Long-term Endothelial Cell Loss Research Articles

Predicting Long-Term Endothelial Cell Loss after Preloaded Descemet Membrane Endothelial Keratoplasty in Fuchs’ Endothelial Corneal Dystrophy: A Mathematical Model

(1) Background: This study offers a biexponential model to estimate corneal endothelial cell decay (ECD) following preloaded “endothelium-in” Descemet membrane endothelial keratoplasty (DMEK) in Fuchs’ endothelial corneal dystrophy (FECD) patients; (2) Methods: A total of 65 eyes undergoing DMEK alone or combined with cataract surgery were evaluated. The follow-up period was divided into an early phase (first 6 months) and a late phase (up to 36 months). Endothelial cell count (ECC) and endothelial cell loss (ECL) were analyzed; (3) Results: The half time of the ECD was 3.03 months for the early phase and 131.50 months for the late phase. The predicted time-lapse interval to reach 500 cells/mm2 was 218 months (18.17 years), while the time-lapse interval to reach 250 cells/mm2 was 349 months (29.08 years). There was no statistically significant difference between the ECL in DMEK combined with cataract extraction and DMEK alone at 24 months (p ≥ 0.20). At the late phase, long-term ECL prediction revealed a lower ECC half time in patients undergoing DMEK combined with cataract surgery (98.05 months) than DMEK alone (250.32 months); (4) Conclusions: Based on the mathematical modeling, a predicted average half-life of a DMEK graft could reach 18 years in FECD. Moreover, combining cataract extraction with DMEK could result in excessive ECL in the long term.

Descemet Membrane Endothelial Keratoplasty: 10-Year Cell Loss and Failure Rate Compared With Descemet Stripping Endothelial Keratoplasty and Penetrating Keratoplasty.

The aim of this study was to assess long-term endothelial cell loss (ECL) and graft failure with Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) versus penetrating keratoplasty (PK) performed for the same indications (primarily Fuchs dystrophy and pseudophakic corneal edema) in the Cornea Donor Study. This retrospective study included consecutive primary DMEK (529 recipients, 739 eyes) and DSEK cases (585 recipients, 748 eyes) with 1 or more endothelial cell density (ECD) measurements at 6 months to 16 years. Main outcomes were ECD, longitudinal ECL, and graft failure. Between 6 months and 8 years the ECD declined linearly by approximately 118 cells/mm2/yr after DMEK and 112 cells/mm2/yr after DSEK. Beyond 8 years postoperatively the rate of decline slowed substantially. Selective dropout from graft failure did not significantly affect the ECD trend. At 10 years, median ECL (interquartile range) was 63% (45, 73) with DMEK, 68% (48, 78) with DSEK, and 76% (70, 82) with PK (P = 0.01 DMEK vs. DSEK, P <0.001 DMEK vs. PK, and P < 0.001 DSEK vs. PK). The proportion of surviving grafts with 10-year ECD <500 cells/mm2 was 1.4% with DMEK, 7.3% with DSEK, and 23.9% with PK. The cumulative risk of graft failure between 6 months and 10 years was 5% with DMEK, 11% with DSEK, and 19% with PK (P < 0.001). Compared with PK and DSEK, DMEK had significantly lower ECL and significantly lower risk of secondary graft failure through 10 years.

Comparison of Long-Term Outcomes of DSEK and DMEK in Fuchs Endothelial Dystrophy.

