Endothelial Cell Loss Research Articles

Corneal Endothelial Cell Density and Morphology in Healthy Libyan Eyes

Background Endothelial cell density and morphology vary across ethnic groups. Aim This article investigates the corneal endothelial cell density and morphology in healthy Libyan eyes. Methods A 3-month cross-sectional observational study was conducted at Benghazi Teaching Eye Hospital, involving 198 eyes of 100 healthy Libyan participants. The noncontact Topcon specular microscope (SP-1P model) was used to assess the following parameters: the mean central corneal thickness (CCT), the mean cell density (MCD), the mean coefficient of variation (CV%), and the mean percentage of the hexagonal cell (Hex [%]). The variables were analyzed in relation to age and gender using the Statistical Package for the Social Sciences (SPSS version 25.0) Results The mean age of participants in this study was 47.4 ± 13.8 years (range 21–75 years). The mean CCT was 516.45 ± 43.04 μm, the MCD was 2664.30 ± 371.26 cells/mm2, the mean CV% was 32.3% ± 3.7, and the mean Hex (%) was 52.8% ± 9.6. There was no statistical difference in the age, CCT, and MCD across genders. Whereas CV (%) and Hex (%) showed significant gender differences (p < 0.01 for both). There was a significant negative weak correlation between CCT (r = –0.10) and age, as well as a significant negative moderate correlation between MCD and Hex (%) with age (r = –0.36 and r = –0.31, respectively). CV% exhibited a significant, moderately positive association with age (r = 0.35). The higher endothelial cell loss rate of 8.4% was in the third decade of life whereas other age groups ranged between 1.1 and 2.7%. Conclusion The normative data for the endothelium of Libyan eyes are reported, which can be used as a baseline for future studies.

Early thrombus formation is required for eccentric and heterogeneous neointimal hyperplasia under disturbed flow

BackgroundAnticoagulation and antiplatelet therapy effectively inhibit neointimal hyperplasia (NIH) in both arterial and venous systems but not in arteriovenous fistulae (AVF). The main site of AVF failure is the juxta-anastomotic area that is characterized by disturbed flow compared with laminar flow in the arterial inflow and the venous outflow. ObjectivesWe hypothesized that early thrombus formation is required for eccentric and heterogeneous NIH in the presence of disturbed flow. MethodsNeedle puncture and sutured AVF were created in C57BL/6 mice, in PF4-Cre × mT/mG reporter mice, and in Wistar rats. Human AVF samples were second-stage basilic vein transpositions. The tissues were examined by histology, immunofluorescence, immunohistochemistry, and en face staining. ResultsIn the presence of disturbed flow, both mouse and human AVF showed eccentric and heterogeneous NIH. Maladapted vein wall was characterized by eccentric and heterogeneous neointima that was composed of a different abundance of thrombus and smooth muscle cells. PF4-cre × mT/mG reporter mice AVF showed that green fluorescent protein-labeled platelets deposit on the wall directly facing the fistula exit with endothelial cell loss and continue to accumulate in the presence of disturbed flow. Neither disturbed flow with limited endothelial cell loss nor nondisturbed flow induced heterogeneous neointima in different animal models. ConclusionEarly thrombus contributes to late heterogeneous NIH in the presence of disturbed flow. Disturbed flow, large area of endothelial cell loss, and thrombus formation are critical to form eccentric and heterogeneous NIH. Categorization of adapted or maladapted walls may be helpful for therapy targeting heterogeneous NIH.

Phacoemulsification Techniques and Their Effects on Corneal Endothelial Cells and Visual Acuity: A Review of "Direct-Chop" and "Stop-and-Chop" Approaches Under Topical Anesthesia.

