Decrease In Endothelial Cell Density Research Articles

Long-term dynamic changes and influencing factors of corneal morphology after multiple intravitreal injections of anti-VEGF drugs.

To observe alterations in corneal morphology caused by repeated intravitreal injections of anti-vascular endothelial growth factor (VEGF). Prospective cohort study. Seventy-seven eyes were treated with intravitreal injection of anti-VEGF from June 2021 to March 2023. There were 25 eyes of neovascular age-related macular degeneration (nAMD), 24 eyes of diabetic macular edema (DME), and 28 eyes of retinal vein occlusion (RVO). Aflibercept was used in 37 eyes and Ranibizumab was used in 40 eyes. 3 + PRN was used. Corneal endothelium and corneal thickness were measured using a corneal endothelial microscope. The data related to central corneal thickness, corneal endothelial cell density (ECD), average cell size, coefficient of variation (CV), proportion of hexagonal cells (Hex%) was collected. A comparison was also made between baseline and the dynamic changes of all indexes 1 year following the last injection. It was observed that in comparison to baseline, ECD and Hex% decreased significantly after the 3rd injection of Aflibercept and Ranibizumab. However, ECD did not decrease further and remained at the same level as after the last injection. Hex% and average cell size increased to a certain extent in comparison to the last injection. All the changes were found to be statistically significant (P < .01). After 3 injections, ECD in DME group was markedly lower than that in nAMD and RVO group, but the CV in DME group was higher than that in nAMD as well as RVO groups, and all the differences were statistically significant (P < .05). Following intravitreal anti-VEGF therapy, DME is more likely than other disorders to result in a decrease in ECD. Repeated intravitreal injections of anti-VEGF drugs can reduce the Hex% and ECD to a certain extent. After the last injection, Hex% can progressively recover, and ECD can remain stable without further declining. After injections, ECD in DME group was found to be significantly lower than that in nAMD and RVO groups, but CV in DME group was significantly higher in comparison to the other 2 groups. In patients with macular edema, repeated intravitreal injections of anti-VEGF may have certain effects on corneal morphology. Patients with diabetes mellitus in particular should pay special attention to corneal safety following repeated intravitreal injections if they have significantly reduced ECD at baseline.

Corneal endothelial cell density and associated factors among adults at a regional referral hospital in Uganda: a cross-sectional study.

To assess the prevalence of low corneal endothelial cell density and correlates of corneal endothelial cell density among adults attending Mbarara University and Referral Hospital Eye Centre in Uganda. In this hospital-based cross-sectional study, participants 18 years and older, were enrolled. We obtained informed consent, and basic demographic data. We also conducted visual acuity, a detailed slit lamp examination, intra-ocular pressure, corneal diameter, tear-film break-up time, keratometry, A-scan, and pachymetry on all participants. A confocal microscope Heidelberg HRT3 was used to examine the central cornea and to obtain the mean cell density (cells/mm2). To calculate the proportion of low endothelial cell density, descriptive statistics were used, whereas correlates of endothelial cell density were assessed, using linear regression analyses. We evaluated a total of 798 eyes of 404 participants aged between 18 and 90 years (males = 187, females = 217). The average endothelial cell density was 2763.6 cells/mm2, and there was a decrease in endothelial cell density with increasing age, irrespective of gender. There was no significant difference in endothelial cell density between males and females. Increasing age (adjusted coefficient - 10.1, p < 0.001), history of smoking (adjusted coefficient - 439.6, p = 0.004), history of ocular surgery (adjusted coefficient - 168.0, p = 0.023), having dry eye (adjusted coefficient - 136.0, p = 0.051), and having arcus senilis (adjusted coefficient - 132.0, p = 0.08), were correlated with lower endothelial cell density. However, increasing corneal diameter (adjusted coefficient 134.0, p = 0.006), increasing central corneal thickness (adjusted coefficient 1.2, p = 0.058), and increasing axial length (adjusted coefficient 65.8, p = 0.026), were correlated with higher endothelial cell density. We found five eyes (0.63%) from different participants with a low endothelial cell density (< 1000cells/mm2). Our study established baseline normal ranges of ECD in a predominantly black African population, and found that low ECD is rare in our population. The elderly, smokers, and those with past ocular surgery are the most vulnerable. The low prevalence could be due to a lack of reference values for the black African population.

