Cornea Guttata Research Articles

Prevalence and severity of cornea guttata in the graft following Descemet Membrane Endothelial Keratoplasty (DMEK).

The aim of this study was to determine the prevalence and severity of cornea guttata (CG) in grafts after Descemet membrane endothelial keratoplasty (DMEK) and to investigate its impact on various clinical parameters during follow-up. This retrospective study included 664 operations (DMEK and triple-DMEK) on 466 patients. The prevalence and progression of CG after the operation were examined using endothelial specular microscopy images. The severity grade of CG was classified into four grades: G0 without CG, G1 - G3 with increasing severity of CG. Clinical parameters such as central corneal thickness (CCT), visual acuity (VA), endothelial cell density (ECD), pleomorphism and polymegalism were examined during a postoperative follow-up time of 19.6 ± 15.8 months. Cornea guttata (CG) appeared postoperatively in 124 (18.7%) eyes. 112 (16.9%) could be classified as G1, 9 (1.4%) as G2 and only 3 (0.5%) as G3. The examination of clinical parameters showed significant differences between healthy and low-grade CG (G0/G1) and high-grade CG (G2/G3). A significant deterioration was found in the corrected distance visual acuity (CDVA) (p = 0.02). CCT showed an increase between G0 (534 ± 58 μm) and G2 (549 ± 71 μm)/G3 (558 ± 56 μm) with a p-value of 0.02. Additionally, a significant increase in pleomorphism (p = 0.003) and polymegalism (p = 0.04) was detected. Cornea guttata (CG) prevalence after DMEK and triple-DMEK was found to be 18.7%, although most of these cases were classified as low-grade CG and showed no clinical significance. Around 1.9% were classified as high-grade CG and significantly affected several clinical parameters during the follow-up.

Donation Process and Evaluation of Corneal Tissue in a Slit Lamp

The process of capturing and classifying the viability of corneal tissue for corneal transplantation is complex. The biomicroscopic examination is one of the techniques used to evaluate the quality of corneal tissues. The aim of this study was to analyze the relationship between the evaluation criteria used in biomicroscopic examination using a slit lamp and the classification of the quality of corneal tissue. This is a longitudinal, retrospective cohort study, performed at the Human Ocular Tissue Bank in the state of Rio Grande do Norte, Brazil. The sample consisted of 419 corneas donated between 2005 to 2016. After the evaluation, the 419 corneas were classified as excellent (8 -1.91%), good (217 - 51.79%), regular (85 - 20.29%), and bad (109 - 26.01%). The classification of corneal quality attributed by ophthalmologists considered 13 criteria: senile arch, scars, epithelial defect, epithelial exposure, stromal infiltrate, subepithelial opacity, pterygium, Descemet's folds, stromal edema, stromal streak, cornea guttata, specular reflex, and cell loss endothelial. The quality of the cornea classified as excellent and good showed a statistically significant association (P value < .05) with senile arch, scar, epithelial defect, epithelial exposure, Descemet's folds, stromal edema, stromal streak, cornea guttata, specular reflex, and losses of endothelial cells; they had evaluated criteria that were absent or slightly present. The evaluation of the corneal quality for corneal transplantation should involve the implementation of reliable techniques and trained, qualified professionals. There is a need to create evaluation instruments that consider the criteria according to their degree of interference in the quality of corneal tissue.

Age-related Changes of the Corneal Endothelium in the Hispanic Elderly Population

Purpose: To assess the corneal endothelial morphometry in healthy elderly Hispanic eyes. Methods: A retrospective, cross-sectional, observational, descriptive, and analytical study was designed to assess the central region of the corneal endothelium by specular microscopy. A total of 241 eyes from 125 patients were studied. All eyes included were from healthy patients 65 or older (mean: 74.56± 6.74), without ocular disease or surgeries. Results: The mean cell density (MCD) was 2198.92±493.43 cells/mm2. 125 (51.87%) eyes had polymegethism, with a mean coefficient of variation (CV) of 42.89 ± 9.16%. 148 (61.41%) eyes presented pleomorphism, with an average of 46.25 ± 7.13% hexagonal cells. The mean corneal thickness was 527.55±28.37 μm. A statistically significant difference between age groups was found for MCD and pachymetry (P&lt;0.05). 41 eyes (17.01%) had cornea guttata. Conclusion: This study suggests that the elderly Hispanic population has a high prevalence of polymegethism, pleomorphism, and guttata. Surprisingly, the oldest age group (&gt;85) had an above-average MCD, with lower rates of polymegethism and pleomorphism. Trial Registration Number: #ARCC/ECH2019 Date of Registration: October 18, 2019

Prevalence and Impact of Cornea Guttata in the Graft After Penetrating Keratoplasty in Germany.