Phacoemulsification is a widely adopted technique in cataract surgery that offers a minimally invasive approach to lens removal and intraocular lens implantation. Among the various methods of phacoemulsification, "direct-chop" and "stop-and-chop" techniques are particularly notable for their efficiency and safety profiles. This review aims to evaluate the effects of these two techniques on corneal endothelial cells and visual acuity, specifically under topical anesthesia. Cataract surgery outcomes hinge on the preservation of corneal endothelial cells and the achievement of optimal visual acuity. Endothelial cell loss can lead to corneal decompensation, while visual acuity is a primary measure of surgical success. The "direct-chop" technique involves the immediate chopping of the lens nucleus after groove creation, reducing phacoemulsification time and energy. Conversely, the "stop-and-chop" technique incorporates a central groove before chopping, offering increased control and safety. This review synthesizes current research and clinical studies to compare these techniques, focusing on their respective impacts on endothelial cell count and postoperative visual acuity. It examines the advantages and disadvantages of each approach, considers the role of surgeon experience, phacoemulsification energy, and anterior chamber stability, and assesses patient outcomes under topical anesthesia. The findings aim to provide insights that can guide surgeons in selecting the most appropriate technique for their patients, ultimately enhancing surgical outcomes by ensuring the preservation of corneal health and the achievement of superior visual acuity.

Comparative Evaluation of Anterior Segment Optical Coherence Tomography Findings Following Accelerated Corneal Crosslinking Protocols Using Different Riboflavin Formulations and Soaking Durations

Purpose To comparatively evaluate the influence of different riboflavin formulations and soaking durations on the anterior segment optical coherence tomography (AS-OCT) findings following accelerated corneal crosslinking (ACXL) at 9 mW/cm2 for in progressive keratoconus. Methods In this prospective study, consecutive patients with progressive keratoconus were randomized into 4 groups. Group 1: hydroxypropyl methylcellulose (HPMC)-based riboflavin for 10 min; Group 2: HPMC-based riboflavin for 20 min; Group 3: dextran-based riboflavin (0.1%) for 30 min. Riboflavin soaking was followed by ultraviolet-A irradiation at 9 mW/cm2 for 10 min in all three groups. Group 4 underwent conventional CXL (CCXL) using Dresden protocol. The AS-OCT features of the crosslinked cornea were evaluated at postoperative month 1 and correlated to the clinical outcomes at postoperative month 12. Results The study enrolled 26 eyes of 26 patients in each group. In groups 1 and 2, the AS-OCT findings were similar (p > .05) and the demarcation lines depth (DLD) were deep as obtained following CCXL. The DLD was significantly shallower in group 3 compared to the other groups (p < .01). There were no between-group differences in regards to the visual, refractive, keratometric, and tomographic outcomes at postoperative month 12. No significant endothelial cell loss or any other clinically significant adverse event was encountered in any patient’s eye at 12 months follow-up. Conclusion Although structural variations were noted in the crosslinked cornea, DLDs observed following ACXL (9 mW/cm2) using HPMC-based solution for 10 or 20 min were similar to those observed following CCXL. Whereas, ACXL (9 mW/cm2) using dextran-based solution for 30 min resulted in the shallowest DLD. Despite these remodeling differences, the visual, refractive and tomographic outcomes of all groups were comparable at postoperative 1-year follow-up. Studies with a greater number of patients and longer follow-ups are required to establish any relation between AS-OCT characteristics of crosslinked cornea and ACXL efficacy.

Trocar-assisted extraocular technique for intrascleral intraocular lens fixation using a 90°-curved forceps: a modified extraocular forceps-guided technique.

To investigate the surgical outcomes of intrascleral intraocular lens (IOL) fixation using a modified extraocular forceps-guided technique. Retrospective case series. Overall, 81 eyes of 78 patients who underwent intrascleral IOL fixation using the modified extraocular forceps-guided technique were included. The procedure entailed creating 2 scleral half-layer T-shaped incisions perpendicular to the main incision and forming a scleral tunnel. A 25-gauge trocar was inserted at the lower end of the T-shaped incision to perform vitrectomy. A 27-gauge needle was inserted from the left-hand port, and the leading haptic was inserted into the needle lumen. After removal of the right-hand trocar, a 90°-curved intrascleral fixation forceps was inserted into the eye, exposing the tip at the main incision, thus allowing the tip of the extraocular trailing haptic to be gripped and both haptics to be pulled out. The left-hand trocar was removed, and the haptics were buried in the scleral tunnel. The surgical outcomes of this technique were retrospectively evaluated on the basis of the medical records. The induction of haptics was successful in all cases. The preoperative best-corrected visual acuity improved from 0.35±0.68 to 0.12±0.36 logMAR postoperatively (P<0.01). The refractive error was -0.27±0.87 D; IOL decentration, 0.39±0.18 mm; IOL tilt, 5.97±2.65°; IOL astigmatism, 0.35±0.36 D; and corneal endothelial cell loss, 10.3±12.7%. There were no serious complications related to the surgical technique. The modified extraocular forceps-guided technique allows for safe and straightforward induction of the trailing haptics and enables the performance of intrascleral IOL fixation with minimal scleral incisions.