A Shape Memory Polymeric Shield for Protecting Corneal Endothelium During Phacoemulsification.

The purpose of this study was to explore the protective effect of a shape memory polymeric shield on corneal endothelium during phacoemulsification in rabbits. Poly-(glycerol dodecanedioate) (PGD) with a transition temperature of 24.416°C was prepared to make a shape memory shield with a thickness of 100µm, an arc length of 14 mm, and a radius of curvature of 8.8 mm. In the control group, a phaco-tip with bevel-down was used to simulate injury to the corneal endothelium by phacoemulsification in rabbits. In the experimental group, the pre-cooled and curled shape memory shield was injected into and removed from the anterior chamber before and after phaco-power release. Anterior segment optical coherence tomography (AS-OCT), confocal microscope, trypan blue/alizarin red staining, and scanning electron microscope were performed to measure endothelial damage after surgery. One day postoperatively, the lost cell ratio of the control group and the experimental group were 28.08 ± 5.21% and 3.50 ± 1.43%, respectively (P < 0.0001), the damaged cell ratios were 11.83 ± 2.30% and 2.55 ± 0.52%, respectively (P < 0.0001), and the central corneal thicknesses (CCT) were 406.75 ± 16.74µm and 340. 5 ±13.48µm, respectively (P < 0.0001). Seven days postoperatively, the endothelial cell density (ECD) of the control group and the experimental group were 1674 ± 285/mm2 and 2561 ± 554/mm2, respectively (P < 0.05). The above differences were all statistically significant. This PGD based shape memory shield has a protective effect on corneal endothelium during phacoemulsification. It reduces postoperative corneal edema and ECD decrease in the short term after surgery. The shape memory PGD "shield" in this study may have a use in certain human patients with vulnerable corneas of low endothelial cell count or shallow anterior chambers.

Repositioned versus exchanged flanged intraocular lens fixation for intraocular lens dislocation

This study aimed to compare the outcomes of flanged intraocular lens (IOL) fixation with new IOL exchange after dislocated IOL removal and repositioned dislocated IOL in patients with IOL dislocation. Eighty-nine eyes that underwent flanged IOL fixation were retrospectively included, with 51 eyes in the exchanged IOL group and 38 eyes in the repositioned IOL group. In both groups, best-corrected visual acuity (BCVA) improved at 1, 3, 6, and 12 months postoperatively and did not differ between the two groups at any of these time points. However, at 1 week postoperatively, BCVA in the repositioned IOL group improved compared with baseline, whereas that in the exchanged IOL group did not. Moreover, there were lesser changes in the corneal endothelial cell density (ECD) and corneal astigmatism in the repositioned IOL group than in the exchanged IOL group. The IOL positions, including IOL tilt and IOL decentration, were not different between the groups. Flanged IOL fixation with new IOL exchange and with repositioned dislocated IOL for patients with IOL dislocation had similar visual outcomes and IOL position. However, the latter had a smaller corneal ECD decrease and astigmatic change. This technique was effective in treating IOL dislocation while minimizing corneal injury.

Avaliação do endotélio corneano através de microscopia especular em participantes com edema macular diabético

Introduction: While the morphological and functional integrity of the corneal endothelium, which is essential for corneal transparency, is affected by diabetes mellitus (DM), its relationship with the severity of diabetic retinopathy and the presence of diabetic macular edema is unclear. Aims: To assess the morphological characteristics of the corneal endothelium in patients with Type 2 Diabetes Mellitus (T2DM) with different therapeutic response profiles to diabetic macular edema (DME). Methods: With a cross-sectional approach, 24 participants with T2DM were divided into 2 groups (without DME versus with DME). Subsequently, the group with DME was subdivided according to the type of therapeutic response (responder versus persistent). Parameters obtained through specular microscopy (endothelial cell density, coefficient of variation, hexagonality, and central corneal thickness) and optical coherence tomography (minimum foveal thickness, central 1mm thickness, macular ganglion cell layer thickness, and peripapillary retinal nerve fiber layer thickness) were analyzed and compared in the different groups. Results: No significant changes were found in the corneal endothelium between the groups with and without DME (p&gt;0.05). However, differences were found in the density of endothelial cells (p=0.04) in participants with persistent DME (1900.3 ± 270.1) compared to participants with responding DME (2307.9 ± 121.2) and control group (2191.7 ± 165.5). Conclusion: There were no differences in the different parameters of the corneal endothelium between participants with and without DME. However, the kind of therapeutic response to DME seems to be associated with a decrease in endothelial cell density.