This study aimed to compare the long-term endothelial cell loss, graft survival, and clinical outcomes in patients with Fuchs endothelial dystrophy (FED) after Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK) using a standardized surgical protocol. Three hundred and six consecutive DSEK and DMEK grafts of 223 patients with FED performed by 8 surgeons between January 2006 and August 2022 were analyzed. The primary outcome measures were graft survival, endothelial cell loss, and best spectacle-corrected visual acuity. At 5 years, graft survival was 96% for both DSEK and DMEK eyes. The mean percentage of endothelial cell loss was 57.7 ± 17.1 in DSEK and 56.8 ± 15.2 in DMEK eyes ( P = 0.430). The mean best spectacle-corrected visual acuity was 0.13 ± 0.14 logMAR in DSEK and 0.01 ± 0.18 logMAR in DMEK grafts ( P <0.00001) at 5 years postoperatively. Rebubbling was performed in 7.8% DSEK and 2.1% DMEK grafts ( P = 0.441). Cox regression identified rejection episodes (HR 6.5; 95% CI: 1.70-24.8; P = 0.0062) as a significant contributing factor for graft failure. DMEK had superior visual acuity outcomes compared with DSEK in these patients up to 5 years after surgery. At 5 years, there was no significant difference in graft survival or endothelial cell loss between DSEK and DMEK eyes with FED. We propose that our standardized technique reduces the need for rebubbling.

Clinical comparison of manual and laser-cut corneal tunnel for intrastromal air injection in femtosecond laser-assisted deep anterior lamellar keratoplasty (DALK).

The most crucial step in deep anterior lamellar keratoplasty (DALK) is to achieve a bare Descemet's membrane. We aimed to assess a new femtosecond laser software that allows for a precise intrastromal tunnel creation for big bubble (BB) air injection using a real-time microscope-integrated optical coherence tomography. A retrospective review of 61 eyes of 61 patients with keratoconus. Before introducing the new software update, DALK was performed using a partial-assisted femtosecond laser (partial-thickness circular cut followed by a lamellar cut) with manual intrastromal tunnel creation (partial FS-DALK group). After the software update, the femtosecond laser created the intrastromal tunnel (full FS-DALK group). In the full FS-DALK group, the BB's formation was significantly higher (64.3% vs. 36.4%, p = 0.04), and surgery time was shorter (21.8 ± 5.1 vs. 25.6 ± 6.8min, p = 0.025) than in the partial FS-DALK. Penetrating keratoplasty conversion rate (7.1% vs. 15.1%, p = 0.432) was similar between the groups. Both groups showed statistically significant improvement in uncorrected and corrected distance visual acuity, central corneal thickness, surface asymmetry, and regularity indices. Endothelial cell density loss at 12 and 18months was lower in the full compared with the partial FS-DALK group (12months:10.0% vs. 16; 18months: 10.7 vs. 16.5%, p < 0.001 for both comparisons). Creating the intrastromal guiding tunnel using FS laser for air injection resulted in a higher rate of BB formation, reduced long-term endothelial cell loss, and operating room time.

Ten-year safety follow-up and post-explant analysis of an anterior chamber phakic IOL.

To assess endothelial cell loss (ECL) rate and collect safety data in patients with AcrySof L-series Cachet phakic intraocular lens (pIOL) up to 10 years post-implantation. Clinical settings in the United States, European Union, and Canada. Nonrandomized, observational, open-label safety study. Central and peripheral endothelial cell density was evaluated and compared with 6-month post-implantation baseline. Nonlinear analysis was performed to identify factors affecting post-explantation ECL. Additional evaluations included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), adverse device effects (ADEs), and serious adverse events (SAEs). The study included 1123 implanted eyes (mean age, 37.5 years). At 10 years, mean central and peripheral ECL was 16% (1.7% annualized). Explantations were performed in 10% of eyes (n = 136/1323). For eyes with pIOL explantation because of ECL (7%), annualized ECL rate post-explantation was numerically lower compared with the overall rate in eyes that underwent explantation for any reason (annualized rate, -1.65% vs -2.03%, respectively; n = 96) and compared with pre-explantation ECL. Mean ± SD CDVA and UCVA were -0.12 ± 0.11 and 0.03 ± 0.22 logarithm of the minimum angle of resolution, respectively. Common ocular ADEs included ECL (10%), pIOL extraction (9%), iris adhesion (7%), and pupillary deformity (2%). Common SAEs included pIOL extraction (11%), ECL (9%), and iris adhesions (8%). Cachet pIOLs were associated with long-term ECL in some cases. Overall, only 10% of all implanted eyes underwent explantation during 10-year follow-up. In patients requiring explantation because of ECL, the annualized ECL rates decreased post-explantation in some eyes. Continued monitoring of patients regardless of explantation is recommended.

