Endothelial Cell Density Research Articles

Intracellular dark endothelial spots detected using specular microscopy are associated with graft failure after Descemet's membrane endothelial keratoplasty.

To investigate the correlation between intracellular dark endothelial spots (IDESs) detected by specular microscopy and the incidence of graft failure after Descemet's membrane endothelial keratoplasty (DMEK). We reviewed 100 consecutive DMEK patients performed by a single surgeon at two centres between January 2015 and July 2022. Central corneal thickness was evaluated using anterior segment optical coherence tomography (SS-1000; Tomey, Aichi, Japan), and endothelial cell density was measured using specular microscopy. Kaplan-Meier estimates and Cox regression models were used to evaluate graft failure and associated risk factors. Of the 97 eyes included, 9 experienced graft failure within the follow-up period (52.9 ± 23.9 months). IDES presence significantly correlated with decreased endothelial cell density and higher graft failure rates (hazard ratio = 4.68, 95% confidence interval = [0.96, 22.7], P = 0.034). IDESs represent a significant risk factor for graft failure post-DMEK. Careful postoperative management is imperative to minimise this risk.

Nd:YAG Laser Iridotomy Versus Surgical Iridectomy in Descemet Membrane Endothelial Keratoplasty: Comparison of Postoperative Outcome and Incidence of Ocular Hypertension.

To evaluate outcome and incidence of ocular hypertension after Descemet membrane endothelial keratoplasty (DMEK) and DMEK combined with cataract surgery (triple DMEK) after Nd:YAG laser iridotomy (IO) and surgical iridectomy (IE). This is a single-center, retrospective cohort study of patients who underwent DMEK or triple DMEK surgery at the Department of Ophthalmology, University Hospital Düsseldorf, Germany, from January 2018 to June 2020 and had received either a prophylactic preoperative IO or an intraoperative IE. Patient demographic data; best corrected visual acuity; central corneal thickness; intraocular pressure (IOP); endothelial cell density; and complications such as occurrence of early postoperative IOP elevation, macular edema, rebubbling rate, and incidence of glaucoma were analyzed. A total of 75 patients were included in each study arm with a follow-up of 22.04 ± 12.8 months. Best corrected visual acuity significantly increased postoperatively in both cohorts without significant differences. Early postoperative IOP elevation due to pupillary block was significantly more common in eyes with IO (33.3%, n = 25) than with IE (2.67%, n = 2, P < 0.001). The incidence of de novo glaucoma was 5.34% in both cohorts without significant differences in prevalence at the last follow-up (YAG IO cohort: 17.3%, IE cohort: 14.7%, P > 0.05). Rebubbling was required in 16% (n = 12) of eyes in each cohort (P > 0.999). Postoperative pupillary block after DMEK occurs significantly more often after preoperative Nd:YAG laser iridotomy compared with surgical intraoperative iridectomy but does not negatively affect long-term visual outcome or glaucoma incidence after DMEK.

Correlation between preoperative aqueous cytokine levels and mid-term corneal endothelial cell loss following penetrating keratoplasty.

To investigate the association between preoperative aqueous humour (AqH) cytokines and mid-term endothelial cell density (ECD) following penetrating keratoplasty (PKP). This study analysed a total of 87 eyes of which 54 underwent PKP and 33 eyes underwent cataract surgery. AqH samples were collected at the beginning of surgery. The levels of cytokines (interleukins [ILs]-1α, -1β, -4, -6, -8, -10, -17A, monocyte chemotactic protein [MCP]-1, interferon [IFN]-α, IFN-γ, E-selectin, P-selectin, and soluble intercellular adhesion molecule-1 [sICAM-1]) in the AqH were measured using a multiplex beads immunoassay. The subjects who underwent PKP were classified into two groups: Group 1: ECD < 1200 cells/mm2 at 36 months and graft failure during follow-up (38 eyes); Group 2 ECD ≥ 1200 cells/mm2 at 36 months (16 eyes). The ECD reduction per year was significantly correlated with the preoperative levels of protein (r = 0.48; P < 0.001), IL-6 (r = 0.29; P = 0.048), IL-8 (r = 0.42; P = 0.003), IL-12p70 (r = 0.46; P = .007), MCP-1 (r = 0.28; P = 0.049), IFN -γ (r = 0.43; P = 0.008), and s-ICAM-1 (r = 0.30; P = 0.03). The preoperative levels of IL-8, and IFN-γ in AqH were significantly higher in eyes with ECD < 1200 cells/mm2 compared to those with ECD ≥ 1200 cells/mm2 at 3 years (P ≤ 0.02). Preoperative AqH cytokine levels are associated with mid-term ECD reduction after PKP. Pathological alterations of the AqH microenvironment may affect mid-term corneal endothelial cell survival.

