. Retinal parameters did not vary among all eyes or when compared by IOP setting. Visual acuity was similar at all timepoints. Low IOP settings resulted in less inflammation and less corneal trauma, as evidenced by a smaller drop in ECD and less postoperative corneal edema, when compared with high IOP settings. Retinal parameters did not change significantly. The different outcomes did not result in a difference in visual acuity.

Enhanced Surgical Safety through Protective Penetrating Keratoplasty: A Retrospective Analysis of 22 Cases.

To assess the surgical safety, postoperative outcomes, and the impact of PPK on corneal endothelial cell density through a retrospective analysis of 22 cases. Settings and Design. A retrospective cross-sectional observational study was executed at Hermanos Ameijeiras Hospital from February 2018 to December 2021, involving 22 patients (22 eyes) who were unresponsive to other medical treatments and had a corrected distance visual acuity of ≤0.1. Patients underwent PPK, with surgical procedures and postoperative care documented. Statistical analysis was performed on qualitative and quantitative variables to evaluate the surgical outcomes and the corneal endothelial cell density changes postoperation. All surgeries demonstrated a significant improvement in postoperative visual acuity (p ≤ 0.001) and recorded a 9.2% decrease in the corneal endothelial cell density at 12 months. Noteworthy complications included one case of intraoperatively discovered haptic dislocation and one postoperative bacterial keratitis. PPK could potentially mitigate perioperative complications, ensure graft clarity, and reduce corneal endothelial cell loss, presenting itself as a viable alternative to traditional PK. Although the results are encouraging, larger-scale studies are essential to validate the benefits and applicability of PPK in broader clinical settings.

Donor Cornea Storage Temperature: Investigation of the Time Period Immediately Before Cornea Transplantation Surgery

Purpose: Donor cornea storage temperature seems to affect tissue viability; however, the time period between removal from storage and transplant surgery has not been explored. We investigated the possible impact time at room temperature in the operating room may have on endothelial cell density (ECD) and corneal thickness (CT). Methods: In our simulation, transplant-ineligible corneas underwent 1 of 4 room temperature protocols. ECD (by specular microscopy) and CT (by anterior segment optical coherence tomography [OCT]), measured before and after protocols, were used to explore possible effects of time at room temperature. Control group tissue resided at room temperature only long enough for warming and subsequent ECD and CT measurements. Results: Corneas underwent one of the following protocols: 1) 17 (±1) minutes at room temperature (for baseline OCT measurements; n = 13) followed by 23 minutes at 35°C (to facilitate specular imaging, conducted for all 4 protocols), 2) 60 (±1) minutes (1 hour; n = 8) at room temperature, 3) 187 (±1) minutes (approximately 3 hours; n = 7) at room temperature, and 4) 416 (±1) minutes (approximately 7 hours; n = 7). Statistical analysis showed no significant difference in ECD change (P = 0.353) or CT change (P = 0.415) between protocol groups. Controlling for donor age and death-to-preservation time rendered no statistical significance. Conclusions: Time at room temperature did not seem to significantly influence ECD or CT measured soon after warming. Studies exploring ECD postoperatively and long-term graft survival are needed to assess the possible clinical impact of preoperative time at room temperature.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

Comparison of Corneal Endothelial Cell Loss during Manual Small-incision Cataract Surgery using Visco-expression versus Irrigating Wire Vectis-assisted Nucleus Removal: A Prospective Randomised Study