Hybrid Descemet Membrane Endothelial Keratoplasty (H-DMEK): results of a donor insertion pull-through technique using donor stroma as carrier

AimTo evaluate the outcomes and complications of hybrid Descemet membrane endothelial keratoplasty (H-DMEK) using a Descemet stripping automated endothelial keratoplasty (DSAEK) pull-through donor inserter and donor stroma as carrier.MethodsThis was...

Long-term endothelial cell loss with the iris-claw intraocular phakic lenses (Artisan®).

To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm2. None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm2). There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.

Long-term (≥10 years) results of corneal endothelial cell loss after cataract surgery

To investigate the extent of long-term corneal endothelial loss after uneventful cataract surgery and the factors associated with decreases in corneal endothelial cell density (ECD). Retrospective case series. Patients who had undergone uncomplicated cataract surgery. This study comprised 81 eyes of 48 patients who had undergone cataract surgery >10 years previously by a single surgeon with the same intraocular lens and visited the outpatient clinic between January 2014 and February 2017. Long-term (≥10 years) changes in visual outcome and ECD after uncomplicated cataract surgery were evaluated. To analyze factors correlated with endothelial cell loss, preoperative biometric variables, including cataract grade, anterior chamber depth, axial length, and postoperative corneal edema, were evaluated. The mean ± SD preoperative and long-term postoperative ECD was 2793 ± 351.09 and 2148 ± 478.38 cells/mm2, respectively. The mean follow-up period was 11.08 ± 1.06 years and 10-year ECD loss rate was 20.62 ± 13.63%. Preoperative nuclear firmness was most statistically correlated with 10-year ECD loss (β-coefficient 0.394 [95% CI 3.402-9.448]; p < 0.001). The degree of postoperative corneal edema was also a significant predictive factor of 10-year ECD loss after cataract surgery (β-coefficient 0.378 [95% CI 2.854-8.358]; p = 0.002). Preoperative nuclear firmness and postoperative corneal edema were predictors of long-term (≥10 years) endothelial cell loss and severe endothelial cell loss after cataract surgery. It is important to remember that eyes with increased nuclear firmness have a significantly higher risk of long-term enhanced ECL.

Clinical Factors for Early and Late Endothelial Cell Loss After Corneal Transplantation

To consider the relative importance of factors associated with post-keratoplasty endothelial cell loss. Lamellar keratoplasty continues to supplant penetrating keratoplasty. When host endothelium is healthy, retaining it with deep anterior lamellar keratoplasty significantly reduces long-term endothelial cell loss. Endothelial keratoplasty and penetrating keratoplasty differ fundamentally in relative rates of early and late central endothelial cell loss, yet at 10 years, their cumulative cell loss is similarly substantial. The greatest risk factor for post-keratoplasty endothelial decompensation is prior glaucoma filtration surgery, particularly an aqueous shunt. Interestingly, vital dye staining and sophisticated imaging software suggest that the actual viable endothelial cell density of donor corneas is often overestimated by specular microscopy, inflating estimates of early cell loss. Corneal graft longevity is often determined by endothelial cell survival. Adoption of new surgical techniques has improved graft survival, and new imaging techniques allow more accurate preoperative endothelial cell evaluation.