Regeneration of Vascular Endothelium in Different Large Vessels.

The regeneration of endothelial cells (ECs) lining arteries, veins, and large lymphatic vessels plays an important role in vascular pathology. To understand the mechanisms of atherogenesis, it is important to determine what happens during endothelial regeneration. A comparison of these processes in the above-mentioned vessels reveals both similarities and some significant differences. Regeneration is carried out by moving intact ECs from the edges of the viable endothelial layer towards the centre of the EC damage zone. A sharp decrease in contact inhibition leads to the spreading of the edges of the ECs situated on the damage border. This stimulates the second row of ECs to enter the S-phase, then the G2 phase of cell cycle, and finally mitosis. In all three types of vessels studied, mitotically dividing ECs were found using correlation light and electron microscopy. These ECs have a body protruding into the lumen of the vessel, covered with micro-villi and other outgrowths. The level of EC rounding and protruding is highest in the arteries and least pronounced in the lymphatic vessels. The intercellular contacts of mitotically dividing cells become wider. The EC division leads to an increase in the density of ECs. ECs moving over the damaged area and partially outside the damaged area acquire a fusiform shape. In the process of regeneration of arterial endothelium, the damaged ECs are removed. Then health ECs move to a surface devoid of endothelium, and detach spreading out, flattened platelets from the luminal surface of the vessel. In the veins, ECs grow on the surface of platelets and microthrombi. In lymphatic vessels, ECs detach from the basement membrane slower than in the veins and arteries. There, the migrating ECs grow under fibrin fibres. After some time (usually after 30 days), the EC mosaic returns to normal in all three types of vessels.

Outcomes and safety of Descemet's membrane endothelial keratoplasty (DMEK) as a surgical treatment for corneal endothelial dysfunction: A multicenter study.

To analyze the outcomes and frequency of complications after Descemet's membrane endothelial keratoplasty (DMEK) and evaluate the parameters associated with the occurrence of these complications. A multicenter retrospective study of 143 DMEK procedures performed consecutively by five surgeons between June 2018 and March 2021 was performed. Surgeon-specific surgical and graft characteristics were also assessed. Data on best-corrected visual acuity (BCVA), central pachymetry, and endothelial cell density (ECD) were collected at one, three, six, and 12months. Postoperative complications and secondary procedures (rebubbling and regrafting) were also recorded. The mean BCVA at one year was 0.17 logMAR (±0.19). There was a mean hyperopic shift at one year of +0.26 diopters. The mean pachymetry at one year was 526μm (±53). The mean ECD at one year was 1164cells/mm2 (±479). Graft detachment occurred in 51% of the procedures and was significantly associated with the performance of an intraoperative iridotomy (OR=2.8) [95% CI: 1.2-6.6]. Rebubbling occurred in 34% of the procedures, and a new graft was performed in 21% of cases. Performing a peripheral iridotomy during DMEK is a significant risk factor for graft detachment. DMEK significantly improves patients' vision and restores normal pachymetry.

Diabetes Endothelial Keratoplasty Study: Methods and Impact on the Use of Corneas From Donors With Diabetes for Descemet Membrane Endothelial Keratoplasty.