The effect of irrigation and aspiration on the corneal endothelial cell density in patients undergoing Implantable Collamer Lens with a central hole implantation for myopia correction.

In the conventional technique, viscoelastic agents are typically rinsed away with balanced salt solution (BSS), but it may lead to a series of complications such as viscoelastic residue, anterior chamber instability and intraoperative TICL rotation. The utilization of irrigation and aspiration (I/A) has been shown to be effective in maintaining anterior chamber stability, reducing the incidence of postoperative high intraocular pressure, and minimizing postoperative fundus complications. However, there is a lack of previous studies investigating the impact of I/A on corneal endothelial cells during ICL implantation. The objective of this study was to examine the effect of I/A on corneal endothelial cells in patients undergoing myopia correction through implantation of Implantable Collamer Lens with a central hole (V4c ICL). A retrospective selection was made of 344 eyes from 172 patients who underwent V4c ICL implantation and I/A to remove viscoelastic agent from the anterior chamber between 2021 and 2022. The intraocular pressure (IOP) was measured at 1h, 2h and 3h after surgery. Corneal endothelial cell density (ECD), coefficient of variation in cell size (CV), standard deviation of cell area (SD), and percentage of hexagonal cells (HEX) were evaluated at 1week postoperatively to assess corneal endothelial cells. The first two represent polymegethism or morphological variation, while the third parameter represents the degree of polymorphism of the corneal endothelial cells. Electronic medical records were utilized for data collection purpose. All surgeries proceeded without complications. The IOP was 16.50 ± 3.42mmHg (range: 11.5-22.3mmHg) prior to surgery and increased to 21.25 ± 5.61mmHg (range: 9.5-34.8mmHg), 19.85 ± 5.18mmHg (range: 11.4-36.2mmHg) and finally settled at an average of 18.81 ± 4.57mmHg (range: 10.1-38.8mmHg) at the respective time points of 1h, 2h and 3h after surgery. The preoperative ECD was recorded as being approximately 3004 ± 295 cell/mm2, which exhibited a marginal decreased of 1.17% postoperatively, resulting in an average ECD value of 2969 ± 303 cell/mm2 one week after surgery (P = 0.12). Similarly, the preoperative CV was determined as 31.10 ± 3.78%, and it experienced a slight reduction with an average CV value of 30.74 ± 3.77% at week after surgery (P = 0.21). And, the preoperative SD was reported as 104.76 ± 17.26, and it remained virtually unchanged with an average SD value of 104.85 ± 18.75 at one week after surgery (P = 0.95). The preoperative HEX was calculated as 55.38 ± 8.94%, and it remained its stability with an average HEX value of 55.45 ± 8.73% one week after surgery (P = 0.92). The utilization of I/A led to a slight decrease in postoperative ECD when compared to conventional surgical techniques. Nevertheless, the reduction in ECD remained within acceptable limits, taking into accout the avervantaged it offered, such as stabilization of the anterior chamber and decreased occurrence of viscoelastic residue after surgery. It is challenging to anticipate the long-term safety of corneal endothelial cells based on current short-term studies. However, this study provides a valuable reference indicating that neither anterior chamber irrigation nor I/A aspiration have an adverse impact on the safety of corneal endothelial cells in the short term. Further research is imperative to enhance our understanding of their effects over an extended period.

Üveitik Hastalarda Korneal Değişikliklerin Non-Kontakt Speküler Mikroskopi ile Değerlendirilmesi: Retrospektif Çalışma