Introduction: Age-related cataract is the leading cause of curable blindness in India, and Manual Small-Incision Cataract Surgery (MSICS) is a machine-independent and cost-effective alternative to phacoemulsification for handling this significant burden. In every cataract surgery, some endothelial cell loss is inevitable. Therefore, the present study was conducted to compare endothelial cell loss in the two most commonly practiced methods of nucleus delivery in MSICS. Aim: To compare and analyse endothelial cell loss during MSICS using viscoelastic/viscoexpression-assisted nucleus removal versus irrigating wire vectis-assisted nucleus removal. Materials and Methods: A prospective randomised interventional study was conducted at the Regional Institute of Ophthalmology, Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India. The study duration was three years, from May 2018 to May 2021. A total of 250 patients with uncomplicated senile cataract over 40 years of age, with nuclear sclerosis of grade 2 or higher and “with the rule” astigmatism, were included in the study. The patients were randomly divided into Group A and Group B (125 each), who underwent MSICS using visco-expression (Group A) versus irrigating wire vectis-assisted (Group B) nucleus removal. Visual Acuity (VA), keratometry, astigmatism, pachymetry, and Endothelial Cell Density (ECD) were recorded in every patient preoperatively and postoperatively on day 1 and day 40. The Shapiro-wilk test was used to assess the normality of the data, and student’s t-test was performed to identify significant differences in continuous factors between the two groups. Chi-square test was used to find the association between factors and techniques, with a p-value &lt;0.05 considered statistically significant. Results: The mean age of the patients was 68.5±9.4 years (range 52-89 years) with a significant male preponderance. The mean LogMAR visual acuity on Postoperative Day (POD)-1 was 0.3±0.1 for Group A, while for Group B, it was 0.5±0.2, showing a statistically significant difference (p=0.004). However, on day 40, visual acuity was comparable in both groups, with Group A (0.1±0.2) and Group B (0.1±0.1), and no significant difference (p=0.09). On POD-1, the percentage change in Endothelial Cell Density (ECD) was 4.2% in Group A and 10.6% in Group B, with a statistically significant difference (p=0.0017). On day 40, it was 2.1% and 4.8% in Group A and Group B, respectively, also showing a statistically significant difference (p=0.003). On postoperative day 40, the mean Surgically Induced Astigmatism (SIA) in Group A and Group B was 0.67±0.24 and 0.74±0.41, respectively, but this difference was statistically insignificant (p=0.074). Intra and postoperative complications such as hyphema, iridodialysis, and corneal oedema were more common in Group B than Group A. Conclusion: The study concludes that there was a statistically significant endothelial cell loss in the irrigating wire vectisassisted nucleus delivery method compared to the viscoexpression of the nucleus during MSICS. The present method also showed delayed visual rehabilitation and a higher risk of intra and postoperative complications. Therefore, viscoexpression of the nucleus should be the preferred method of nucleus delivery in every MSICS where feasible.

Comparison of short‐term clinical outcomes between sutured scleral fixation and modified Yamane sutureless scleral fixation

Aims/Purpose: To compare and investigate the short‐term clinical outcomes between 10‐0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analysed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for 1 week after surgery and IOL astigmatism for 1 week and 1 month after surgery were significantly lower in sutureless fixation group. There was no significant difference in post‐operative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

Comparison of implantation of posterior chamber phakic IOL implantation and laser vision correction in terms of corneal endothelial cells: 3-year observational paired-eye study.

To compare the postoperative endothelial cell counts of EVO-implantable collamer lenses (ICLs) with a central hole (V4c and V5) and laser vision correction surgery (laser in situ keratomileusis or photorefractive keratectomy). B&VIIT Eye Center, Seoul, South Korea. Retrospective observational and paired contralateral study. 62 eyes of 31 patients who underwent EVO-ICLs with a central hole implantation in one eye (phakic intraocular lens [pIOL] group) and laser vision correction in the contralateral eye (LVC group) to correct refractive errors were retrospectively reviewed. Central endothelial cell density (ECD), percentage of hexagonal cells (HEX), coefficient of variation (CoV) in cell size, and adverse events were evaluated for at least 3 years. The endothelial cells were observed using a noncontact specular microscope. All surgeries were performed, without complications during the follow-up period. The mean ECD loss values compared with the preoperative measurements were 6.65% and 4.95% during the 3 years after pIOL and LVC, respectively. There was no significant difference in ECD loss compared with the preoperative values (paired t test, P = .188) between the 2 groups. No significant loss in ECD was observed at any timepoint. The pIOL group showed higher HEX ( P = .018) and lower CoV ( P = .006) values than the LVC group at the last visit. According to the authors' experience, the EVO-ICL with a central hole implantation was a safe and stable vision correction method. Moreover, it did not induce statistically significant changes in ECD at 3 years postoperatively compared with LVC. However, further long-term follow-up studies are required to confirm these results.