Intraocular Lens Opacification After Descemet's Membrane Endothelial Keratoplasty-Risk Factors and Outcomes After Intraocular Lens Exchange.

To determine risk factors for intraocular lens opacification (IOLop) after Descemet membrane endothelial keratoplasty (DMEK) and to analyze clinical outcomes after IOL exchange. Cross-Sectional Study: Analysis of all cases of IOL exchange because of post-DMEK IOLop with a minimum of 6-month postoperative follow-up observed in clinic between November 2021 and April 2022. Main outcomes analyzed at the study visit were change in logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity after IOL exchange, endothelial cell loss (ECL), and graft survival. An historical cohort of 232 pseudophakic DMEK eyes was retrospectively analyzed to determine risk factors for post-DMEK IOLop. Cross-Sectional Study: Four eyes were observed (median follow-up = 45 (35.5-86.8) months). IOL materials were hydrophilic acrylic IOLs in 2 eyes and hydrophobic-hydrophilic in the other 2. At the study visit, improvement in median best-corrected visual acuity after IOL exchange was statistically significant (0.25 (0.19-0.41) logMAR to 0.00 (0-0.10) logMAR; P = 0.041). ECL ranged between 57.7% and 85.3%, without cases of graft failure. In the historical cohort, 21 eyes (9.05%) had some IOLop. In multivariate logistic regression model (105 eyes where IOL material data was available), IOLs with high water content material (odds ratio = 65.5, P = 0.0005) and rebubbling (odds ratio = 9.51, P = 0.0138) were independent risk factors for post-DMEK IOLop. Post-DMEK IOLop is infrequent, but a non-neglectable proportion of cases may require IOL explantation. IOL exchange is safe and effective in these eyes but may pose a risk for increased ECL. This study confirms that IOL material and number of rebubblings are major risk factors for post-DMEK IOLop.

Simple Modification of a DSAEK Carrier Enables Graft Insertion by Injection Without Compromising Endothelial Cell Viability.

We evaluate the quality and feasibility of preloading Descemet stripping automated endothelial keratoplasty (DSAEK) grafts into a modified EndoGlide Ultrathin system for graft injection. DSAEK grafts were prepared by experienced processing technicians at 2 separate locations, loaded into a modified EndoGlide Ultrathin, and placed in storage media. Grafts processed at one location were shipped cross-country overnight to the other location and were examined on arrival for positioning within the modified EndoGlide Ultrathin. All grafts were ejected and analyzed for endothelial cell loss (ECL) with calcein acetoxymethyl staining and FIJI segmentation. A subset of grafts was measured by optical coherence tomography for graft thickness 1 hour after cut, 1 hour after loading, and 1 day after loading. No grafts were displaced from the modified carrier over 3 shipping events (n = 9), and all grafts (n = 18) were successfully ejected. Grafts loaded into the modified carrier and ejected exhibited no more cell loss than grafts loaded into the standard carrier and removed by pull-through (14.0% ± 2.8% vs. 12.2% ± 3.4%, respectively, P = 0.24). Carrier modification skills can be successfully transferred as grafts loaded by a processing technician new to carrier modification were within the acceptable limit of 25% ECL for transplant DSAEK grafts. Graft thickness increased significantly (P < 0.05) between the postcut and 1-hour postload measurement and the postcut and 24-hour postload measurement. The EndoGlide Ultrathin can be modified to enable its use for graft injection while not compromising the ability to use the pull-through method for graft delivery. Preloaded DSAEK grafts swell significantly during the 24-hour storage period, and patterns of ECL may be linked to swelling.

Comparison of corneal endothelial cell density reduction between primary open-angle glaucoma and pseudo-exfoliation glaucoma patients at 3years after Ex-Press® surgery.

We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3years. We measured the CED before and after (at 12, 24, and 36months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients.

Descemet Membrane Endothelial Keratoplasty in Aphakic, Aniridic, and Vitrectomized Eyes: A Review.