Objective: To demonstrate the changes in specular microscopy between uveitic eyes and healthy eyes. Material and Methods: A retrospective study included 66 patients followed in the Uvea clinic of Selcuk University between 2015-2018. The right eyes of all patients were evaluated. The right eye data of 37 healthy individuals were used as the control group. The patients were divided into subgroups anterior, intermediate, and posterior uveitis. Specular microscopy measurements were made with Confo Scan 4. Comparisons were made between the groups in terms of endothelial cell density (ECD), pleomorphism (%), polymegatism (%), central corneal thickness (CCT), and intraocular pressure (IOP). A p-value less than 0.05 was considered significant. Results: The mean age was 33.71±15.29 in the uveitis and 37.78±13.17 in the control group (p=0.432). There was a significant difference between the groups in terms of ECD, pleomorphism and polymegatism (all groups; p&amp;lt;0.01). No significant difference was found in terms of CCT and IOP (respectively; p=0.812, p=0.381). In the subgroup analysis, a significant difference was found between anterior, intermediate and posterior uveitis groups in terms of ECD (respectively; p=0.020, p=0.018). However, no significant difference in other groups (p=0.999). In comparison with healthy eyes of patients with monocular uveitis were significant differences in all parameters (all groups; p&amp;lt;0.01). Conclusion: It is seen that ECD decreases, pleomorphism and polymegatism increase in patients with uveitis. This result showed the importance of preventing sequelae with early treatment in patients with uveitis. Speccular or confocal microscopy scanning is important in uveitic patients scheduled for intraocular surgery.

Biomaterials used for tissue engineering of barrier-forming cell monolayers in the eye.

Cell monolayers that form a barrier between two structures play an important role for the maintenance of tissue functionality. In the anterior portion of the eye, the corneal endothelium forms a barrier that controls fluid exchange between the aqueous humor of the anterior chamber and the corneal stroma. This monolayer is central in the pathogenesis of Fuchs endothelial corneal dystrophy (FECD). FECD is a common corneal disease, in which corneal endothelial cells deposit extracellular matrix that increases the thickness of its basal membrane (Descemet's membrane), and forms excrescences (guttae). With time, there is a decrease in endothelial cell density that generates vision loss. Transplantation of a monolayer of healthy corneal endothelial cells on a Descemet membrane substitute could become an interesting alternative for the treatment of this pathology. In the back of the eye, the retinal pigment epithelium (RPE) forms the blood-retinal barrier, controlling fluid exchange between the choriocapillaris and the photoreceptors of the outer retina. In the retinal disease dry age-related macular degeneration (dry AMD), deposits (drusen) form between the RPE and its basal membrane (Bruch's membrane). These deposits hinder fluid exchange, resulting in progressive RPE cell death, which in turn generates photoreceptor cell death, and vision loss. Transplantation of a RPE monolayer on a Bruch's membrane/choroidal stromal substitute to replace the RPE before photoreceptor cell death could become a treatment alternative for this eye disease. This review will present the different biomaterials that are proposed for the engineering of a monolayer of corneal endothelium for the treatment of FECD, and a RPE monolayer for the treatment of dry AMD.

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.

Corneal Endothelial Morphological Alterations in Type 2 Diabetes: Associations with Glycemic Control, Disease Duration, and Diabetic Retinopathy Severity—A Cross-Sectional Study in Benghazi, Libya

Background The corneal endothelium is essential for maintaining corneal transparency and fluid regulation, and its dysfunction can lead to corneal edema and decreased visual acuity. Corneal specular microscopy is used to detect corneal disorders early. Aim This study aimed to evaluate morphological changes in the corneal endothelium of patients with type 2 diabetes mellitus (DM) using specular microscopy. Methods This study enrolled 50 individuals with type 2 diabetes and 50 nondiabetic individuals as control subjects. Patients with certain ocular and systemic conditions were excluded. The collected data included demographic information, medical history, recent hemoglobin A1c (HbA1c) values, visual acuity, ophthalmological examination, and diabetic retinopathy (DR) staging. The corneal endothelial morphology was evaluated using a noncontact specular microscope, which measured corneal endothelial cell density (ECD), central corneal thickness (CCT), coefficient of variation of cell size (CV), and hexagonality. The data were analyzed using SPSS software, and the results were presented as mean ± standard deviation, numbers, and percentages. An unpaired t-test was used to compare different means, and a p-value less than 0.05 was considered statistically significant. Results A majority of diabetic patients (62%) had diabetes for more than 10 years, and 58% of them had higher than 7.5% HbA1c levels. In terms of DR severity, 46% of patients had mild nonproliferative diabetic retinopathy (NPDR), 36% had moderate NPDR, and 10% had severe NPDR. There were significant differences between diabetic and nondiabetic groups in corneal ECD (2480 ± 223 cells/mm2 for DM group vs. 2652 ± 234 cells/mm2 for non-DM), hexagonality (39.6 ± 2.8% for DM group vs. 47 ± 2.1% for non-DM), CV (42 ± 2.9% for DM group vs. 35.5 ± 2.3% for non-DM), and CCT (550 ± 14.8 µm for DM group vs. 530 ± 9.6 µm for non-DM). Patients who had diabetes for more than 10 years had significantly lower ECD (2356 cells/mm2 vs. 2689 cells/mm2), lower hexagonality (39 vs. 41%), and higher CV (43 vs. 41%) and higher CCT (553.9 ± 4.6 vs. 545.5 ± 4.0) than those with less than 10 years of diabetes. As the severity of DR increased, there was a significant decrease in ECD (from 2641 ± 194 cells/mm2 for mild NPDR to 2310 ± 82 cells/mm2 for severe PDR), a decrease in hexagonality (from 40.9 ± 3.2% for mild PDR to 37.4 ± 1.1% for severe PDR), an increase in CV (from 40.1 ± 2.3% for mild PDR to 44 ± 2.9% for severe PDR), and an increase in CCT (from 543.7 ± 13.8 for mild PDR 563.8 ± 2.9 for severe PDR). Conclusion This study revealed that type 2 diabetes is associated with significant reductions in ECD and hexagonality, as well as an increase in CV and CCT. The severity of DR and the duration of diabetes were correlated with changes in these parameters. These findings underscore the need for a comprehensive evaluation of corneal health in diabetic patients.