The aim of this study was to analyze the prevalence and severity of corneal guttata (CG) in grafts after penetrating keratoplasty (PKP) and to determine its clinical significance. This retrospective study included 1758 PKP performed in 1522 patients. In total, 6662 postoperative endothelial images revealed the prevalence and severity of CG (divided into categories G0 without CG and G1-G3 with increasing severity). Origin of the graft, postoperative corneal thickness, visual acuity, pleomorphism, polymegethism, and endothelial cell density (ECD) were analyzed. CG was detected in 14.9% of the grafts within 9 months after PKP, most of them were low-grade G1 (13.6%). Grafts from Homburg/Saar showed significantly less CG cases compared with other eye banks ( P = 0.034). The mean corrected distance visual acuity (logMAR) did not differ between G1 (0.45 ± 0.31) and G0 (0.46 ± 0.31). The mean ECD was lower in G1 compared with G0 ( P < 0.001). The mean corneal thickness was higher in G3 (597 ± 101 μm) compared with G0 (541 ± 65 μm) ( P < 0.001). Pleomorphism and polymegethism were correlated with CG ( P < 0.001). A progression of CG severity was detected in 13.5% of the cases during a follow-up time of 25.0 ± 19.9 months. Our study suggested that CG are transplanted in 14.9% of PKP, most of which are low-grade CG not affecting the visual acuity but already leading to an increase in corneal thickness, loss of ECD, and alteration of endothelial cell morphology. In 13.5% of the cases, a progression was demonstrated in the postoperative course.

К вопросу о коморбидности кератоконуса и первичной эндотелиальной дистрофии роговицы Фукса (клинические случаи)

Purpose. To describe the clinical cases and surgery results in patients with concomitant of keratoconus and Fuchs' corneal endothelial dystrophy. Material and methods. Retrospective analysis of 3 patients using different surgical techniques. All patients were female, they underwent diagnostic procedures including: keratotopography, optical coherence tomography of the anterior segment of the eye, Scheimpflug keratotomography, endothelial microscopy. First patient underwent penetrating keratoplasty (PKP), the second one – descemet stripping automated endothelial keratoplasty (DSEK), and the third one – descemet membrane endothelial keratoplasty (DMEK). Results. In all cases the combination of keratoconus and fuchs endothelial corneal dystrophy occurred in one eye, while cornea guttata was observed in both eyes. The diagnosis of keratoconus was complicated by the presence of corneal edema due to endothelial dysfunction. As a result, visual rehabilitation was achieved in 2 patients after PKP and DSEK, and in the third case (DMEK), the presence of pronounced opacities of the stroma in the central zone did not result in increase of visual acuity, despite the good function of the graft endothelium, which required the PKP. Conclusion. Surgical tactics should be based primary on the replacement of the pathologically altered endothelial monolayer (DSEK, DMEK). As for the simultaneous replacement of the corneal stroma (PKP), the decision is based on the progression of keratoconus, the degree of corneal thinning, and the presence of its surface irregularity. Key words: Fuchs' endothelial corneal dystrophy, keratoconus, endothelial keratoplasty, penetrating keratoplasty, Descemet's membrane endothelial keratoplasty, corneal endothelium

Semiquantitative Criteria in the Eye Bank That Correlate with Cornea Guttata in Donor Corneas.