Describe aims, methods, characteristics of donors, donor corneas and recipients, and potential impact of the Diabetes Endothelial Keratoplasty Study (DEKS). The DEKS is a randomized, clinical trial to assess graft success and endothelial cell density (ECD) 1 year after Descemet membrane endothelial keratoplasty (DMEK) using corneas from donors with versus without diabetes in a 1:2 minimization assignment. Diabetes severity in the donor is assessed by medical history, postmortem HbA1c, and donor skin advanced glycation end-products and oxidation markers. A central image analysis reading center assesses baseline donor, 1-month and 1-year postoperative ECD. The DEKS used corneas from 1154 donors for 1421 DMEK procedures on 1097 participants (324 bilateral) at 28 clinical sites. Forty-eight tissue preparations failed (3%). Mean donor age was 65 years; mean eye bank-determined screening ECD was 2709 cells/mm2. Ultimately, 106 (9%) of 1154 donors without diabetes history were classified as diabetic based on postmortem HbA1c ≥6.5%, and 509 (36%) of 1421 donor lenticules were classified as coming from diabetic donors. Recipients were 58% female, 96% White, and 53% phakic. Study eyes were treated for Fuchs endothelial corneal dystrophy (96%), pseudophakic corneal edema (2%), and failed endothelial keratoplasty (2%). Mean recipient age was 70 years; 21% had diabetes history and 26 (2%) had central laboratory determined HbA1c ≥6.5% without diabetes history. The DEKS will increase understanding of factors related to DMEK success while determining whether diabetes and/or diabetes severity in the donor and/or recipient adversely affects graft success and endothelial cell loss.

A Pilot Case Series on the Use of a Large Mushroom-Shaped Corneal Graft for the Surgical Management of Post-Penetrating Keratoplasty Ectasia and Endothelial Failure.

Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet's membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 µm; and the endothelial cell density was 1926 ± 199 cells/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation.

Smaller-incision new-generation implantable miniature telescope in late-stage age-related macular degeneration: 6 month outcomes.

To evaluate the intermediate-term visual and safety outcomes of the small-incision second-generation implantable miniature telescope (SING IMT) in patients with late-stage age-related macular degeneration (AMD) at 6 months post-surgery. Retrospective cohort study. Medical records of patients implanted with the SING IMT at two sites in Italy were reviewed. Outcomes evaluated up to 6 months post-surgery included best-corrected distance (BCDVA) and distance-corrected near (DCNVA) visual acuity, intraocular pressure (IOP), anterior chamber depth (ACD), corneal endothelial cell density (ECD), and adverse events. The study involved 35 patients (mean age: 77.4 years). At 6 months post-surgery, the mean±standard deviation (SD) change in BCDVA from baseline was -0.29±0.142, and at least 1-, 2-, and 3-line gains in BCDVA were achieved in 97.1%, 68.6% and 51.4%, of operated eyes, respectively. The percentage of patients able to read at near distance increased from 28.6% at baseline to 97.1% at 6 months post-surgery with a mean improvement of -0.57±0.206. No clinically meaningful change from baseline was observed in terms of IOP or ACD. The mean (SD) change from baseline in ECD at 6 months in operated eyes was -280.7 (315.9) cells/mm2 (-11.4%). The most frequent adverse event was corneal edema, and all cases were resolved with topical medications. This intermediate-term assessment confirms that SING IMT implantation improved distance and near vision, with a low impact on the corneal endothelium and an acceptable and manageable rate of complications and adverse effects.

Demographic Profile and Clinical Characteristics of Fuchs Endothelial Corneal Dystrophy in Thai Patients: A Retrospective Cohort in a Tertiary Referral Center.

To describe the demographic profile, clinical characteristics, and treatment trends of Fuchs endothelial corneal dystrophy (FECD) in Thai patients, reflecting the evolving landscape of corneal transplantation in this region. This retrospective cohort study included 900 patients (1,743 eyes) diagnosed with FECD at a tertiary referral center in Thailand between January 2017 and June 2023. Demographic, clinical, and surgical data were analyzed, focusing on best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), surgical interventions, and graft survival rate. The mean age was 63.9 years, with 77.2% of patients being female. Most eyes were classified as Adamis grade I (83.7%). Diabetes mellitus and hypertension were prevalent in 17.4% and 38.6% of patients, respectively. The rate of corneal transplantation was 8.1%, with DMEK accounting for 69.3% of transplants. Graft survival rates were 94.3% at 1 year and 76.2% at 5 years. The average post-operative ECD declined from 1667.8 ± 668.0 cells/mm² at 1 year to 1140.7 ± 684.4 cells/mm² at 5 years.Cataract surgery was performed in 20.4% of phakic eyes, with only 2.2% requiring corneal transplantation within five years. FECD in Thailand, as reflected by this large cohort, predominantly presents at an early stage, allowing for conservative management. The growing use of DMEK highlights the shift towards less invasive procedures, mirroring global trends in Southeast Asia. These findings emphasize the importance of advancing surgical techniques and improving eye banking practices in the region.

