Corneal Endothelial Cell Loss Rate Research Articles

Comparison of keratoplasty outcomes at the scar versus edema stages of keratoconus.

To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed. The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision. In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.

Application of vertical chop combined with horizontal chop in hard nuclear cataract surgery

Objective To evaluate the efficacy of vertical chop combined with horizontal chop in hard nuclear cataract surgery. Methods A retrospective study. Total of 86 eyes of 86 patients with senile cataract were randomly divided into two groups, and all nuclear classification ranged from IV to V. Group A, 43 patients, received vertical chop combined with horizontal chop. Group B, 43 patients, received phacoemulsification with high vacuum splitting. The efficacy were compared between the two groups. Results The ultrasonic time (UST) was (67.77±14.68) s of group A and (103.09±44.89) s of group. The cumulative dissipated energy (CDE) was 35.33±12.75 of group A and 41.25±14.35 in group B. The difference in UST and CDE were significant statistically between the two groups (P 0.3 occupied 86.05 % in group A and 67.44 % in group B (P=0.04). The corneal edema at 1 day postoperatively in group A was lower than that in group B, the difference was statistically significant between the two groups (P=0.03). The difference in degree of corneal edema at 7 days after surgery was not statistically significant between the two groups. The corneal endothelial cells (CECs) in 1 month postoperatively was (2 371.30±179.02)/mm2 in group A and (2 157.80±156.46)/mm2 in group B(P<0.01). The loss rate of CECs was (8.73±3.74)% in group A and (15.41±3.54)% in group B(P<0.01). Conclusion Application of vertical nuclear chop combined with horizontal nuclear chop in hard nuclear cataracts surgery is effective. Key words: Cataracts, hard nuclear; Chop, vertical; Chop, horizontal

Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis

To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). Systematic review and network meta-analysis. The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.

The efficacy of femtosecond laser-assisted cataract surgery in high myopic

Objective To evaluate the efficacy of femtosecond laser-assisted cataract surgery for the treatment of cataract of high myopia. Methods The data of 120 eyes of 120 patients with high myopia and cataract were collected and retrospectively analyzed. Patients were randomly divided into two groups: study group, 60 eyes of 60 cases, received femtosecond laser-assisted phacoemulsification with intraocular lens implantation; control group, 60 eyes of 60 patients, received traditional phacoemulsification combined with intraocular lens implantation. The follow-up time was 3 months after surgery. Results After surgery BCVA (log MAR) in the study group was 0.32±0.36 and in the control group was 0.37±0.41. The difference in BCVA after surgery was not significant between the two groups (P=0.52). Keratometric astigmatism of (-0.76±0.72)D in the study group was lower than (-1.16±0.82)D in the control group after surgery (P=0.03). Central endothelial cell density of (2 254.35±298.79)/mm2 in the study group was significantly higher than (2 124.29±324.75)/mm2 in the control group after surgery (P=0.00). Corneal endothelial cell loss rate of 10.00% in the study group was lower than 15.00% in control group (P=0.00). The effective phacoemulsification time during surgery in the study group of (45.53±25.13)s was significantly lower than (64.99±45.76)s in control group (P=0.01). The rate of subconjunctival hemorrhage of 35.00% in the study group was significantly higher than 23.33% in the control group postoperatively (P=0.01). Conclusion The femtosecond laser-assisted phacoemulsification can reduce keratometric astigmatism, corneal endothelial cell loss rate and the effective phacoemulsification time during operation. Key words: Cataract surgery, femtosecond laser- assisted; Phacoemulsification; Myopia, high

Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma.

To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow-up. Postoperative corneal endothelial cell loss was also compared. The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05). ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density.

Effect of continuous ultrasonic phacoemulsification with anterior chamber maintainer on corneal endothelial damage in hard nuclear cataract.

To study the effects of continuous ultrasonic phacoemulsification performed with and without an anterior chamber maintainer (ACM) on corneal endothelial damage in patients with hard nuclear cataract. Sixty eyes in 60 patients with hard nuclear cataract (grade IV), one lesion per eye, were randomly allocated into 2 groups: continuous ultrasonic phacoemulsification with (group A) or without (group B) ACM. The intraoperative accumulated energy complex parameter (AECP), frequency of shallow anterior chamber, and postoperative corneal incision edema, corneal endothelial cell counts, and visual recovery were compared between the groups. The intraoperative AECP, postoperative corneal incision edema, and postoperative visual recovery showed no significant differences between the groups (p&gt;0.05). At 1 month postoperatively, the corneal endothelial cell loss rate and hexagonal cell percentage (postoperative compared to preoperative) in groups A and B were 0.117 ± 0.12 and 9.97 ± 9.52% and 0.15 ± 0.73 and 8.5 ± 4.60%, respectively, with no significant difference noted (p&gt;0.05). The endothelial cell mutation rate was significantly lower in group A than in group B at 6.41 ± 6.78% and 28.27 ± 27.95%, respectively (p&lt;0.05). The frequency of intraoperative shallow anterior chamber was significantly lower in group A than in group B (2 vs 17 times, p&lt;0.05). Continuous ultrasonic phacoemulsification with ACM is a safe, effective, simple, and easy method to treat hard nuclear cataract and causes minimal damage to corneal endothelial cells. It is an ideal surgical option and is worth popularizing.

Comparison of Artisan iris-claw intraocular lens implantation and posterior chamber intraocular lens sulcus fixation for aphakic eyes.