Factors associated with severe corneal endothelial damage following acute primary angle closure in Chinese subjects

PurposeTo investigate the corneal endothelial damage caused by acute primary angle closure (APAC) and related risk factors for severe corneal endothelial cell damage in Chinese subjects.MethodsIn this multicentre retrospective study, 160 Chinese patients (171 eyes) diagnosed with APAC were recruited. Endothelial cell density (ECD) and morphological changes short after APAC were studied. Univariate regression and multivariate regression were used to identify risk factors associated with the extent of ECD reduction, including age, gender, education level, patients’ location, systemic diseases, APAC duration (hours), highest recorded intraocular pressure (IOP), and presenting IOP. Factors associated with the probability of severe corneal damage (ECD lower than 1000/mm2) were analysed based on a linear function.ResultsAfter one APAC episode, 12.28% eyes had ECD lower than 1000/mm2, 30.41% had ECD between 1000 and 2000/mm2, and 57.31% had ECD more than 2000/mm2. Attack duration was the only factor associated with severe endothelial damage (p < 0.0001). If the attack were to be subsided within 15.0 h, possibility of ECD lower than 1000/mm2 could be controlled under 1%.ConclusionShortly after the abortion of APAC, 12.28% patients experienced severe endothelial cell damage with ECD less than 1000/mm2. The only factor associated with severe ECD decrease was attack duration. Immediate and effective treatment is pivotal for preserving corneal endothelial function in APAC patients.

Endothelial Cell Density before and after Phacoemulsification in patients with Diabetes Mellitus

Introduction: Cataract is the leading cause of treatable blindness worldwide. Phacoemulsification with intraocular lens (IOL) implantation is the most common surgical procedure performed for the treatment of cataract. The diabetic cornea has decreased corneal endothelial cell density (CED) due to cell dysfunction and malfunctioning repair systems. Objective: To compare the mean endothelial cell density before and after phacoemulsification in patients with diabetes mellitus. Material and Methods: A total number of 30 patients who presented for cataract extraction were included. Data regarding patients age, gender, duration of diabetes mellitus and side of cataract was collected. One day before surgery, CED was measured in all patients using Specular Microscope. After 2 weeks of surgery, CED was measured again. Results: Mean age of patients included in this study was 48.70±8.39 years. Mean duration of diabetes mellitus was 5.03±2.85 years. There were 16 (53.33%) males and 14 (46.67%) female patients. There were 15 (50.00%) patients with right eye and also 15 (50.00%) with left eye. On comparison of mean ECD between the Groups, the mean pre-operative ECD was 2753.05±126.91 Cells/mm2 and post-operative ECD was 2451.16±160.93 Cells/mm2, this difference was statistically significant with p value &lt;0.0001. Conclusion: Phacoemulsification is associated with significant decrease in endothelial cell density in diabetic patients presenting with cataract. The benefit of this study is that it adds to the existing body of literature on impact of phacoemulsification on endothelial cell density in diabetic patients which can help in the development of advanced surgical techniques and better post operative management in such patients. Keywords: Endothelial cell density, phacoemulsification, diabetes mellitus.