Phase 3, Randomized, Comparison Study of Intracameral Bimatoprost Implant 10 µg and Selective Laser Trabeculoplasty.

To evaluate the intraocular pressure (IOP)-lowering effect and safety of up to two bimatoprost implant administrations versus selective laser trabeculoplasty (SLT). Phase 3 (Stage 2), randomized, 24-month, multicenter, patient- and efficacy evaluator-masked, paired-eye clinical trial (NCT02507687). Patients (n=183) with open-angle glaucoma or ocular hypertension inadequately managed with topical IOP-lowering medication for reasons other than efficacy. Patients received a single 360° SLT procedure in one eye and 10-µg bimatoprost implant administration in the contralateral eye. Initially, implant-treated eyes received a second implant at week 16 if safety criteria were met. After a protocol amendment, implant-treated eyes were retreated with flexible scheduling if IOP was >17 mm Hg and safety criteria were met. The primary efficacy variable was IOP change from baseline, with primary timepoints at weeks 4, 12, and 24. Safety measures included treatment-emergent adverse events (TEAEs) and ocular safety measures. Mean (±SE) baseline IOP (mm Hg) was 25.2±0.22 and 25.1±0.22 in implant- and SLT-treated eyes, respectively. Least-squares mean (±SE) IOP reduction from baseline (mm Hg) for eyes treated with up to two implants versus SLT was 6.8±0.28 versus 6.2±0.28 at week 4, 6.9±0.30 versus 6.4±0.30 at week 12, and 6.9±0.27 versus 6.5±0.28 at week 24. The probability of not having required nonstudy (rescue) IOP-lowering treatment at days 360 and 720, respectively, was 67.5% and 50.2% for implant-treated eyes versus 68.7% and 60.6% for SLT-treated eyes. The most common ocular TEAE in both implant- and SLT-treated eyes was increased IOP attributed to wearing off of efficacy. Mean (±SE) percentage change in corneal endothelial cell density from baseline at month 24 was -6.2±1.13% in implant-treated eyes (-7.9±2.04% with fixed readministration; -5.2±1.35% with flexible readministration) versus -3.1±0.43% in SLT-treated eyes. The bimatoprost implant demonstrated statistical and clinical noninferiority to SLT in IOP reduction from baseline at weeks 4, 12, and 24. In subgroup analysis, patients with flexible implant readministration met the same criteria. Both the implant and SLT demonstrated sustained (2-year) IOP lowering in many eyes. A flexible administration schedule improved the safety profile of the implant over the fixed administration schedule.

Expression of Yes-associated protein in endothelial cells of human corneas before and after storage in organ culture

The cornea, the anterior meniscus-shaped transparent and refractive structure of the eyeball, is the first mechanical barrier of the eye. Its functionality heavily relies on the health of its endothelium, its most posterior layer. The treatment of corneal endothelial cells (CECs) deficiency is allogeneic corneal graft using stored donor corneas. One of the main goals of eye banks is to maintain endothelial cell density (ECD) and endothelial barrier function, critical parameters influencing transplantation outcomes. Unlike in vivo, the stored cornea is not subjected to physiological mechanical stimuli, such as the hydrokinetic pressure of the aqueous humor and intraocular pressure (IOP). YAP (Yes-Associated Protein), a pivotal transcriptional coactivator, is recognized for its ability to sense diverse biomechanical cues and transduce them into specific biological signals, varying for each cell type and mechanical forces. The biomechanical cues that might regulate YAP in human corneal endothelium remain unidentified. Therefore, we investigated the expression and subcellular localization of YAP in the endothelium of corneas stored in organ culture (OC). Our findings demonstrated that CEC morphology, ECD and cell–cell interactions are distinctly and differentially associated with modifications in the expression, subcellular localization and phosphorylation of YAP. Notably, this phosphorylation occurs in the basal region of the primary cilium, which may play central cellular roles in sensing mechanical stimuli. The sustained recruitment of YAP in cellular junctions, nucleus, and cilium under long-term OC conditions strongly indicates its specific role in maintaining CEC homeostasis. Understanding these biophysical influences could aid in identifying molecules that promote homeostasis and enhance the functionality of CECs.