Cornea guttata may not be recognized in the eye bank and recent studies have displayed that guttae are transplanted in about 15% of cases in varying severities. The purpose of this study was to establish semiquantitative criteria for the detection of cornea guttata in donor corneas in the eye bank. In this retrospective cohort study, preoperative endothelial pictures of donor corneas were collected and classified according to the post-penetrating keratoplasty cornea guttata grade into three distinct groups: group 1 consists of healthy corneas with no guttae (guttata grade 0); group 2 constitutes corneas with mild asymptomatic cornea guttata (guttata grade +); and group 3 comprises corneas with advanced widespread cornea guttata (guttata grade ++/+++/++++). The preoperative pictures of each group were then individually analyzed using the following five semiquantitative criteria: The number and the area of the cell-depleted surfaces, the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions, the presence of blebs in the cell membrane, and the presence of groups of cells with a distinct whitish color. In total, 262 patients were included in this study, with a total number of 1582 preoperative donor corneal endothelial pictures. Out of those pictures, groups 1, 2, and 3 encompassed 995 (62.9%), 411 (26.0%), and 176 (11.1%) pictures, respectively. Three out of the five eye bank criteria were found to correlate with postoperative cornea guttata with a highly significant p value of < 0.001. These three criteria are the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions and, the presence of blebs. The presence of groups of cells with a distinct whitish color was only a weak predictive factor for cornea guttata (p = 0.069). There was no statistically significant correlation between the number and the area of cell-depleted surfaces and postoperative cornea guttata with a p = 0.181. Three semiquantitative criteria that can be detected in the eye bank using inverted light microscopy seem to correlate with postoperative cornea guttata: The presence of blebs, the presence of cell membrane defects and interruptions, as well as endothelial pictures with less than 50% of the cells having a hexagonal of circular shape. The presence of groups of cells with a distinct whitish color appears to be a weak predictor of cornea guttata.

A Composite Risk Score for Capsule Complications Based on Data from the Swedish National Cataract Register: Relation to Surgery Volumes

To investigate case mix in relation to capsule complication, possible associations between case mix and operation volume, and change in case mix over time. Register-based study. Swedish patients who underwent cataract surgery between 2007 and2016. Demographics and data on ocular comorbidity, intraoperative difficulties, and capsule complications were registered from 2007 to 2016 and analyzed retrospectively in relation to coded data on individual surgeons' operation volume. Single factor analysis and logistic regression were performed, and a composite risk score was created. Risk of capsule complication, given as adjusted and composite odds ratio in relation to cataract surgery volume. Preoperative and intraoperative variables significantly associated with capsule complications were best-corrected visual acuity (BCVA) ≤0.1 (decimal, adjusted odds ratio [aOR], 1.82; P < 0.001); pseudoexfoliation (PEX) (aOR, 1.53; P < 0.001); sight-threatening ocular comorbidity other than age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, or cornea guttata (aOR, 1.35; P= 0.006); use of Trypan blue (aOR, 1.76; P< 0.001); mechanical pupil dilation (aOR, 1.36; P= 0.024); and iris hooks at the rhexis margin (aOR, 6.99; P <0.001). The composite risk score was 3.09 ± 6.40 (mean ± standard deviation) for patients with capsule complication and 1.28 ± 1.66 for uncomplicated procedures (P < 0.001). High-volume cataract surgeons (≥500 procedures yearly) had a significantly lower composite risk score (mean risk score ≤1.28; range, 1.01-2.02) compared with low- and medium-volume cataract surgeons (1.34 ± 0.56; range, 1.00-4.55 and 1.49 ± 0.58; range, 1.01-5.19), respectively. During the period 2007-2016, the proportion of patients aged >88 years, patients with BCVA ≤0.1, and patients with intraoperative difficulties decreased. Case mix, as calculated from a composite risk score based on preoperative and intraoperative parameters registered in the National Cataract Register (NCR), may contribute to the decrease in capsule complications from 2007 to 2016 and the lower complication rate observed in cases managed by high-volume cataract surgeons.

Clinical safety and efficacy of a hydrophilic acrylic intraocular lens in a real-world population: a 1-year follow-up retro-prospective study