The aim of this review is to examine the techniques, complications, and outcomes of Descemet membrane endothelial keratoplasty (DMEK) in aphakic, aniridic, and vitrectomized eyes. A literature search was conducted in the MEDLINE database (via PubMed), using as keywords "(DMEK) AND (aphakia OR aniridia OR vitrectomy OR vitrectomized)." The research was limited to 10 years (January 2014-March 2024), in view of lack of literature before 2014. Articles, including case reports and case series, were included. Twenty articles were included. No randomized controlled trials were found nor comparative studies with more than 1 technique used. Mean rebubbling rate in complex eyes was 29%, whereas mean endothelial cell loss at 6 months was 37%. The mean postoperative visual acuity improved from 1.47 logarithm of the minimal angle of resolution to 0.7 logarithm of the minimal angle of resolution. Despite being more challenging, compared with the techniques reported in literature, DMEK can be considered a valid option for the management of endothelial decompensation in complex eyes, with rebubbling rate and endothelial cell loss at 6 months, which are similar to non-complex eyes.

Impact of the ratio between graft and host corneal size on immune rejection, re-bubbling rate and postoperative endothelial cell loss in 457 eyes after Descemet membrane endothelial keratoplasty (DMEK)

The aim of this study was to assess the impact of the ratio between the graft and host corneal size (RGH) on postoperative complications, such as immune reactions, re-bubbling rate and endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK). Retrospectively, 457 patient eyes were included which had undergone surgery between 2016 and 2019 in the Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar using DMEK or triple DMEK, diagnosed as Fuchs' endothelial dystrophy (n = 431), pseudophakic bullous keratopathy (n = 9) and others (n = 17). The follow-up period extended until the end of 2020.Main outcome measures included immune reaction (IR), re-bubbling rate and the postoperative endothelial cell loss (ECL) at 6weeks, 6months and 12months and whether these measures depended on the RGH. The RGH in this study ranged from 0.35 to 0.62 (0.46 ± 0.04). There were 33(7.2%) postoperative IRs (DMEK n = 25; triple DMEK n = 8). The average RGH without IR (0.46 ± 0.04) was significantly (p = 0.038) smaller than in the group with IR (0.47 ± 0.05). Re-bubbling was necessary in 159 of 457 (34.8%) patient eyes. The RGH in patient eyes with re-bubbling (0.47 ± 0.04) was significantly (p = 0.014) higher than that in eyes without re-bubbling (0.45 ± 0.04). The mean preoperative endothelial cell count (ECD) was 2603 ± 251 cells/mm2 (min: 2161, max: 3500 cells/mm2). It was shown that alarger RGH had no positive influence on endothelial cell loss (r = 0.001; p = 0.974). Our results suggest that alarger graft diameter compared to host corneal size is associated with an increased rate of immune reactions and ahigher re-bubbling rate after DMEK. Otherwise, alarger RGH had no positive influence on endothelial cell loss after DMEK. Accordingly, the graft size for DMEK should not be unnecessarily large, especially in eyes with Fuchs' endothelial dystrophy.

Identification of a subpopulation of highly adherent endothelial cells for seeding synthetic vascular grafts

ObjectiveThere is an unmet clinical need for alternatives to autologous vessel grafts. Small-diameter (<6 mm) synthetic vascular grafts are not suitable because of unacceptable patency rates. This mainly occurs due to the lack of an endothelial cell (EC) monolayer to prevent platelet activation, thrombosis, and intimal hyperplasia. There are no reliable methods to endothelialize small-diameter grafts because most seeded ECs are lost due to exposure to fluid shear stress after implantation. The goal of this work is to determine if EC loss is a random process or if it is possible to predict which cells are more likely to remain adherent. MethodsIn initial studies, we sorted ECs using fluid shear stress and identified a subpopulation of ECs that are more likely to resist detachment. We use RNA sequencing to examine gene expression of adherent ECs compared with the whole population. Using fluorescence activated cell sorting, we sorted ECs based on the expression level of a candidate marker and studied their retention in small-diameter vascular grafts in vitro. ResultsTranscriptomic analysis revealed that fibronectin leucine rich transmembrane protein 2 (FLRT2), encoding protein FLRT2, is downregulated in the ECs that are more likely to resist detachment. When seeded onto vascular grafts and exposed to shear stress, ECs expressing low levels of FLRT2 exhibit 59.2% ± 7.4% retention compared with 24.5% ± 6.1% retention for the remainder of the EC population. ConclusionsFor the first time, we show EC detachment is not an entirely random process. This provides validation for the concept that we can seed small-diameter vascular grafts only with highly adherent ECs to maintain a stable endothelium and improve graft patency rates.