Evaluating the safety and effectiveness of the sub-400 corneal cross-linking protocol: initial clinical and morphological findings.

To assess the safety and the efficacy of the "Sub-400 corneal cross-linking (CXL) protocol" for progressive keratoconus (KC) in ultrathin corneas. The study included thirty four patients with progressive KC, who underwent CXL using the "Sub-400" protocol due to intraoperative thinnest corneal pachymetry ranging from 295 to 398μm after epithelial removal. After the epithelium was removed, the following ultraviolet A irradiation was applied at a fluence of 3 mW/cm2 and the duration was adjusted based on the specific corneal stromal thickness. In addition to slit-lamp microscopy and visual acuity assessment, our evaluation included measurements of the maximal anterior keratometry value (Kmax), mean anterior and posterior K values (Kmean), thinnest corneal thickness (TCT), central corneal thickness, intraoperative pachymetry, and corneal endothelial cell density (ECD) preoperatively and 1year postoperatively. Stromal demarcation line depth (DL) was measured in the first postoperative month. At the first year postoperative follow-up visit, 88% (30 eyes) exhibited tomographic stability, with average values of change in Kmax (ΔKmax) 0.61 ± 6.45 D after CXL. None of the eyes showed signs of endothelial decompensation. The mean DL depth was 250.76 ± 44.05μm. Moderate positive correlations were observed between DL and ultraviolet A irradiation time, DL, and intraoperative stromal thickness (r = 0.473, p = 0.005 and r = 0.517, p = 0.002, respectively). ΔKmax was negatively correlated with preoperative Kmax (r = - 0.559,P = 0.001) and positively correlated with preoperative TCT (r = 0.373, P = 0.030). The "Sub-400 protocol" for CXL has a broad application possibility for ultrathin corneas with KC and has shown promising results.

A Multicenter Study on Clinical Outcomes of Simultaneous Implantable Collamer Lens Removal and Phacoemulsification with Intraocular Lens Implantation in Eyes Developing Cataract.

This study evaluated the clinical outcomes of simultaneous implantable collamer lens (ICL) removal and phacoemulsification with intraocular lens (IOL) implantation in a multicenter study. We retrospectively investigated 83 eyes of 72 patients requiring ICL extraction and cataract surgery at five institutions. Preoperatively and 3months postoperatively, we determined visual acuity (logMAR), spherical equivalent refraction, and endothelial cell density (ECD), in addition to the preoperative backgrounds and the postoperative complications. The patients' age at the time of cataract surgery was 49.8 ± 6.8years, and the axial length was 28.49 ± 1.97mm. The most prevalent type of cataract was anterior subcapsular cataract, followed by nuclear and cortical cataract. Uncorrected and corrected visual acuities significantly improved to 0.09 ± 0.30 and - 0.12 ± 0.12 logMAR, respectively (p < 0.001). Sixty-three (76%) and 78 (94%) eyes were within ± 0.5D and 1.0D, respectively, of the targeted correction. The mean percentage of ECD loss was 1.3 ± 11.3%. No vision-threatening complications were observed in any case. Our multicenter study showed that simultaneous ICL removal and phacoemulsification with IOL implantation is a safe, effective, and predictable procedure, with no significant complications, making it a feasible option for ICL-implanted eyes developing cataracts.