Evaluation of Corneal Endothelial Cell Density Changes in Eyes with Silicone Oil Tamponade after Pars Plana Vitrectomy

Aim To assess the changes in corneal endothelium by non-contact specular microscopy in eyes treated by pars plana vitrectomy (PPV) with temporary silicone oil (SO) tamponade with or without phacoemulsification. Patients and Methods We enrolled 24 patients, assigned into two groups: 12 patients underwent pars plana vitrectomy with SO injection (group 1) and 12 patients underwent combined phaco-vitrectomy with SO injection (group 2). All of them underwent an ophthalmological examination, which included: best corrected visual acuity (BCVA), intraocular pressure measurement, fundus examination and specular microscopy follow ups at the 1st week,1st month and 3rd month visits. Results The initial count of endothelial cell density (ECD) in group 1 was 2543.58 ± 759.62 cell/mm2 which decreased at 3rd month visit to 2299.33 ± 729.87 cell/mm2, while in group 2 was 2621.08 ± 514.50 &amp; 2307.50 ± 575.55 cell/mm2 respectively. We found statistically significant decrease in the mean cell density (MCD) in group 1 and group 2, at the 3rd month than at the 1st week. Three months after operation, coefficient of variation (CV) was 34.58 ± 4.29 % and 35.75 ± 4.16%, hexagonality (HEX) was 46.83 ± 8.67 % and 47.83 ± 10.50%, while mean central corneal thickness (CCT) was 553.08 ± 22.13 μm and 548.17 ± 33.12 for group 1 and 2 respectively, and no corneal edema reported at the study end. Conclusion The pars plana vitrectomy (PPV) with silicone oil (SO) injection procedure caused changes in corneal endothelial cells in varying between pleomorphism (decreased HEX), polymegathism (increased CV) and endothelial cell loss. A higher incidence of CV increase (polymegathism) reported after combined phaco-vitrectomy than pars plana vitrectomy alone with silicone tamponade. We recommend SO removal after achieving the proposed tamponading action of SO to avoid SO keratopathy.

Safety and effectiveness comparison of a new cohesive ophthalmic viscosurgical device.

Evaluation of the safety and effectiveness of a new cohesive OVD (StableVisc) compared to a marketed cohesive OVD (ProVisc) in patients undergoing cataract surgery. 22 sites in the United States. Prospective, multicenter, controlled, double-masked, and randomized 1:1 (StableVisc:ProVisc; stratified by site, age group, and cataract severity). Adults (≥45 years) with age-related non-complicated cataract considered amenable to treatment with standard phacoemulsification cataract extraction and IOL implantation were included. Patients were randomized to receive either StableVisc or ProVisc during standard cataract surgery. Postoperative visits occurred at 6 hours, 24 hours, 7 days, 1 month, and 3 months. The primary effectiveness outcome was the change in endothelial cell density (ECD) from baseline to 3 months. The primary safety endpoint was the proportion of patients who experienced at least one IOP measurement ≥30 mmHg at any follow-up visit. Noninferiority between the devices was tested. Inflammation and adverse events were evaluated. 390 patients were randomized; 187 patients with StableVisc and 193 patients with ProVisc completed the study. StableVisc was noninferior to ProVisc in mean ECD loss from baseline to 3 months (17.5% and 16.9%, respectively). StableVisc was noninferior to ProVisc in the proportion of patients with postoperative IOP ≥30 mmHg at any follow-up visit (5.2% and 8.2%, respectively). StableVisc cohesive OVD, which provides both mechanical and chemical protection, is safe and effective when used in cataract surgery and provides surgeons with a new cohesive OVD.

Corneal Outcomes Following Cataract Surgery Using Ophthalmic Viscosurgical Devices Composed of Chondroitin Sulfate-Hyaluronic Acid: A Systematic Review and Meta-Analysis.