Long-Term Endothelial Cell Loss in Patients with Artisan Myopia and Artisan Toric Phakic Intraocular Lenses: 5- and 10-Year Results

To evaluate the long-term change in endothelial cell density (ECD) after the implantation of 2 types of rigid iris-fixated phakic intraocular lenses (pIOLs) for the treatment of myopia and astigmatism. Prospective, clinical cohort study. A total of 507 eyes of 289 patients receiving the Artisan Myopia or Artisan Toric (Ophtec B.V., Groningen, The Netherlands) iris-fixated pIOL for the treatment of myopia or astigmatism at the University Eye Clinic Maastricht as of January1998. A total of 381 myopic and 126 toric pIOLs were implanted. Five- and 10-year follow-ups were completed by 193 and 127 eyes implanted with the myopic pIOL and by 40 and 20 eyes implanted with the toric pIOL, respectively. Chronic endothelial cell (EC) loss, percentage of eyes with a decrease of ≥25% in ECD, and percentage of eyes with an ECD <1500 cells/mm2. Chronic EC loss was calculated from 6 months postoperatively to the end of follow-up and showed an annual ECD decline of 48 cells/mm2 (standard error, 3.14) and 61 cells/mm2 (standard error, 6.30) in the myopic (P < 0.001) and toric (P < 0.001) groups, respectively, resulting in a total EC loss of 16.6% and 21.5% from 6 months to 10 years postoperatively, respectively. Ten years after implantation, ECD had decreased by ≥25% in 7.9% and 6.3%, whereas ECD was <1500 cells/mm2 in 3.9% and 4.0% in the myopic and toric groups, respectively. Explantation of the pIOL occurred in 6.0% in the myopic group and 4.8% in the toric group. Risk factors for increased EC loss were a shallow anterior chamber depth (ACD) (P ≤ 0.005) and a smaller distance between the central and peripheral pIOL edge to the endothelium (P ≤ 0.005). A significant linear chronic EC loss was reported after implantation with myopic or toric iris-fixated pIOLs. A smaller ACD and smaller distance between pIOL edge and endothelium were risk factors for EC loss. Modification of preoperative age-related ECD thresholds is indicated to maintain an ECD that warrants safe future combined pIOL explantation and cataract surgery.

Donor Age and Factors Related to Endothelial Cell Loss 10 Years after Penetrating Keratoplasty: Specular Microscopy Ancillary Study

Objective To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). Design Multicenter, prospective, double-masked clinical trial. Participants We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Methods Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Main Outcome Measures Endothelial cell density at 10 years. Results Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm2 (interquartile range [IQR], 522–850 cells/mm2), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm2 (IQR, 483–694 cells/mm2; P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P < 0.001) and larger donor tissue size (P < 0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm2 at 10 years and only 24 (14%) had an ECD of >1000 cells/mm2. Conclusions Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). Multicenter, prospective, double-masked clinical trial. We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Endothelial cell density at 10 years. Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm2 (interquartile range [IQR], 522–850 cells/mm2), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm2 (IQR, 483–694 cells/mm2; P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P < 0.001) and larger donor tissue size (P < 0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm2 at 10 years and only 24 (14%) had an ECD of >1000 cells/mm2. Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.

Ten-Year Results of a Randomized Controlled Trial Comparing 0.02% Mitomycin C and Limbal Conjunctival Autograft in Pterygium Surgery

To compare the long-term outcome of pterygium surgery and the long-term effect on endothelial counts after mitomycin C (MMC) or limbal conjunctival autograft (LCAU) in pterygium surgery. We performed a 10-year follow-up study of a randomized controlled trial. A total of 115 eyes of 114 patients with primary pterygium were treated with intraoperative MMC (n = 63) or LCAU transplants (n = 52). A total of 76 patients completed the current 10-year long-term follow-up (47 in the MMC group, 29 in the LCAU group). This is a follow-up study of a randomized controlled trial of a cohort of 114 patients in 2 groups that was performed at the Prince of Wales Hospital 10 years ago: group 1, intraoperative 0.02% MMC for 5 minutes; group 2, LCAU. Consecutive patients enrolled in the original study (recruitment began in February 2001) were invited back for a detailed clinical examination to document the long-term outcome of both surgical groups. The main outcome measures included the recurrence rate, residual conjunctival bed status, complications, and corneal endothelial cell density (ECD) differences. A total of 115 eyes of 114 patients were enrolled and randomized in our previous study. For the current study, 76 of the 114 patients (47 in the MMC group, 29 in the LCAU group) were contacted, whereas 18 patients were lost to follow-up and 20 patients had died. The mean follow-up period was 138 ± 2 months in the MMC group and 137 ± 2 months in the LCAU group. Twelve of 47 patients (25.5%) in the original MMC group and 2 of 29 patients (6.9%) in the LCAU group had recurrent pterygium (P = 0.021). The mean ECD was 2,39 2 ± 342 cells/mm(2) in the MMC group and 2,390 ± 388 cells/mm(2) in the LCAU group (P = 0.978). There was no significant difference in the ECD between the operated eyes and the fellow eyes in both groups (P = 0.926 MMC, P = 0.468 LCAU). No other significant ocular complications were observed in either group at the 10-year postoperative follow-up. Limbal conjunctival autograft was more effective than intraoperative MMC in minimizing pterygium recurrence at the 10-year follow-up. Treatment with intraoperative MMC was not associated with long-term corneal endothelial cell loss.