Retrospective Clinical Outcomes of Keratoplasty Using Human Donor Corneas Preserved in Eusol-C Hypothermic Storage Medium.

Objective: To evaluate the clinical outcomes of cornea transplantation (penetrating keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, and deep anterior lamellar keratoplasty) using donor corneas stored in Eusol-C hypothermic storage medium compared to corneas stored in organ-culture. Methods: The clinical outcomes of 92 patients who underwent corneal transplantation with human donor corneas stored in Eusol-C medium at 2-8 °C were retrospectively evaluated. The control group consisted of 169 patients who received corneas organ-cultured at 31 °C. Donor age, sex, death-to-preservation time, and storage time were recorded. Endothelial cell (EC) density (ECD), EC mortality, and EC morphology scores were evaluated during storage in both groups. Complication rates, visual outcomes, and corneal transparency were monitored for up to six months. Results: The mean storage in Eusol-C time was 7.7 ± 2.5 days, while organ-culture time was 14.2 ± 4.0 days. In the Eusol-C group, ECD was 2398 ± 354 cells/mm2, with an average EC morphology score of 3.4 ± 0.7/4. Approximately 28% of the corneas in the Eusol-C group had no EC mortality. In the organ-culture group, ECD was 2256 ± 328 cells/mm2, with an average EC morphology score of 3.5 ± 0.5/4, and 42% were devoid of EC mortality. No complications, such as re-bubbling, were observed in both groups during surgery. Transparent corneas were achieved in 81.3% of the Eusol-C group the day after surgery. Mean corrected distance visual acuity (CDVA) at 3 and 6 months was 4.5 ± 4.0/10 and 5.4 ± 3.7/10 for the Eusol-C group and 5.0 ± 2.9/10 and 5.7 ± 2.8/10 for the organ-culture group, with no statistical differences observed between the groups. No graft failure was observed up to three months. Graft rejection occurred in the Eusol-C group and in the organ-culture group in, respectively, one and two cases at the six-month follow-up. Conclusions: Comparable surgical outcomes were achieved with donor corneas stored in both hypothermic Eusol-C and organ-culture media.

Arginase-II gene deficiency reduces skeletal muscle aging in mice.

Age-associated sarcopenia decreases mobility and is promoted by cell senescence, inflammation, and fibrosis. The mitochondrial enzyme arginase-II (Arg-II) plays a causal role in aging and age-associated diseases. Therefore, we aim to explore the role of Arg-II in age-associated decline of physical activity and skeletal muscle aging in a mouse model. Young (4-6 months) and old (20-24 months) wild-type (wt) mice and mice deficient in arg-ii (arg-ii-/-) of both sexes are investigated. We demonstrate a decreased physical performance of old wt mice, which is partially prevented in arg-ii-/- animals, particularly in males. The improved phenotype of arg-ii-/- mice in aging is associated with reduced sarcopenia, cellular senescence, inflammation, and fibrosis, whereas age-associated decline of microvascular endothelial cell density, satellite cell numbers, and muscle fiber types in skeletal muscle is prevented in arg-ii-/- mice. Finally, we demonstrate an increased arg-ii gene expression level in aging skeletal muscle and found Arg-II protein expression in endothelial cells and fibroblasts, but not in skeletal muscle fibers, macrophages, and satellite cells. Our results suggest that increased Arg-II in non-skeletal muscle cells promotes age-associated sarcopenia, particularly in male mice.

Examination of the Corneal Endothelium in Patients With Congenital Aniridia With a PAX6 Mutation Using In Vivo Confocal Laser Scanning Microscopy.