Effect of the Presence of Silicone Oil in the Anterior Chamber After Complicated Retinal Detachment Surgery on Corneal Morphology by In Vivo Confocal Microscopy

Purpose This study evaluated the corneal endothelium, stromal keratocytes, subbasal nerve number and density in patients with silicone oil transferred to the anterior camera after pseudophakic complicated retinal detachment surgery by in vivo laser scanning confocal microscopy (IVLSCM). Methods Sequential measurements were made by IVLSCM between 3–6 months after surgery in two groups of patients: a) with silicon oil migration (Group 1) and without silicone oil migration (Group 2). Results A total of 63 cases (Group 1: 32 and Group 2: 31) were examined. The mean ages of patients were 65 ± 12 and 61 ± 11 and M/F ratio was 18/14 and 17/14, respectively. Mean intraocular pressures were 16.60 ± 4.60 and 15.75 ± 5.70 mm Hg, respectively. Changes were detected by IVLSCM mostly on the superior part of the cornea. A significant decrease in endothelial cell density and the number was detected in group 1 (2072 ± 116.2 cells/mm2 vs 2752 ± 512.3 cells/mm2; p < 0.001). Significant increases in posterior keratocyte density and stromal hyperreflective deposits were observed in group 1 (887 ± 45.8 cells/mm2 vs 725 ± 65.8 cells/mm2; p < 0.001). A significant negative correlation was observed between the size of stromal deposits and endothelial cell density (r=–0.758; p < 0.001). The number and density of corneal subbasal nerves were significantly lower in group 1 (1.8 ± 0.8 and 4.8 ± 1.2 vs 420 ± 101 and 701 ± 112 µm/square; p < 0.001). Conclusion IVLSCM is a useful tool for the early detection of corneal abnormalities caused by silicone oil injection. This study verified silicone oil’s detrimental effect on the corneal endothelium and revealed stromal changes in the anterior chamber, which we believe can be also been associated with the presence of silicone oil.

Relationship of Corneal Endothelial Morphology and Central Corneal Thickness to Age and Sex in Normal Healthy individuals in our Community

Background: Central corneal thickness and corneal endothelial morphology was studied along it's relationship with age and sex. Objective: To determine the normative data of central corneal thickness and endothelial morphology in our population. Methodology: This is a Cross-sectional study. The study was done at Ophthalmology Department, FRPMC in accordance with the declaration of Helsinki from March 2021 to August 2021 with approval from the Institutional review board. All healthy individuals aged 20 to 70 years presenting with any ocular complaints but no corneal pathology were included. Individuals with any systemic and ocular co-morbidity were excluded. After a complete ocular examination, corneal specular microscopy was done using REXAM SPM-700 corneal specular microscopes. In our study, we analyzed CCT, ECD, MCA, CV and hexagonality. The data was collected and recorded on an Excel spreadsheet and then transformed to SPSS version 22 for statistical analysis. Results: 724 eyes from 362 individuals were studied for CCT and endothelial morphology using Rexam SPM-700 microscopes. There were 241(66.6%) males and 121(33.4%) females with mean age 38.33±10.17 years. Among 724 eyes we found CCT (508.43±33.4um), ECD (2565.12±254.15cell/mm2), AVG (393.81±40.72um2), CV (39.54±6.43%), and Hexa (46.18±6.64%). Statistically, there was no significant difference between the right and left eyes of the study population as well as gender-wise. There is a statistically significant inverse correlation of ECD with age (p&lt;0.00, r:-0.19). However, a statistically insignificant inverse correlation is found for CV and Hexa with age (p&lt;0.17, r:-0.05) (p&lt;0.70, r:-0.014) respectively. Conclusion: Our study reports the normative corneal endothelial morphology and thickness in the Pakistani population attending FRPMC Ophthalmology Department. We also found that Central corneal thickness and Endothelial cell density decrease with aging and no statistical difference gender-wise.

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.

The Impact of Robotic Fractionated Radiotherapy for Benign Tumors of Parasellar Region on the Eye Structure and Function.