BackgroundThis multicentre, retro-prospective real-world study evaluated the visual, refractive and safety outcomes of a monofocal lens 1 year after implantation in cataract patients with or without pre-existing ocular pathologies.MethodsRecords from 4 centres in Germany and Sweden were reviewed to select eyes with aged-related cataracts, having undergone crystalline lens extraction by phacoemulsification and implantation of a CT ASPHINA 409 IOL. Preoperative, 1-month and 3-month postoperative data was collected retrospectively. In addition, included patients attended a prospective visit 12 months or later after surgery. The examination included: monocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), subjective refraction, slit-lamp examination, optical biometry, intraocular pressure (IOP), endothelial cell count and postoperative complications.Results282 eyes, including 94 with pre-existing ocular pathologies, were analysed. Twelve months after the surgery, 95% of eyes achieved monocular CDVA equal or better than 0.3 logMAR, mean postoperative CDVA was 0.06 ± 0.17 logMAR, and mean UDVA 0.31 ± 0.29 logMAR. Visual acuity outcomes were better in eyes with no pre-existing ocular pathologies, but both groups showed a statistically significant improvement after surgery compared with preoperative values (p ≤ 0.002). The mean sphere and spherical equivalent values also improved significantly postoperatively (p = 0.003). Overall, 62.1% of eyes had spherical equivalent within ±0.5 D and 80.9% within ±1.0 D. The IOL was stable in the capsular bag as demonstrated by tilt and decentration measurements. IOP, corneal status, and endothelial cell count values were in the normal range. Nd:YAG treatment was performed on 9.9% of the eyes.ConclusionThe implantation of the monofocal CT ASPHINA 409 IOL was beneficial to restore vision in eyes with or without concomitant ocular pathology such as macular degeneration, glaucoma, Sicca syndrome, epiretinal membrane, cornea guttata, or amblyopia. Good to excellent long-term visual and refractive outcomes, and a low rate of complications in both healthy and pathological eyes were found 12 months after the surgery.Trial registrationTrial registered on under the identification NCT03145103 (date of registration 9 May 2017).

Corneal thinning and cornea guttata in patients with mutations in TGFB2

ObjectiveHuman genome-wide association studies and animal models suggest a role for TGFB2 in contributing to the corneal thickness phenotype. No specific mutations, however, have been reported in this gene that affect corneal thickness. We sought to determine if haploinsufficiency of TGFB2 in humans associated with Loeys–Dietz syndrome type 4 is associated with corneal thinning. DesignObservational cohort study of families with Loeys–Dietz syndrome type 4, caused specifically by TGFB2 mutations, in a tertiary care setting. ParticipantsThree probands with pathogenic mutations in TGFB2 and family members underwent comprehensive ophthalmic examination. MethodsClinical assessment included Scheimpflug imaging, specular microscopy, and slit-lamp biomicroscopy. We measured visual acuity, axial length, refractive error, and central corneal thickness. ResultsClinical evaluation of 2 probands identified corneal thinning and cornea guttata, despite a young age and distinct mutations in TGFB2 (c.905G>A, p.Arg302His; c.988C>A, p.Arg330Ser). In the third family, corneal thinning co-segregated with a TGFB2 mutation (c.1103G>A, p.Gly368Glu), although without apparent guttae. ConclusionsIn this series, participants with TGFB2 mutations associated with Loeys–Dietz syndrome type 4 demonstrated decreased corneal thickness, and in 2 cases with splice site mutations, also demonstrated cornea guttata. The data demonstrate the importance of considering distinct phenotype–genotype correlations within this condition.

Ex vivo excimer laser ablation of cornea guttata and ROCK inhibitor-aided endothelial recolonization of ablated central cornea.

To determine whether excimer laser ablation of guttae is a viable strategy for removal of diseased tissue in Fuchs' endothelial corneal dystrophy (FECD) on excised human Descemet membranes and whether an excimer laser-created wound on healthy human corneas ex vivo is recolonized with corneal endothelial cells. Descemet membranes of FECD patients and corneal endothelium of normal human corneas were ablated ex vivo using an excimer laser licensed for glaucoma surgery. Specimens were kept in cell culture medium supplemented with 10μm of rho-kinase inhibitor ripasudil. Corneal endothelial cell regeneration was observed using light and electron scanning microscopy. Furthermore, the whole corneal samples were evaluated by haematoxylin/eosin staining and immunohistochemical analysis using antibodies against Na+ /K+ -ATPase. Guttae and corneal endothelium could be ablated with an excimer laser without total ultrastructural damage to theDescemet membrane or stroma. Nearly complete endothelial wound closure was accomplished after 26-38days in treated corneas. Light and electron scanning microscopy suggested the establishment of a layer of flat endothelial cells. Additionally, Na+ /K+ -ATPase expression could only be observed on the inner side of the Descemet membrane. Our proof of concept study demonstrated that excimer lasers can be used to ablate diseased tissue from excised FECD Descemet membranes ex vivo. Additionally, corneal endothelial cells recolonize a previously ablated endothelial area in healthy human corneas ex vivo under treatment with ripasudil. Thus, our results are the first experimental basis to further investigate the feasibility of an excimer laser ablation as a graftless FECD treatment option.