In PAX6 syndrome, it is still not clear, whether prenatally, parallel to the iris tissue developmental anomaly, there is neural ectodermal, neural crest, or mesodermal cell deposition at the corneal endothelium, affecting endothelial structure and function. In addition, because of the postnatal corneal inflammation and commonly appearing secondary glaucoma, progressive endothelial changes are expected. Our purpose was to study the corneal endothelium in subjects with PAX6 aniridia, using in vivo confocal laser scanning microscopy. Twenty-seven eyes of 16 subjects with congenital aniridia (age 28.25 ± 16.32 [11-59] years, 8 [50%] female) and 40 eyes of 26 healthy subjects (age 33.8 ± 15.2 [14-67] years, 17 [58.6%] females) were examined. Aniridia-associated keratopathy and iris malformation were graded, and means of endothelial cell density, cell area, cell diameter, spatial pattern of cell centroids (Clark-Evans index), polygonality, neighbor count, percentage of hexagonal cells, and endothelial deposit number were determined by in vivo confocal laser scanning microscopy. Mean cell diameter and mean Clark-Evans index were significantly lower (P = 0.049; P = 0.008) in congenital aniridia eyes than in controls. There were hyperreflective endothelial deposits in congenital aniridia eyes but not in controls (P < 0.001). Only aniridia-associated keratopathy grade correlated positively with mean endothelial deposit number (P = 0.017). In congenital aniridia, the corneal endothelium might possess a slightly better quality and greater reserves than in healthy subjects. Corneal endothelial deposition seems to be independent from developmental abnormalities but may be related to up to date undescribed endothelial inflammatory or metabolic changes.

Effects of small incision cataract surgery and routine ultrasonic phacoemulsification on vision recovery, anterior segment parameters and corneal regularity

Objective To compare the effects of minor incision cataract surgery (SICS) and routine ultrasonic phacoemulsification (PHACO) on vision recovery, anterior segment parameters and corneal regularity. Methods Ninety-two age-related cataract patients (100 eyes) were prospectively selected from January 2017 to December 2019. Fifty cases (50 eyes) were treated with SICS, while the remaining 42 cases (50 eyes) underwent PHACO. Their post-operative visual acuity, central corneal thickness (CCT), endothelial cell density, coefficient of variation and proportion of hexagonal cells were compared. Results CCT was more extensive in the two groups one week after the operation than before, while it returned to the pre-operative level 6 weeks after. Compared with before the operation, CCT had a significant difference in the two groups one week after the operation (P &lt; 0.05). In contrast, there was no significant difference six weeks after the operation (P &gt; 0.05). CCT had a substantial difference between the two groups 1-week after operation (P &lt; 0.05). The endothelial cell density had a significant difference in PHACO group 1 and 6 weeks after operation compared to before (P &lt; 0.01). In contrast, the two groups had no significant difference at each time point before and after operation (P &gt; 0.05). There were no significant differences in the coefficient of corneal endothelial cell area variation or proportion of hexagonal cells between the two groups at each time point (P &gt; 0.05). Conclusions SICS and PHACO have comparable clinical effects. For patients with senile hard-nucleus cataracts, SICS is characterised by fewer surgical complications.

Prevalence and Severity of Corneal Guttata After Descemet Membrane Endothelial Keratoplasty.

The postoperative occurrence of corneal guttae (CG) in patients after Descemet membrane endothelial keratoplasty (DMEK) can lead to a significant reduction in visual acuity (VA) with the subsequent need for repeat DMEK. Therefore, the aim of this study was to analyze the prevalence and clinical significance of CG in transplanted corneas after DMEK. The prevalence and progression of CG after DMEK of 1657 patients were examined using endothelial specular microscopy images. The severity grade of CG was classified into 3 grades (G1 <40%, G2 40-80%, G3 >80%). Central corneal thickness, VA, and endothelial cell density (ECD) were examined during a postoperative follow-up time of 19.5 ± 17.6 months (range 6-84 months). The prevalence of CG postoperatively was 1.3% (22/1657 eyes) after 4-6 weeks. We could classify 15/22 (68%) as G1, 5/22 (23%) as G2, and 2/22 (9%) as G3. In 12/22 (55%), either preparation and/or implantation was conspicuously difficult. None of the eyes showed an increase in CG during follow-up. 21/22 were stable in VA, central corneal thickness, and ECD during the entire follow-up. One patient with G3 required a repeat DMEK after 12 months (secondary graft failure). The prevalence of CG in our study population was notably lower than previously described and was mainly characterized by mild, low-grade findings without clinical significance and were stable during the follow-up. Preoperative overlook of CG in the tissue bank cannot be completely excluded, but the remarkable proportion of intraoperative complications in this group may have led to the occurrence of these CG.