Refractive Surgery in Children.

Refractive surgery in children is controversial. The main indications are bilateral high ametropia and anisometropia where conventional treatment with spectacles or contact lens is not tolerated. Other reported indications include accommodative strabismus and previous cataract surgery. The most commonly performed procedures currently are surface ablation procedures using excimer laser. The main disadvantage of surface ablation procedures is refractive regression, which is more pronounced in higher degrees of ametropia. More recently, there is a growing number of studies evaluating the safety and effectiveness of phakic intraocular lenses (IOLs) as an alternative surgical management for children who are noncompliant with conventional treatment and unsuitable for laser ablative procedures. The advantages of phakic IOLs are reversibility, predictability, and lack of regression. The principal concern with phakic IOL insertion is long-term endothelial cell loss. Clear lens extraction has been performed in patients with shallow anterior chambers beyond the range of corneal laser refractive procedures; however, major drawbacks include loss of accommodation and significant risk of retinal detachment. In summary, results to date show that refractive surgery can be successfully performed in children and meets an important need in a select subgroup of patients who are recalcitrant to traditional therapy. Issues that remain controversial are the age at which to perform surgery, choice of procedure, need for anesthesia, instability of refractive errors in children, and long-term safety considerations.

Long-Term Results of Deep Anterior Lamellar Keratoplasty for the Treatment of Keratoconus

To evaluate the long-term endothelial cell density (ECD) changes and visual and refractive outcomes after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus. Retrospective interventional case series study. setting: Single hospital. patients: Two hundred forty-one eyes of 214 patients who underwent DALK for moderate to advanced keratoconus. main outcome measures: Intraoperative and postoperative complications, postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, topographic astigmatism, and ECD. Two hundred thirty-four procedures (97%) were completed as DALK. Big bubble was successfully achieved in 193 eyes (82.4%). In 7 eyes (3%), the procedure was converted to penetrating keratoplasty because of Descemet membrane macroperforations. Microperforations occurred in 18 eyes (7.5%). The mean follow-up time was 50.5 ± 22.2 months (range 24 to 96 months). UCVA was lower than 20/100 in all eyes preoperatively and better than 20/100 in 191 eyes (81.6%) postoperatively. BSCVA was 20/40 or better in 187 eyes (79.9%) and 20/20 or better in 38 eyes (16.2%). The mean (± SD) preoperative ECD that was possible in 166 eyes was 2797 ± 561 cells/mm(2). Mean (± SD) endothelial cell loss was 8.1% ± 4.6% at 1 year, 10.5% ± 5.7% at 2 years, 15.1% ± 14.8% at 6 years, and 22.5% ± 15.9% at 8 years. Stromal graft rejection episodes occurred in 4 eyes, which resolved with appropriate therapy. Deep anterior lamellar keratoplasty that uses the big-bubble technique is effective in patients with keratoconus. Long-term endothelial cell loss was moderate and lower than penetrating keratoplasty grafts.