Risk of corneal transplantation after phacoemulsification in patients with cornea guttata

AbstractPurposeTo investigate the risk of corneal transplantation after phacoemulsification related to cornea guttata.MethodsIn this retrospective registry‐based cohort study, patient data from the Swedish National Cataract Register for years 2010‐2012 were linked with data from the Swedish Cornea Transplant Register for years 2010‐2017. Altogether, data from 276,354 cataract patients was linked with data from 2,091 patients with primary and secondary endothelial failure as indication for corneal transplantation. Other surgical methods for cataract extraction than phacoemulsification were excluded. If both eyes had surgery, one eye was randomly selected to obtain unrelated samples. A Kaplan‐Meier curve and Cox regression analysis were used to investigate the risk for corneal transplantation due to endothelial failure after phacoemulsification.ResultsOut of the 3,346 phacoemulsification patients with cornea guttata, 153 underwent corneal transplantation within 6.2 years in median. The cumulative transplantation rate, 6 years after the phacoemulsification was 4.8% in the group with cornea guttata and 0.08% in the group without. The annual transplantation rate among the cornea guttata patients during the first year was 1.64% and diminished the following 5 years to 0.55% in average. The annual transplantation rate among the patients without cornea guttata was 0.01% in average after phacoemulsification during the same period of time. The transplantation hazard ratio for cornea guttata present at the phacoemulsification was 67.6 (95% CI: 53.6.0‐85.3, p &lt; 0.001), when adjusting for potential confounders.ConclusionsThe hazard of corneal transplantation after phacoemulsification was 67.6 times higher with cornea guttata than without. Still, the great majority of the patients with cornea guttata did not undergo corneal transplantation during the study period.

Cornea guttata associated with special phenotypic variants of granular corneal dystrophy type 2 in a Chinese family.

The aim of this study was to analyze the relevant gene mutations in a Chinese family with special phenotypic variants of granular corneal dystrophy type 2 with cornea guttata. A total of 11 individuals from the affected family underwent complete ophthalmic examination. Genomic DNA was extracted from peripheral leukocytes of affected and unaffected family members. High-throughput sequencing was performed to screen for mutations in 290 genes associated with inherited ophthalmic diseases. Results were validated by bidirectional Sanger sequencing. An Arg124His (R124H) mutation of the transforming growth factor beta-induced gene was identified in three members of the affected family: the proband (II-1), his mother (I-2), and his son (III-1). The eyes of the proband and his mother had bilateral superficial whitish ring patches with clear centers occupying their central corneas and appeared to be discoid or ring shaped. In addition, specular microscopic examination showed the presence of dark, round bodies. In vivo confocal microscopy showed some hyporeflective round images (cornea guttata), containing occasionally central highlight, in the proband, his mother, and one of his elder sisters. We report, for the first time, atypical granular corneal dystrophy type 2 with cornea guttata associated with a single R124H mutation in a Chinese family. Our findings emphasize that genotyping is essential for the accurate diagnosis and classification of granular corneal dystrophy type 2.

Association of incidental epithelialization of corneal endothelium with endothelial barrier impairment