A Prospective, Randomized, Controlled Clinical Investigation Comparing the Efficacy and Safety of Sodium Hyaluronate-Based Ophthalmical Viscosurgical Devices FIDIAL PLUS and IAL®-F in Cataract Surgery.

Purpose: To protect the corneal endothelium, various ophthalmical viscoelastic devices (OVDs) are used during cataract surgery. In this study, we compared two sodium hyaluronate-based OVD, the bacteria-derived FIDIAL PLUS OVD (test) with the animal-derived IAL®-F OVD (reference) during the surgical procedure. Methods: Fifty patients with bilateral cataract participated in the study: 50 eyes randomly received FIDIAL PLUS and 50 eyes received IAL®-F (ratio 1:1). Noninferior efficacy of FIDIAL PLUS compared with reference OVD (first objective) was evaluated using a paired t-test comparing the mean percent loss of corneal endothelial cells (CECs) with FIDIAL PLUS against the mean percent loss with IAL®-F. Corneal endothelial protection during cataract surgery with FIDIAL PLUS without significant (≥30 mmHg) postoperative intraocular pressure (IOP) increase (main secondary objective) was assessed using a repeated measures logistic model comparing the incidence of significant postoperative IOP elevation between the two groups. Safety, tolerability, and efficacy were also evaluated by assessing secondary endpoints before and after surgery. Results: FIDIAL PLUS showed a statistically noninferior efficacy compared with IAL®-F; there was no significant increase in IOP in either group or different trends of the secondary endpoints were observed between the OVD groups. The safety profile was similar in both OVD groups and no adverse device effects were reported. Conclusions: This study demonstrates the equivalent efficacy, tolerability, and safety of the bacteria-derived FIDIAL PLUS compared with the animal-derived IAL®-F, confirming the clinical value of this product.

Contact Lens-Assisted DMEK for Corneal Decompensation With an Anterior Chamber Intraocular Lens: A Novel Technique.

To describe a novel technique in which a contact lens was used to facilitate Descemet membrane endothelial keratoplasty (DMEK) in an eye with an anterior chamber intraocular lens (ACIOL). A 71-year-old man with a long-standing ACIOL developed bullous keratopathy. As the patient was at high risk of complications due to multiple ocular comorbidities, DMEK was performed with the ACIOL left in the anterior chamber. An inserted cosmetic contact lens was used as a platform for the graft unfolding. Partial graft detachment on the third postoperative day required rebubbling. This successfully cleared up the cornea after a few weeks. At the one-month follow-up, the uncorrected distance visual acuity improved to 20/50, with an endothelial cell loss of 35.2%. Steroid-induced ocular hypertension necessitated a trabeculectomy by the fifth postoperative month. At the sixth follow-up month, endothelial cell loss was 64%. Contact lens-assisted DMEK is a safe procedure for eyes with an ACIOL. However, good foresight is needed regarding whether the ACIOL should be kept or exchanged.

Challenges in cataract surgery after penetrating keratoplasty managed using femtosecond laser: A series of 3 case reports.

Cataract surgery in patients after penetrating keratoplasty (PKP) is often challenging because of changes in corneal structure induced by PKP and primary corneal disease. Femtosecond laser-assisted cataract surgery offers several advantages over conventional phacoemulsification, and has been widely used in complicated cataract surgery. We report the use of femtosecond laser-assisted cataract surgery in 3 challenging cases after penetrating keratoplasty. Case 1 involved a patient with hard nuclear grade IV° cataract. After surgery, his corrected distance visual acuity (CDVA) improved from 20/400 to 20/25, and the endothelial cell loss (ECL) % was 12.05 % at 3 months postoperatively. The rotation of the toric IOL in Case 1 was 2°. Case 2 involved a patient with severe nuclear cataract and an endothelial cell density of 837 cells/mm2. After surgery, the CDVA improved from 20/100 to 20/40. The ECL% was 4.06% at 1 week postoperatively. Case 3 was a 91-year-old woman with a short axis length of 21.35 mm and an endothelial cell density number of 1238 cells/mm2. After surgery, the CDVA improved from light perception to 20/133, and the ECL% was 26.09% at 1 week postoperatively; ECL% was 2.67% at 1 month post-operation. The corneal grafts were transparent. Femtosecond laser-assisted cataract surgery seems to be an effective, predictable, and safe approach for challenging patients after PKP, and improves visual recovery and optimal refractive outcomes.