Long-term Endothelial Cell Loss After Traumatic Dislocation and Repositioning of Artisan Phakic IOL

To evaluate long-term endothelial cell loss after traumatic dislocation and repositioning of an Artisan phakic intraocular lens (PIOL). Traumatic PIOL dislocation occurred in the patient's left eye 4 months after uneventful implantation for unilateral congenital myopia. Using the Konan semi-automated analysis method, endothelial cell density was measured preoperatively, before Artisan repositioning, and 1, 2, and 4 years after primary implantation. Endothelial cell density was 2770 cells/mm2 preoperatively and 2634 cells/mm2 before Artisan repositioning. After successful repositioning, endothelial cell density progressively decreased--1, 2, and 4 years from primary implantation, endothelial cell density was 2582, 2524, and 2538 cells/mm2, respectively, corresponding to losses of 6.8%, 8.9%, and 8.4%, respectively. Progressive and long-term endothelial loss after traumatic dislocation and repositioning of the Artisan PIOL may be comparable to that reported after uneventful implantation.

Long-term endothelial cell loss after phacoemulsification: peribulbar anesthesia versus intracameral lidocaine 1%: Prospective randomized clinical trial

Purpose: To evaluate endothelial cell loss after phacoemulsification with posterior chamber intraocular lens implantation using peribulbar anesthesia or topical anesthesia combined with intracameral unpreserved lidocaine 1%. Setting: Department of Ophthalmology, Charité, Humboldt-University of Berlin, Berlin, Germany. Methods: Before and 20 months ± 5.1 (SD) after surgery, specular microscopy was used to evaluate the number and morphology of endothelial cells in 78 eyes having peribulbar anesthesia or topical anesthesia combined with an intracameral injection of 0.15 cc unpreserved lidocaine 1%. Results: The mean endothelial cell loss was 11.11% in the peribulbar group and 12.55% in the topical/lidocaine group. There was no statistically significant difference in the amount of endothelial cell loss or cell morphology between the 2 groups. Conclusion: The long-term postoperative endothelial cell course showed that topical anesthesia combined with an intracameral injection of 0.15 cc unpreserved lidocaine 1% is a safe alternative to peribulbar anesthesia.

Endothelial changes in phakic eyes with anterior chamber intraocular lenses to correct high myopia

Purpose: To evaluate the long-term endothelial cell loss after implantation of Worst-Fechner and Baikoff ZB5M anterior chamber intraccular lenses.Setting: Jiménez-Díaz Foundation and San Carlos University Hospital, Madrid, Spain.Methods: Preoperative and serial postoperative specular microscopy was performed on 30 eyes that had a Worst-Fechner lens and on 28 eyes that had a Baikoff ZB5M lens to correct high myopia. A video specular microscope adapted to an image analysis system was used to analyze the endothelium for cell density. Follow-up was 24 months.Results: In the Worst-Fechner lens group, postoperative endothelial cell density was significantly lower than preoperative density at all times (P < .001). Endothelial cell loss was 7.26% at 3 months, 10.64% at 6 months, 13.00% at 12 months, and 17.60% at 24 months. In the Baikoff ZB5M lens group, postoperative cell density was also significantly lower than preoperative density at all times (P < .001). It was 7.50% at 3 months, 10.94% at 6 months, 12.33% at 12 months, and 12.30% at 24 months. Cell loss did not stabilize between 1 and 2 years after surgery in the Worst-Fechner group (P = .047). However, no additional cell loss was noted during this period in the Baikoff ZB5M group (P = .968). Endothelial cell densities in the two groups did not differ during the first year. However, 2 years after surgery, cell density in the Worst-Fechner group was significantly lower than it was in the ZB5M group (P = .048).Conclusions: Endothelial cell loss during the first year was similar in eyes with Worst-Fechner and Baikoff ZB5M lenses; however, at 2 years after surgery, endothelial cell loss was higher in eyes with Worst-Fechner lenses than it was in eyes with Baikoff ZB5M lenses.

Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision

Purpose: To evaluate central endothelial cell loss (ECL) following clear corneal cataract surgery using two different incision sizes and the effect of ultrasound time (UST) and power on postoperative ECL and various cell parameters.Methods: Fifty-eight patients had phacoemulsification through temporal, two-step clear corneal tunnel incisions. In Group A (n = 28), a one-piece, plate-haptic, foldable silicone intraocular lens (IOL) was implanted through a 3.5 mm sutureless incision. In Group B (n = 30), a poly(methyl methacrylate) IOL was implanted through a 5.0 mm incision with one radial suture. The central endothelial cell counts were recorded preoperatively and postoperatively at 2 to 5 days, after 6 months, and after 1 year. Color-coded, computer-assisted specular microscopy was used for special cell analysis after 1 year.Results: Collective data showed an ECL of 7.9 ± 4.1 % (mean ± standard deviation) at 2 to 5 days postoperatively, 6.7 ± 2.9% after 6 months, and 7.3 ± 3.3% after 1 year. A direct linear relationship was found between ECL and UST and power: ECL increased as UST and power increased. After 1 year, ECL in Group A was 4.2% with UST ≤1 1/2 minutes, 6.7% with UST ≥ 1 1/2 to 2 1/2 min, and 9.6% with UST > 2 1/2 to 3 1/2 min; in Group B, it was 6.0%, 7.5%, and 11.4%, respectively. Specular microscopy showed normal, age-related cell parameters 1 year postoperatively.Conclusions: Phacoemulsification with 3.5 mm clear corneal incisions produced slightly less ECL (6.7%) than phacoemulsification with 5.0 mm incisions (7.9%). Total ECL of 7.3% at 1 year postoperatively compared favorably with ECL rates of other cataract extraction methods.

Long-Term Endothelial Cell Loss Following Phacoemulsification: Model for Evaluating Endothelial Damage After Intraocular Surgery

Newer concepts of phakic intraocular lens (IOL) surgery present concerns as to their long-term deleterious effect on the endothelium. We examine the behavior of the endothelium for up to 6 years following uneventful phacoemulsification surgery, to establish a baseline for what might be an acceptable level of endothelial cell loss due to intraocular surgical trauma. Ninety-three eyes undergoing phacoemulsification surgery who had multiple endothelial specular microscopy examinations for up to 6 years were examined. Central endothelial specular photomicrographs were analyzed in all cases and the percent of endothelial cell loss as a function of time was calculated. Cell density calculations were corrected for the normal endothelial cell loss as a function of age. Routine uncomplicated phacoemulsification surgery demonstrated a 9% endothelial cell loss 1 year postoperatively. This is in marked contrast to the 16% average endothelial cell loss cited in the literature after phakic AC-IOL surgery. In general, anterior chamber IOL surgery following cataract removal compares unfavorably to posterior chamber IOL insertion long term (20% cell loss versus 12% cell loss). A model is proposed to look at the rate of endothelial cell loss that would be significant enough to create the threat for corneal edema long term following refractive intraocular surgery in young patients. Suggestions for critical comparisons between the observed endothelial aging seen with phakic IOLs and values for more routine IOL surgery are proposed to predict the long-term threat for endothelial cell loss and corneal decompensation, which might result many years after phakic refractive IOL surgery.

Long-term endothelial cell loss and breakdown of the blood-aqueous barrier in cataract surgery

Progressive endothelial cell loss and endothelial cell loss induced at the time of surgery occurs in all eyes with rigid anterior chamber intraocular lenses (IOLs). Eyes with surgical tuck or late ovaling of the pupil following surgery have greater yearly rates of cell loss than eyes that have no complications. This progressive loss may be related to chronic uveitis from iris chafing by the implant or to direct mechanical damage to the corneal endothelium. We have demonstrated that fluorophotometry shows chronic damage to the blood-aqueous barrier in all eyes with rigid anterior chamber IOLs, but this does not correlate with the degree of endothelial cell loss. Our results suggest there is damage to the blood-aqueous barrier and to the corneal endothelium, but the damage to the latter influences progressive endothelial cell loss.