PurposeTo identify patients with incidental epithelialization of corneal endothelium (IECE) detected in in vivo confocal microscopy (IVCM) and analyze its association with corneal decompensation.MethodsWe performed a retrospective analysis of IVCM (Rostock Cornea Module, HRT III) scans of 327 patients treated in outpatients clinic for various corneal diseases. After identification of cases with IECE, visual acuity (VA), central corneal thickness (CCT) data, endothelial cell density, as well as slit‐lamp photographs were collected. CCT measurements were obtained using Pentacam (Oculus).ResultsFrom among of 327 IVCM examinations, IECE was visible in 8 patients associated with Posterior Polymorphous Corneal Dystrophy (PPCD) in 3 out of 6 patients with an IVCM diagnosis of PPCD; Fuch's Endothelial Dystrophy (FED) in 3 out of 12 FED patients with available IVCM scans. One patient was diagnosed with unilateral IECE after the incident of facial UV‐light burn (tanning salon) with the unilateral mild burn of the ocular surface. One patient presented unilateral IECE in superior half of the cornea due to epithelial ingrowth after cataract surgery. PPCD patients with presence of IECE developed corneal edema and greater endothelial cell loss, in contrast to age‐matching PPCD patients without IECE. Patients with FCD or cornea guttata developed corneal decompensation and visual impairment at the earlier age (before 50 y.o.) than FCD patients without IECE. Advanced IECE observed in the patient with ingrowth syndrome, as well as epithelial metaplasia after UV‐light burn resulted in severe visual impairment.ConclusionsDiagnosis of corneal diseases should be supplemented by IVCM examination. IECE observed in IVCM could be considered as a prognosis factor of visual impairment in corneal endothelial diseases, however it requires more research.

Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser–assisted cataract surgery: Three-month follow-up

To quantify changes in endothelial cell counts and corneal thickness measurements in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal. Ruhr University Eye Clinic, Bochum, Germany. Prospective randomized intraindividual cohort study. One eye of each patient had standard phacoemulsification (control group) and the other eye had femtosecond laser-assisted phacoemulsification (study group), both with intraocular lens implantation. Pulsed ultrasound energy was used for phacoemulsification. Noncontact endothelial cell microscopy and corneal pachymetry were performed preoperatively and 1 day, 3 to 4 days, 7 to 10 days, 50 to 60 days, and 90 to 100 days postoperatively. The mean endothelial cell loss was 7.9% ± 7.8% (SD) 1 week postoperatively and 8.1% ± 8.1% 3 months postoperatively in the study group and 12.1% ± 7.3% and 13.7% ± 8.4%, respectively, in the control group. The mean relative change in corneal thickness from the preoperative values was -0.0% ± 1.9% at 1 day, 2.8% ± 1.8% at 1 week, and 3.3% ± 1.7% at 3 months in the study group and -0.9% ± 2.3%, 2.4% ± 1.5%, and 3.2% ± 1.4%, respectively, in the control group. The femtosecond laser did not add to the endothelial damage caused by cataract surgery and might be beneficial in eyes with low preoperative endothelial cell values (eg, cornea guttata cases).

DNA damage and repair in Fuchs endothelial corneal dystrophy

Fuchs endothelial corneal dystrophy (FECD) is a slowly progressive eye disease leading to blindness, mostly affecting people above 40 years old. The only known method of curing FECD is corneal transplantation. The disease is characterized by the presence of extracellular deposits called “cornea guttata”, apoptosis of corneal endothelial cells, dysfunction of Descement’s membrane and corneal edema. Oxidative stress is suggested to play a role in FECD pathogenesis. Reactive oxygen species produced during the stress may damage biomolecules, including DNA. In the present study we evaluated the extent of endogenous DNA damage, including oxidatively modified DNA bases, and damage induced by hydrogen peroxide as well as the kinetics of DNA repair in peripheral blood mononuclear cells of 50 patients with FECD and 43 age-matched controls without visual disturbances. To quantify DNA damage and repair we used the alkaline comet assay technique with the enzymes recognizing oxidative DNA damage, hOGG1 and EndoIII. We did not observe differences in the extent of endogenous and hydrogen peroxide-induced DNA damage between FECD patients and controls. However, we found a lower efficacy of DNA repair in FECD patients as compared with control individuals. The results obtained suggest that the lowering of the DNA repair capacity may be one of the mechanisms underlying the role of oxidative stress in the FECD pathology.

