Corneal Endothelial Cell Density Loss Research Articles

Corneal endothelial density loss in patients after gonioscopy‑assisted transluminal trabeculotomy.

To compare short-term changes in corneal endothelial cells after gonioscopy-assisted transluminal trabeculotomy(GATT). This retrospective comparative study included 138 patients(138 eyes), and 98 of these patients underwent GATT procedure and 40 underwent SLT procedure as a control group. Changes in the corneal endothelium in patients who underwent GATT and SLT were analyzed retrospectively. Endothelial changes in the central cornea were examined using specular microscopy before and 6 months after the GATT and SLT procedure. Intraocular pressure(IOP), number of glaucoma medications, and side effects were evaluated at visits before and after two methods. One hundred and thirty-eight eyes of 138 patients with a mean age of 62.9±12.7 years in the SLT group and 62.5±11.8 years in the GATT group were included in this study. Pre-procedure mean ± SD IOP was 27.7±3.6 mmHg and 27.4±5.3 mmHg (p=0.173) 2.8±0.5 and 2.9±0.8 (p=0.204) glaucoma drugs are in the SLT and GATT group, respectively. The mean corneal endothelial cell density (CECD) in the SLT group was 2433.1±581.4 cells/mm2 before the procedure and 2435.1±585 cells/mm2 6 months after the procedure, a change of 0.1±0.6% which was not statistically significant (p>0.967).The mean CECD at baseline in the GATT group was 2443.4±508.2 cells/mm2 and decreased to 2290.2±527.7 cells/mm2 6 months after this procedure, representing a cell loss of 6,2±9,1% (p<0.001). GATT caused more CECD damage than SLT at the sixth month after the procedure. Considering the loss of CECD in candidates for GATT, sufficient number of endothelial cells in the central cornea is recommended.

Clinical Outcomes after Phacoemulsification in Brunescent Cataract

Purpose To compare the clinical outcomes after phacoemulsification in a brunescent cataract group and a control cataract group. Methods Using slit-lamp microscopy, the Lens Opacities Classification System III was applied to classify brunescent cataract from “other” types based on nuclear opalescence and nuclear color cut-off levels of 5 and 5, respectively. From December 2016 to December 2019, 33 eyes of 33 brunescent cataract patients who underwent cataract surgery were included in the brunescent cataract group; 33 eyes of 33 other cataract patients with similar conditions were included as the control group. The corneal endothelial cell density and best-corrected visual acuity were compared between the two groups. Results In the three cases of posterior capsular rupture that developed in the brunescent cataract group, the intraocular lens was implanted at the ciliary sulcus, and in two cases, total vitrectomy was performed. In the one case of posterior capsular rupture in the control group, the intraocular lens was implanted at the ciliary sulcus, and total vitrectomy was performed. There were no significant differences in best-corrected visual acuity between the two groups at 1 week, 1 month, 3 months, or 6 months postoperatively. The mean corneal endothelial cell density loss measured at 1 month after surgery was significantly higher in the brunescent cataract group. Conclusions Phacoemulsification in the brunescent cataract group showed good clinical results in terms of visual acuity and mean corneal endothelial cell density loss compared with the control cataract group, when performed by an experienced surgeon. Keywords: Brunescent cataract; Clinical outcomes; Complications; Phacoemulsification

Corneal endothelial cell changes and surgical results after Ahmed glaucoma valve implantation: ciliary sulcus versus anterior chamber tube placement

We compared the changes in corneal endothelial cells and surgical outcomes after Ahmed glaucoma valve (AGV) implantation with the valve tip inserted either into ciliary sulcus (CS) or anterior chamber (AC). We retrospectively reviewed the medical records of patients treated with CS AGV (n = 24) and AC AGV (n = 38). We compared the preoperative and postoperative central corneal endothelial cell density (ECD), endothelial cell coefficient of variation (CV), best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications in the two groups. Both groups had similar baseline characteristics and follow-up period. At the last follow-up, the AC AGV group had significantly higher mean monthly ECD loss (17.47 ± 11.50 cells/mm2 vs. 6.40 ± 7.69 cells/mm2, p < 0.0001) and greater proportion of mean monthly ECD loss than the CS AGV group (0.84 ± 0.53 vs. 0.36 ± 0.39%, p < 0.0001). Both groups had similar mean monthly CV changes. The qualified success rates at 2 years were 83.3% and 76.3% for the CS AGV and AC AGV groups, respectively. Although similar surgical outcomes including visual acuity, IOP, number of glaucoma medications, and postoperative complications were obtained following CS AGV and AC AGV, corneal ECD loss was higher in the AC AGV group. Thus, CS AGV may be a better surgical option than AC AGV.