In vivo confocal microscopy findings about ocular surface recovery in patients following pterygium excision combined with conjunctival autograft

PurposeTo study cellular and neural changes around the donor and recipient areas after pterygium excision combined with autologous conjunctival transplantation using corneal confocal microscopy, we evaluated the postoperative impact of this surgical procedure.MethodsPatients with primary pterygium located on the nasal side who visited the Department of Ophthalmology of Wuxi Second People’s Hospital between April and August 2023 were enrolled. Age-matched healthy eyes were included as the control group. IVCM was performed in the affected eyes, 6 months after pterygium excision. The images of the central conjunctival cells in the recipient and donor areas, the cells of each layer of the cornea around the recipient and donor area (around 2 mm from the nasal and upper corneal margins), and the structures of the corneal margins were recorded in the affected eyes and statistically compared with the corresponding areas in the control eyes.ResultsSeventeen eyes of 14 patients with primary pterygium located on the nasal side (mean 64 ± 8.74 years old), and 17 eyes of nine patients as age-matched normal controls were included. Compared with those of normal eyes, the density of corneal pterygoid epithelium around the recipient area (5104 ± 599 cells/mm2 vs. 5700 ± 515 cells/mm2, P < 0.01) and the central conjunctival epithelial cells in the recipient areas (3984 ± 453 cells/mm2 vs. 4834 ± 244 cells/mm2, P < 0.01) were significantly lower 6 months postoperatively. However, the superficial stromal, deep stromal, and endothelial cell densities around the recipient area exhibited no significant differences (P > 0.05). Highly illuminated basal cells were visible at the nasal corneal margin, with an irregular intersection of fibrous tissue with corneal epithelial cells. More dendritic Langerhans cell infiltration was seen in the junctional area. Compared with those in the normal eyes, the densities of the corneal pterygoid epithelium (4896 ± 428 cells/mm2 vs. 5557 ± 367 cells/mm2, P < 0.01), deep stromal cells (337 ± 65 cells/mm2 vs. 419 ± 39 cells/mm2, P < 0.01), endothelial cells (2305 ± 170 cells/mm2 vs. 2547 ± 212 cells/mm2, P < 0.01) around the donor area and the central conjunctival epithelial cells (3700 ± 446 cells/mm2 vs. 4282 ± 272 cells/mm2, P < 0.01) in the donor area were significantly lower 6 months postoperatively. However, no significant differences were observed in superficial stromal cell density (P > 0.05). A slight wavy interfacial intersection was visible on the superior corneal margin, with some of the highlighted basal cells visible.ConclusionsPterygium excision combined with autologous conjunctival transplantation with corneal stem cells can better promote the repair of most corneal cells around the recipient area and fence-like structures of the corneal rim 6 months postoperatively, but there may be some damage to the corneal conjunctival structures around the donor area.

Ocular safety of 222-nm far-ultraviolet-c full-room germicidal irradiation: A 36-month clinical observation.

The ocular safety of 222-nm far-ultraviolet-C (UV-C) irradiation, widely recognized for its germicidal properties, was evaluated in a clinical setting to assess its long-term health effects on the human eye. This prospective observational study involved a 36-month follow-up of physicians working in an ophthalmic examination room equipped with 222-nm UV-C lamps. Initially, a 12-month observation showed no signs of acute or chronic ocular damage. To further substantiate these findings, the study period was extended to 36 months, during which four participants underwent regular ocular examinations, including assessments of visual acuity, refractive error, and corneal endothelial cell density. The irradiation dose was meticulously controlled to remain within the previous threshold limit of 22 mJ/cm2 over an 8-h period, as advised by the ACGIH prior to 2022. Results indicated no significant changes in these parameters, suggesting no clinically significant ocular hazards associated with prolonged exposure to 222-nm UV-C irradiation under real-world conditions. Additionally, no delayed side effects, such as pterygium, keratopathies, or cataracts, were observed. Our study supports the safe use of 222-nm UV-C for microbial disinfection in occupied environments and provides a robust foundation for updated safety guidelines.