To evaluate the radiation effect of fractionated robotic radiotherapy of benign tumors located in the parasellar region on the anterior and posterior segments of the eye. A prospective observational study based on the expanded ophthalmological examination. The pre-treatment baseline was used as a control for the post-radiotherapy follow-up examinations. The study group consists of 34 patients (68 eyes) irradiated using the CyberKnife system. There were ten patients with cavernous sinus meningioma, nine with pituitary adenoma, five with meningioma of the anterior and middle cranial fossa, five with meningioma in the region close to optic chiasm, three with craniopharyngioma, and two with meningioma of the orbit. All patients were treated using three fractions of 600-800 cGy. We assessed the impact of radiation on the eye based on changes in anatomical and functional features. The condition of the eye surface, central corneal thickness (CCT), endothelial cell density (ECD), lens densitometry, central macular thickness (CMT), and retinal nerve fiber layer (RNFL) were the anatomical features assessed. The functional tests were best-corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) and visual-evoked potentials (VEP). An ophthalmologic examination was performed before and 6, 12, 18, and 24 months after radiotherapy. We did not observe any significant changes in BCVA, IOP, CCT, CMT, VF, and VEP, nor in the slit-lamp examination during the two-years observation. We found a significant decrease in ECD at all follow-up measurements. The drop in ECD exceeded approximated age-related physiological loss. The reduction in ECD was not large enough to disrupt corneal function and thus affect vision. We also observed a statistically significant reduction of RNFL in all observation time points. However, there was no correlation between the dose delivered to the optic pathway and the decrease in RNFL thickness. The thinning of the RNFL was not significant enough to impair visual function. Fractionated robotic radiotherapy of the tumors located close to the optical pathway is safe and does not impair patient's vision. Minor changes found in optic nerve anatomy (RNFL thinning) might be related to radiation effect or tumor compression. The causal relation between low doses of radiation delivered to the cornea and the observed significant but slight decrease in ECD is uncertain. The observed changes did not cause visual disturbances perceivable by the patients.

Utility of Donor Corneas Based on Endothelial Cell Count

Aim: To assess utility of donor corneas based on analysis of endothelial cells qualitatively and quantitatively. Methods: It was a observational study of donor corneas received at eye bank in a tertiary care centre during period of January 2021 to June 2022. 94 corneoscleral buttons were excised and endothelial cell density and morphology were assessed using specular microscope. Results: With increasing age there was decrease in endothelial cell density seen. A highly significant co-relation was found between age and endothelial cell density. (p&lt;0.001).Endothelial cell count was high in phakic compared to pseudophakic eyes. A highly significant co-relation was found between lens status and endothelial cell density (p&lt;0.001). With increasing age there was decrease in hexagonality of endothelial cells seen. A highly significant co-relation was found between age and hexagonality of endothelial Cells (p&lt;0.001). A highly significant correlation was found between utility of endothelial cells of mean 2018.94, hexagonality of mean 54.39 and co-efficient of variation of mean 34.50. Amongst 94 donor corneas 24.4% were used for optical penetrating keratoplasty, 22.3% for therapeutic purpose, 6.3% for DSEK, 4.2% for DALK and remaining 42.5% for research/practice purpose. Conclusion: Analysis of donor corneas demonstrated that age and pseudophakia as predictor of decrease endothelial cell density. A significant co-relation was found between endothelial cell density and utilization.

Difference of corneal endothelial characteristics of diabetic and non‐diabetic cataract patients who underwent phacoemulsification at Dr Saiful Anwar hospital Malang

AbstractPurpose: To compare the corneal endothelial characteristics of diabetic and nondiabetic cataract patients who underwent phacoemulsification.Methods: A retrospective study, data collected from medical records of patients who visited Cataract and Refractive Surgery Outpatient Clinic and underwent phacoemulsification at Saiful Anwar Hospital Malang, the tertiary hospital in East Java, Indonesia, between April 2021 to January 2022. Data collected regarding corneal endothelial condition were endothelial cell density (ECD), hexagonality and Coefficient variation (CV) examined using Specular Microscope (Nidek, CEM 530).Results: There were 32 eyes from 31 patients, consist of 55% men and 45% women, 17 eyes diabetic and 15 eyes non‐diabetic. The most common age range is 40–49 years old (35.5%). Baseline ECD and hexagonality were higher in diabetic compared to non‐diabetic patients (2781.35 ± 283 vs 2625.88 ± 389 and 67.71 ± 4 vs. 65.81 ± 4, respectively), while baseline CV was lower in diabetic patients (30.4 ± 4 vs. 33.2 ± 6) (p &gt; 0.005). There was a decrease of ECD and hexagonality, but increase of CV after surgery in both groups (p &gt; 0.005).Conclusions: There was significant decreased of ECD and Hexagonality but increased CV in diabetic group on pre phacoemulsification compared to post phacoemulsification. There are no statistically significant difference of baseline and endothelial damage between diabetic and non‐diabetic.