Ophthalmic viscosurgical devices (OVDs) are commonly used during cataract surgery to protect the corneal endothelium. A systematic literature review and meta-analysis were conducted to assess the clinical evidence of OVDs composed of chondroitin sulfate-hyaluronic acid (CS-HA) versus other OVDs in maintaining endothelial cell density (ECD) and corneal thickness (CT). MEDLINE and EMBASE databases were searched from 2000 to 2020. Randomized controlled trials (RCTs, N ≥ 20 per group) comparing an OVD containing CS-HA (ie, VISCOAT®, DuoVisc® or DisCoVisc®) to any other OVD were included. The identified comparators were limited to the OVDs found in the literature, which included those composed of HA-only or hydroxypropyl methylcellulose (HPMC). Outcomes of focus included changes in ECD (baseline to 3 months) and CT (baseline to 24 hours). Meta-analyses were performed using R software, to assess mean differences (MD) in ECD and CT change between CS-HA OVDs and HA-only or HPMC OVDs. A total of 966 abstracts were screened, and data were extracted from 12 RCTs. Meta-analyses using a random-effects model revealed significantly lower percent (%) decrease in ECD for CS-HA OVDs compared to both HA-only (MD: -4.10%; 95% CI: -5.81 to -2.40; p < 0.0001; 9 studies) and HPMC (MD: -6.47%; 95% CI: -10.41 to -2.52; p = 0.001; 2 studies) products. Similarly, % CT increase was significantly lower with CS-HA than with HA-only OVDs (MD: -3.22%; 95% CI: -6.24% to -0.20%; p = 0.04; 4 studies). However, there were no significant differences when comparing % CT change between CS-HA and HPMC OVDs (MD: 2.65%; 95% CI: -0.43% to 0.95%; p = 0.4; 2 studies). CS-HA OVDs lead to less postoperative loss of endothelial cells and may better protect corneal endothelium during cataract surgery, relative to other OVDs. Future randomized studies may be needed to solidify these findings.

Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment of dislocated intraocular lenses

BackgroundTo compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL).MethodsThirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed.ResultsThe major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was − 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01).ConclusionAll three IOL repositioning techniques resulted in favorable ocular prognosis.

Donor Endothelial Cell Density Not Changed Immediately After Ex Vivo Corneal Cross-Linking

Purpose: The aim of this study was to evaluate the effect of corneal cross-linking on central endothelial cell density (ECD) by comparing masked measurements before and immediately after preparation of cross-linked (CXL) and non–cross-linked (non-CXL) donor corneas. Methods: Thirty donor corneas were randomized 1:1 to either CXL or non-CXL using a modified Dresden protocol. Specular microscopic images of the central corneal endothelium were obtained within 36 hours of recovery and within 3 hours of preparation completion. Images were sent to a central cornea image analysis reading center for ECD determination in a masked, dual-graded manner. Results: Before and after preparation, the mean ECD was 2567 ± 305 cells/mm2 and 2525± 339 cells/mm2 for the CXL group (n =15) and 2652 ± 365 cells/mm2 and 2572 ± 513 cells/mm2 for the non-CXL group (n =15), respectively. The mean difference in ECD before and after preparation was not statistically significant for the CXL and non-CXL groups (P = 0.36; P = 0.31, respectively). In addition, an independent sample t test showed no statistically significant difference in the ECD change between the CXL and non-CXL groups (P = 0.67). Conclusions: Our specular microscopic findings show that ex vivo cross-linking of donor corneas does not seem to produce acute decrease of central endothelial cell density. These findings are encouraging and assist in warranting a clinical trial examining its value in reducing refractive errors and improving postoperative visual outcomes in eyes with keratoconus that undergo keratoplasty.

Comparison of Short-term Clinical Outcomes between Sutured Scleral Fixation and Modified Yamane Sutureless Scleral Fixation