Brain cell-type shifts in Alzheimer's disease, autism, and schizophrenia interrogated using methylomics and genetics.

Few neuropsychiatric disorders have replicable biomarkers, prompting high-resolution and large-scale molecular studies. However, we still lack consensus on a more foundational question: whether quantitative shifts in cell types-the functional unit of life-contribute to neuropsychiatric disorders. Leveraging advances in human brain single-cell methylomics, we deconvolve seven major cell types using bulk DNA methylation profiling across 1270 postmortem brains, including from individuals diagnosed with Alzheimer's disease, schizophrenia, and autism. We observe and replicate cell-type compositional shifts for Alzheimer's disease (endothelial cell loss), autism (increased microglia), and schizophrenia (decreased oligodendrocytes), and find age- and sex-related changes. Multiple layers of evidence indicate that endothelial cell loss contributes to Alzheimer's disease, with comparable effect size to APOE genotype among older people. Genome-wide association identified five genetic loci related to cell-type composition, involving plausible genes for the neurovascular unit (P2RX5 and TRPV3) and excitatory neurons (DPY30 and MEMO1). These results implicate specific cell-type shifts in the pathophysiology of neuropsychiatric disorders.

Evaluation of endothelial cell loss after cataract surgery in patients with pseudoexfoliative syndrome

Introduction: Despite modern techniques and technologies for cataract surgery, pseudoexfoliative syndrome poses a challenge to surgeons due to weakness of the zonular apparatus and limited pupillary dilation. Quantitative and qualitative morphological changes in the corneal endothelium have been demonstrated by several studies. An accumulated risk of endothelial cell loss can be expected in these patients following more complicated and prolonged surgery, often requiring complex manipulation of the cataract, iris, and IOL. Our present work aims to compare the loss of endothelial cells after uncomplicated phacoemulsification in patients without and with pseudoexfoliative syndrome. Materials and methods: We conducted a prospective comparative study collected at the Rabat specialty hospital, spanning from August to December 2023. Were included in this study 60 candidates for cataract surgery: - 30 patients with pseudoexfoliation syndrome (PXF) and - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. - 30 without capsular exfoliation (non-PXF) as a control group. We excluded from this work diabetic patients, glaucomatous patients, patients with a history of surgery, ocular trauma or uveitis, high myopia, patients with preoperative corneal abnormalities as well as all complicated cataract surgeries. All patients underwent cataract surgery by phacoemulsification with implantation. Discussion: In our series, we did not find a statistically significant difference in the density of preoperative endothelial cells between the 2 groups, this result is similar to that obtained by KALJURAND et al, on the other hand for ken hayashi et al, and wirbelauer et al, the difference between the 2 groups was statistically significant. Regarding postoperative cell loss, our results agreed with those obtained by Ken Hayashi et al, who also reported greater endothelial cell loss in the PXF group compared to the control, unlike Wirbelauer et al, for whom the loss of endothelial cells was similar between the 2 groups. In the study by Kaljurand et al, the average percentage loss was 18% in the PXF group versus 11.6 in the control group, this difference had a statistically low significance. Conclusion: The loss of corneal endothelial cells after phacoemulsification in eyes with capsular pseudoexfoliation was significantly greater than in eyes without PXF, these results suggest that corneal endothelial cells of patients with pseudoexfoliation syndrome are more vulnerable to cataract surgery than healthy endothelial cells. To prevent serious endothelial lesions, a precise preoperative evaluation of the corneal endothelial state by specular microscopy seems necessary in these patients, with more precision and precautions during the procedure.