Light microscopy of the corneal pathologies that we meet in our daily practice as an eye banker

AbstractPurpose Organ culture is the method of choice for the preservation of a human donor cornea for transplantation throughout Europe. This method is often closely connected with the assessment of the cornea using light microscopy. The corneal endothelium, its polymeghatism, pleomorphism, cornea guttata and other endothelial abnormalities as well as epithelial and stromal pathologies will be presented to show the usefulness of light microscopy in the evaluation of corneal pathologies.Methods Photographs from light microscopy (both phase contrast and bright field) taken before and after corneal storage in organ culture will be compared and discussed in relation to changes in endothelial morphology and the swelling of the intercellular spaces. The individual corneal layers (the corneal epithelium, the stroma and the endothelium) of pathological corneas will be compared to those of control corneas.Results Among corneal pathologies, cornea guttata, corneal dystrophies (Fuchs endothelial corneal dystrophy, posterior polymorphous corneal dystrophy) and crystalline keratopathy will be shown using pathological explants. Moreover, the corneal pathologies will be correlated with histological findings. Finally, bacterial and fungal contamination of the cornea during organ culture will be shown.Conclusion Light microscopy is an essential part of qualitative and quantitative corneal assessment, which allows corneas with a variety of pathologies, mostly endothelial in origin, to be excluded from grafting. This work was supported by the project PRVOUK‐P24LF13 of Charles University in Prague.

The 7‐year cumulative incidence of cornea guttata and morphological changes in the corneal endothelium in the Reykjavik Eye Study

To examine the corneal endothelium and establish the 7-year cumulative incidence of cornea guttata (CG). Population-based prospective cohort study with 573 participants (third wave of the Reykjavik Eye Study (RES) in 2008). Four hundred and thirty-seven subjects had either right or left eyes available for analysis after excluding confounding eye conditions. The baseline for eyes at risk for developing CG is the second wave of the RES in 2001. Participants underwent specular microscopy and a standardized eye examination. The cumulative 7-year incidence of CG in either eye was estimated as a 95% confidence interval for the expected value for both genders combined (15-23%), for males (8-18%) and for females (19-29%). In right eye only, the 7-year cumulative incidence for both genders combined was estimated to be 6-11%. For genders combined and for males only, the data indicated no correlation between 7-year cumulated incidence and age at baseline. In women, however, the change of 7-year incidence for CG in at least one eye appeared to be correlated to age at baseline. Reduction of endothelial cell density for corneas with CG at baseline was found [CI (0.95)-132 ± 94]. The cumulative 7-year incidence of primary central CG for a middle-aged and older Caucasian population without history of potentially confounding eye disease has been established. Women tend to have higher incidence if onset occurs at middle age. If CG is present, the cell density and the cell size variation decrease within a 7-year period.

Keratoconus associated with Corneal Guttata

ABSTRACT Purpose To describe clinical findings of cases with keratoconus and concomitant corneal guttata. Setting Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Brazil. Materials and methods In a retrospective study including 138 patients with clinical keratoconus, 22 eyes from 11 (8%) patients with keratoconus were identified with the presence of corneal guttata. Complete ophthalmologic examination was performed in all patients, including Scheimpflug rotation tomography (Pentacam HR, Oculus, Wetzlar, Germany), biomechanical study associated with noncontact tonometry [ocular response analyzer (ORA); Reichert, Depew, USA], and specular microscopy (LSM 12000, Bio-Optics, Oregon, USA). The amount of guttata was correlated with biomechanical and tomographic parameters by nonparametric Spearman test. Results The mean age was 51.8 ± 20.9 (from 25 to 81) years, nine patients were female (81.9%). The mean of corrected distance visual acuity was 0.20 (20/32) ± 0.49 [from 0 (20/20) to 1.9 (10/800)] LogMar. Eleven eyes had corneal guttae grade I, six eyes grade II, four eyes grade III, and one eye grade IV. The average central keratometric readings were 44.45 ± 2.54 (from 39.70 to 50.60) for flattest K (K1), 46.08 ± 2.69 (from 42.40 to 53.50) for steepest K (K2) and 45.24 ± 2.52 (from 42.00 to 52.20) for average K (Km). Maximal keratometric value (Kmax) averaged 47.63 ± 3.10 (from 43.5 to 55.8) D. The mean CCT was 482.54 ± 52.13 µm (from 398 to 585) and in the thinnest point 474.45 ± 50.32 µm (from 387 to 577). The mean of pachymetric progression indices were 0.83 ± 0.41 (from 0.2 to 2.03) (PPI Min), 1.24 ± 0.53 (from 0.7 to 2.73) (PPI Avg), and 1.79 ± 0.92 (from 0.88 to 4.67) (PPI Max). The mean of ART Min was 710.54 ± 372.47 (from 190.64 to 1985), of ART Avg was 433.18 ± 140.96 (from 141.75 to 678.37), and of ART Max was 315.64 ± 122.69 (from 102.78 to 539.78). The mean of front and back elevation at the thinnest point (using best fit sphere to 8 mm) was 5.35 ± 6.77 (from −4 to 20) and 19.15 ± 16.41 (from 1 to 50) respectively. Belin-Ambrósio deviation index (BAD D) was 3.05 ± 3 (from −0.34 to 11.55). The mean corneal hysteresis (CH) was 8.23 ± 2.05 (from 4.1 to 10.9), corneal resistance factor (CRF) was 7.67 ± 2.4 (from 3.4 to 11.3). The amount of guttata was statistically correlated with Km and K1 (Spearman, p &gt; 0.05). Conclusion Keratoconus and cornea guttata can coexist in the same patient. This association can camouflage corneal thinning and protrusion associated with ectasia, but elevation, relational thickness, along with combined tomographic indices and biomechanical properties are altered. The diagnosis should be considered in the complete ophthalmic examination, including corneal topography, and tomographic characterization, along specular documentation of corneal endothelium. How to cite this article Ramos IC, Belin MW, Valbon BF, Luz A, Pimentel LN, Caldas DL, Ambrósio R Jr. Keratoconus associated with Corneal Guttata. Int J Kerat Ect Cor Dis 2012;1(3):173-178.