Purpose: To compare and investigate the short-term clinical outcomes between 10-0 polypropylene sutured intraocular lens (IOL) scleral fixation and modified Yamane sutureless IOL scleral fixation in patients with IOL or crystalline les dislocation and aphakic state.Methods: From August 2012 to May 2022, medical records were retrospectively analyzed for 43 patients with sutured scleral fixation and 40 patients with sutureless scleral fixation. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), total astigmatism, IOL astigmatism, refractive error, corneal endothelial cell density, surgical time and complications were compared before surgery, 1 week, 1 month, and 3 months after surgery.Results: In the two groups, after 3 months of surgery, UCVA and BCVA improved compared to before surgery, but there was no significant difference between two groups. The absolute refractive error and total astigmatism for one week after surgery and IOL astigmatism for one week and one month after surgery were significantly lower in sutureless fixation group. There was no significant difference in postoperative corneal endothelial cell density changes between two groups, and total surgical time and IOL fixation time were measured significantly lower in sutureless fixation group.Conclusions: Although modified Yamane sutureless IOL scleral fixation did not show significant improvement in visual acuity compared with conventional sutured IOL scleral fixation, sutureless fixation provided better stability of IOL in the early stages after surgery and short in the surgical time. So it can be an effective alternative to conventional sutured scleral fixation in patients with IOL or crystalline lens dislocation and aphakic state.

Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure.

To evaluate the effects of micropulse transscleral cyclophotocoagulation (mCPC) and selective laser trabeculoplasty (SLT) on endothelial cell density (ECD) and reduction of the intraocular pressure (IOP) in patients with primary-open angle glaucoma (POAG). In this observational, retrospective study, 40 eyes with POAG were included. Patients were divided into three groups-group I was treated with SLT (n = 13), group II was treated with mCPC (n = 13), and group III included age-matched patients with medically treated glaucoma (n = 14) (control group). In both treatment groups (SLT and mCPC) preoperative and postoperative findings of best-corrected visual acuity (BCVA), ECD, and IOP were compared to the control group. The mean time interval before and after the treatment was 215 ± 120 days in group I (SLT) and 273 ± 177 days in group II (mCPC). The follow-up for group III (control group) was 209 ± 103 days. In both treatment groups (SLT and mCPC) there was a statistically significant reduction of the IOP postoperatively (group I: 3.5 ± 3.7 mm Hg (p = 0.005) and group II: 4.3 ± 4.1 mm Hg (p = 0.003)). The mean IOP for group III was 12.9 ± 3.7 mm Hg at visit 1 and did not change significantly (p = 0.353) at visit 2. In all three groups, there was no statistically significant change in ECD at the last visit. According to our results, both SLT and mCPC seem to be effective in lowering the IOP, without showing any statistically significant effect on ECD in patients with POAG.However, larger and longer-term studies are necessary to understand the effects of the SLT and mCPC procedures on ECD. Garip Kuebler A, Priglinger S, Reznicek L. Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure. J Curr Glaucoma Pract 2023;17(1):40-43.

Long-Term Endothelial Safety Profile With iStent Inject in Patients With Open-Angle Glaucoma

To report 5-year postoperative safety data of iStent inject, including overall stability, endothelial cell density (ECD), and endothelial cell loss (ECL) in patients with mild-to-moderate primary open-angle glaucoma (POAG). 5-year follow-up safety study of the prospective, randomized, single-masked, concurrently controlled, multicenter iStentinject pivotal trial. In this 5-year follow-up safety study of the 2-year iStent inject pivotal randomized controlled trial, patients receiving iStent inject placement and phacoemulsification or phacoemulsification alone were studied for the incidence of clinically relevant complications associated with iStent inject placement and stability. Corneal endothelial endpoints were mean change in ECD from screening and proportion of patients with >30% ECL from screening, from analysis of central specular endothelial images by a central image analysis reading center at several time points through 60 months postoperatively. Of the 505 original randomized patients, 227 elected to participate (iStent inject and phacoemulsification group, n=178; phacoemulsification-alone control group, n=49). No specific device-related adverse events or complications were reported through month 60. No significant differences were observed in mean ECD, mean percentage change in ECD, or proportion of eyes with >30% ECL between the iStent inject and control groups at any time point; mean percentage decrease in ECD at 60 months was 14.3% ± 13.4% in the iStent inject group and 14.8% ± 10.3% in the control group (P=.8112). The annualized rate of ECD change from 3 to 60 months was neither clinically nor statistically significant between groups. Implantation of iStent inject during phacoemulsification in patients with mild-to-moderate POAG did not produce any device-related complications or ECD safety concerns compared to phacoemulsification alone through 60 months.