Corneal Endothelial Changes Following Anterior Chamber Intraocular Lens Implantation in Extracapsular Cataract Surgery

Aim: To determine &amp; quantify corneal endothelial changes after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs) in extracapsular cataract surgery complicated by loss of capsule support. Setting: Ibn Al- Heythem teaching eye hospital, Baghdad. Patients &amp; Methods: This prospective study comprised 125 patients underwent extracapsular cataract surgery complicated by loss of capsular support. Of them 76 patients had primary implantation of open-loop AC IOLs. The other 49 patients were kept aphakic after similar complicated cataract surgery &amp; had secondary AC IOL implantation (open-loop), this was performed 10 weeks to 2 years from initial cataract surgery. At least 2 weeks post AC IOL implantation, non-contact specular microscopy was performed at the center of the cornea for eyes with primary &amp; secondary AC IOLs implantation, their fellow eyes (phakic or pseudophakic with posterior chamber PC IOL) taken as control. Results: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes. Patients with primary AC IOL implantation in 1 eye &amp; PC IOL implantation in fellow eye had a difference in ECD that was not statistically significant. The ECD difference was significantly greater in eyes with secondary AC IOL implantation compared to fellow pseudophakic eyes (PC IOL). The coefficient of variation (CV) in cell size &amp; percentages of hexagonality showed no significant changes in the various groups. Conclusion: AC IOL implantation didn't appear to alter corneal endothelial function. Results indicate that endothelial cell loss was related to surgical trauma rather than the presence of AC IOL.

Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes - A prospective interventional study.

To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes. A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT). Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively. FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS.

Comparison of corneal endothelial cell loss in FLACS: impact on endothelial cells in different regions.

To compare changes in corneal endothelial parameters after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) in different corneal regions. Chang Gung Memorial Hospital, Linkou, Taiwan. Single-center, retrospective. Before and 1, 3, and 6 months postoperatively, specular microscopy was performed to measure endothelial cell density (ECD), corneal thickness, hexagonal cell rate (Hex), and coefficient of variation (CoV). Position 1 referred to the central cornea, position 2 was nearest to the main wound, and position 3 was at the peripheral zone diagonal to the main wound. This study analyzed 96 eyes in the FLACS group and 110 eyes in the CPS group. Preoperatively, position 1 had lower ECD and CoV and higher Hex compared with the peripheral regions. FLACS patients had a significantly less phacoemulsification time and cumulative dissipated energy. At 1 month, FLACS patients showed a significantly smaller increase in corneal thickness at positions 1 and 2. At 3 months, FLACS patients had lower endothelial cell loss (ECL) at positions 1 and 3. ECL remained lower in FLACS patients at 6 months. The highest ECL was observed at position 2 in both groups and was progressive up to 6 months. After phacoemulsification, ECL varied in different corneal regions. At 3 months, the FLACS group exhibited significantly less ECL at the central cornea; however, the continued ECL at 6 months near the main wound suggested ongoing endothelial remodeling in the region.

Comparison of low-energy FLACS and conventional cataract surgery: meta-analysis and systematic review.

To systematically compare the effectiveness of conventional phacoemulsification surgery (CPS) and low-energy femtosecond laser-assisted cataract surgery (FLACS) in patients with cataract. Cataract surgery is a common procedure, and comparing different techniques such as CPS and low-energy FLACS is crucial for optimizing patient outcomes. The PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library databases were searched for clinical trials. Outcomes of procedure time, effective phacoemulsification time, balanced salt solution usage, cumulative dissipated energy, mean change of corrected distance visual acuity, endothelial cells reduction, central corneal thickness (CCT), and aqueous cytokine level were evaluated. The effect measures were weighted mean differences with 95% CI. The protocol was registered at the Prospective Register for Systematic Reviews (registration number CRD42023420173). 11 studies were included in this meta-analysis, of which 1680 eyes were analyzed (637 eyes in the low-energy FLACS group and 1043 eyes in the CPS group). Low-energy FLACS demonstrated significantly fewer reductions in endothelial cell count at 6 months ( P < .001) compared with CPS. It also exhibited a shorter effective phacoemulsification time ( P < .001) and less balanced salt solution usage ( P < .001). However, there were no differences in cumulative dissipated energy, corrected distance visual acuity, CCT changes, or aqueous cytokine levels between the 2 groups. Both low-energy FLACS and CPS are effective in treating cataracts, but low-energy FLACS may offer advantages such as reduced phacoemulsification time and less endothelial cell loss.