Corneal Endothelial Characteristics in Normal Chinese Han Children and Youngsters: A Study from the Specular Microscopy Descriptions

Objective To observe the morphological changes of corneal endothelial cells in healthy Chinese children and youngsters and analyze the sensitive and specificity of the endothelial assessments. Methods 14,670 Chinese healthy volunteers enrolled were examined by specular microscopy, and the endothelial descriptive indexes: the central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in average cell size (CV), the percentage of regular hexagonal cells (hexagonality, HEX), cell size of minimal cell (Smin), cell size of maximal cell (Smax), average cell size (Savg), and size of standard deviation of cell area (Ssd) as well as sex and age were analyzed. Results The average age of this study is 17.36 ± 7.58 (4–30) years. There is no sex predominance: 7,260 male (49.5%) and 7,410 female (50.5%). The mean CCT, ECD, CV, HEX, Smin/max, Savg, and Ssd are 529.94 ± 31.53 (437–644) μm, 3,051.28 ± 375.49 (2,031–4,074) cells/mm2, 28.34 ± 4.36 (18–40) %, 61.21 ± 10.29 (17–89) %, (147.79 ± 21.94 to 678.29 ± 120.96) μm2, 332.74 ± 44.62 μm2, and 95.02 ± 23.17 μm2, respectively. The CCTs keep consistency. The ECD decreased rate is 1.02%/year. The curve of ECD and hexagonality expresses the same linear tender. The CCT and endothelial evaluation indexes have no sex predominant (p > 0.05); the quantitative indicators: CCT, ECD, and HEX are significant negative associated with age (p = 0.001 or p < 0.001); the variability indexes: the CV, Smin, Smax, Savg, and Ssd are positive correlation (p < 0.001). The coefficients of CCT, HE, and Smin are -0.35, -0.59, and 1.17, respectively. Conclusions The ECD decrease rate is 1.02%/year of the normal Chinese Han childhood to the earlier adulthood. The ages 4 to 12, 13 to 20, and 21 to 30 can be named as the childhood, puberty and adulthood from endothelial biologic identity. The HEX is the sensitivity marks for the polymorphisms while the S min is the specificity indicator CVs upon the Topcon Noncon Specular microscopy results.

Five-year clinical outcomes of rigid iris-fixated phakic intraocular lens in northern Chinese

To investigate the 5-year clinic outcomes of rigid iris-fixated pIOL on the visual performance, complications and intraocular light scattering in northern Chinese. Thirty eyes implanted with iris-fixated phakic IOLs (pIOLs group) and 34 eyes with high myopia (myopia group) were involved in this study. At preoperatively, 6months, 1, 3, and 5years postoperatively, the uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), endothelial cell density (ECD), and intraocular pressure (IOP) were measured in pIOLs group. The objective scatter index (OSI), modulation transfer function cut off (MTF cut off), and Strehl ratio were measured by Optical Quality Analysis System and a pseudophakic dysphotopsia questionnaire (PDQ) was used to evaluate the subjects' satisfaction in pIOLs and myopia groups. At 5years postoperatively, an UCVA of 20/20 or better was found in 43.33% of eyes in pIOLs group. At 6months, 1, 3, and 5years postoperatively, the mean ECD decrease were 1.29% ± 0.45%, 2.59% ± 1.30%, 6.67% ± 2.26%, and 10.80% ± 3.48%. The value of OSI in pIOLs group was significantly higher than that in myopia group (P < 0.001). The PDQ results showed that the subjects in myopia group complained less with intolerance of bright lights than those in pIOLs group. The values of Strehl ratio and MTF cut off in pIOLs group were significantly lower than that in myopia group (P < 0.001). Iris-fixated pIOL induce more intraocular light scattering. A significant decrease in ECD was observed at 5years postoperatively. An annual evaluation of ECD is necessary for patients undergoing pIOL implantation.