To compare the efficacy and complications of Artisan iris-claw intraocular lens (IOL) implantation and posterior chamber IOL sulcus fixation for the treatment of aphakic eyes without capsular support after vitrectomy. A prospective study of 45 cases was conducted. Forty-five eyes without sufficient lens capsule support following pars plana vitrectomy (PPV) combined lens extraction were divided into two groups. Group A: 25 eyes received Artisan iris-claw IOL implantation. Group B: 20 eyes received posterior chamber IOL sulcus fixation. The corrected distance visual acuity (CDVA) and intraocular pressure (IOP), corneal endothelial cell loss rate, surgical time and complications were compared between the two groups. Pigment changes of trabecular meshwork and anterior chamber depths were measured at each time point in Artisan group. The mean surgical time of Artisan group was significantly shorter (P<0.05). No statistically significant difference in endothelial cell loss rate was noted between two groups at any time point (P>0.05). CDVA of Artian group was better than that of the sulcus fixation group 1d after surgery (P<0.05) and there was no statistically significant difference 1 and 3mo after surgery (P>0.05). Mean IOP showed no significant differences between groups before and after surgery. The postoperative complications of Artisan group were anterior uveitis, iris depigmentation, pupillary distortion and spontaneous lens dislocation. The complications of sulcus fixation group include choroidal detachment, intraocular haemorrhage, tilt of IOL optic part and retinal detachment. Secondary Artisan IOL implantation can be performed less invasively and in a shorter surgical time period with earlier visual recovery after surgery compared to transscleral suturing fixation of an IOL. This technique is an effective and safe procedure. It is a promising option for the treatment of aphakic eyes without capsular support after vitrectomy.

Corneal endothelial damage and its repair after phacoemulsification

To introduce a grading system for corneal edema after phacoemulsification and to study the corneal endothelial damage and its repair after phacoemulsification. One hundred and five senile cataracts after phacoemulsification were included. Corneal edema was categorized into grades 0 to 4. Endothelial densities at various locations of the cornea were measured with specular microscopy before and three months after surgery. The corneal endothelial cell loss rate was 4.6%, 14.9%, 40.8%, 67.0% and 84.4% in eyes with corneal edema from grades 0 to 4, respectively. Time required for resolution of corneal edema was (2.1 +/- 0.7) days (grade 1), (5.6 +/- 1.9) days (grade 2) and (21.8 +/- 7.1) days (grade 3). The endothelial cell densities at superior, mid and inferior portions of the cornea were (2006 +/- 546) cells/mm(2), (1979 +/- 545) cells/mm(2) and (1754 +/- 543) cells/mm(2) respectively at 3 months after phacoemulsification. Postoperative endothelial cell loss at superior, mid and inferior portions of the cornea was (627 +/- 496) cells/mm(2), (656 +/- 492) cells/mm(2) and (1026 +/- 509) cells/mm(2) respectively. The difference in postoperative endothelial cell densities between the superior and inferior portions of the cornea was statistically significant (P = 0.017), so was the difference between mid and inferior portions of the corneas (P = 0.027). There was no statistically significant difference between the superior and mid portions of the cornea (P = 0.867). The grading system for corneal edema is helpful in evaluating the severity of endothelial damage after phacoemulsification and can be used to predict the outcome of the cornea. The major area of endothelial injury after phacoemulsification occurs at the inferior portion of the cornea.

Preservative-free lidocaine 1 % anterior chamber irrigation as an adjunct to topical anesthesia

Purpose: To evaluate the effect on the central corneal endothelium of anterior chamber irrigation with preservative-free lidocaine 1 % as an adjunct to topical anesthesia during phacoemulsification.Setting: Department of Ophthalmology, Hospital Capuchos, Lisbon, Portugal.Methods: This prospective, randomized, controlled study comprised 59 eyes. Thirtyone eyes had phacoemulsification (in-the-bag cracking technique) under topical anesthesia with anterior chamber irrigation by preservative-free lidocaine 1%. Twenty-eight eyes having the same procedure but with local-regional anesthesia served as the control group. All eyes had preoperative and postoperative specular microscopy and computer-assisted morphometry. A Student's t-test was used for between-group comparison of the following parameters: patient age, central corneal endothelial cell loss, mean endothelial cell size variation, and phacoemulsification ultrasound time. Follow-up was 4 weeks.Results: The between-group differences in mean patient age and ultrasound time were not significant. The differences between groups in the endothelial cell parameters were also not significant. Mean postoperative endothelial cell loss was 3.59% ± 2.79 (SD) in the topical anesthesia group and 4.37 ± 2.00% in the control group. Mean variation in cell size was 3.71 ± 1.57% and 3.79 ± 1.07%, respectively.Conclusion: Intracameral infusion of preservative-free lidocaine 1 % had no effect on the corneal endothelial cell loss rate or mean cell size variation in this short-term assessment.

Single-hook Extraction of the Lens Nucleus

Objective: To introduce and evaluate a new method of extracting the lens nucleus in extracapsular cataract extraction. Study Design: Detailed description of surgical procedures including large anterior capsulotomy, hydrodissection, luxating and extracting the lens nucleus using the Sinskey hook, and observation of intra- and postoperative complications. Setting: Department of Ophthalmology at Shizuoka Red Cross Hospital, Shizuoka, Japan. Patients: Four hundred consecutive patients with cataract undergoing this surgical procedure. Main Outcome Measures: Video monitoring during surgery. Follow-up of three months or longer, and measuring pre- and postoperative corneal endothelial cell density. Results: No intra- or post-operative complications. Corneal endothelial cell loss rate was 5.8% on average at the third postoperative month. Conclusion: Single-hook extraction is a simple and safe procedure for removing the nucleus in extracapsular cataract extraction.