Prevalence of and Risk Factors for Cornea Guttata in a Population-Based Study in a Southwestern Island of Japan

To examine the prevalence of and risk factors for cornea guttata in a rural southwestern island of Japan. Cross-sectional, population-based study. All residents of Kumejima Island, Japan, located in southwestern Japan (eastern longitude, 126° 48'; northern latitude, 26° 20'), 40 years or older were asked to undergo a comprehensive questionnaire and ocular examination, including noncontact specular microscopy of corneal endothelial cells. Of the 4632 residents, 3762 (81.2%) underwent the examination. The presence of guttata was determined when round or oval dark areas were observed in the specular microscopy images. Cornea guttata was graded from 0 to 4 depending on the total area of dark spots observed on the specular microscopy images. Diagnosis of primary cornea guttata was the main outcome measure. Of the 3060 eligible residents, 124 (4.1%; 95% confidence interval, 3.4%-4.8%) had cornea guttata in at least 1 eye. Logistic regression analysis with adjustment for age and/or sex indicated that older age, female sex, and thinner central corneal thickness were associated with an increased risk of cornea guttata. The prevalence of cornea guttata is 4.1% among residents 40 years or older in Kumejima by specular microscopic criteria only, which is lower than the prevalence reported in the Reykjavik, Iceland, study. A higher prevalence may have been determined if slitlamp biomicroscopy findings had been included. Older age, female sex, and a thinner cornea were independently associated with a higher risk of cornea guttata.

Simultaneous phacoemulsification, lens implantation and endothelial keratoplasty: Triple procedure

Simultaneous Descemet stripping endothelial keratoplasty, phacoemulsification, and intraocular lens implantation are indicated in Fuchs' dystrophy with associated cataract. Compared to the standard method of the triple procedure which includes penetrating keratoplasty, this new method has the advantages of sutureless surgery, small limbal incision, faster recovery, less surface problems, less astigmatism, stronger tensile strength and more predictable calculation of the intraocular lens power. This is the first report of such a combination of procedures in our literature. A 76-year-old woman suffered from a gradual bilateral visual loss. The best corrected visual acuity was 20/60 (right eye) and finger counting at 1m (left eye). Corneal thickness was 590 microm and 603 microm, respectively. A marked cornea guttata and nuclear cataract were present in both eyes. Phacoemulsification, lens implantation, and Descemet stripping were done in the left eye. The posterior lamellar corneal graft, 8.0 mm in diameter and about 150 microm thick, was bent and inserted through the limbal incision. The air was injected into the anterior chamber to attach the graft to the recipient stroma. The cornea remained clear, and the transplant was attached during a two-year follow-up. Visual acuity was 20/40 after two months, and 20/25 after one year. CONCLUSION. The new technique proved itself as a good choice for the treatment of a mild Fuchs' dystrophy associated with cataract.