Is Pterygium Morphology Related to Loss of Corneal Endothelial Cells? A Cross-Sectional Study.

PurposeTo determine the difference in mean corneal endothelial cell density (CECD) between the healthy and diseased eyes of the patients with unilateral pterygium with different morphology patterns by using a non-contact specular microscope (SP2000: Topcon Corporation, Japan) and to find out any relationship between severity of pterygium and daily sunlight exposure with the CECD loss.MethodsA descriptive cross-sectional prospective study was carried out at Al-Shifa Trust Eye Hospital (ASTEH), Rawalpindi, Pakistan from 21st January 2019 to 22nd January 2020. Two hundred eyes (n= 100 patients) of age range18 -68 years with unilateral pterygium were selected. Necessary demographic data and essential variables like age, smoking status, occupation, and daily direct sunlight exposure were determined. The severity of pterygium (grading) based on its morphology was determined by slit-lamp examination. CECD of each patient was carried out using a non-contact Specular Microscope. The healthy eye (without pterygium) of a patient was considered as control.ResultsThe age range in this study was 18–68 years, with a mean age of 43.80 ± 24.37 years with a male to female ratio of 1.6:1 (62.00% males vs 38% females). Out of six occupations, the most common occupation was labour/construction work (n=31) followed by farming (n=27). The study reported a mean corneal endothelial cell density (CECD) of 2411.61±143.64 vs 2751.41 ± 123.674 cells/mm2 in diseased and normal eyes, respectively (p-value = 0.0001). CECD was lower in grade 3 pterygium compared to less severe pterygium { grade 3 (Fleshy) =2261 cells/mm2 vs grade 2 (Intermediate)= 2413 cells/mm2 vs grade 1 (Atrophic)=2459 cells/mm2} although this difference between the groups was not found to be significant (p=0.065). No significant association between sunlight exposure and CECD loss was observed (p=0.065).ConclusionThis study concluded that the mean corneal endothelial cell density in patients with unilateral pterygium using a non-contact specular microscope were 2411.61±143.64 cells/mm2.

Effect of Head Position and Tube Entry on Corneal Endothelial Cells in Patients with Glaucoma Drainage Implants: A Cross-sectional Study.

PurposeTo investigate the effect of head tilt on the tube position of the Ahmed glaucoma valve (AGV) implanted in patients with glaucoma and to assess how the head tilt-induced alterations of tube parameters and the level of tube entry influence corneal endothelial cell density (ECD).MethodsA total of 29 eyes of 26 patients with AGV implantation were included. Tube-cornea distance, tube-cornea angle, and intracameral tube length were measured using anterior segment optical coherence tomography in three different head positions (neutral, 30° temporalward tilt, and 30° nasalward tilt). The tube entry was assessed using static gonioscopy. ECD was measured using specular microscopy before and after surgery.ResultsThe mean tube-cornea distance, tube-cornea angle, and intracameral tube length (neutral: 0.87 ± 0.39 mm, 30.56 ± 5.89˚, and 3.10 ± 0.82 mm, respectively) decreased with head tilts (temporalward: 0.82 ± 0.39 mm, 29.27 ± 5.82˚, and 3.04 ± 0.82 mm, respectively; nasalward: 0.83 ± 0.40 mm, 29.61 ± 6.04˚, and 3.05 ± 0.81 mm, respectively; all p < 0.01). The multivariate analyses found age and the tube insertion level to be associated with postoperative changes in the central ECD (p = 0.039 and 0.013, respectively), and the postoperative follow-up period and tube insertion level to be associated with the difference between the inferonasal and superotemporal ECDs (p = 0.034 and 0.007, respectively).ConclusionsMild alterations of head positions induced changes in the intracameral tube positions of AGV implants; nevertheless, it did not significantly affect ECD loss. However, the eyes with tubes inserted anteriorly to Schwalbe’s line may be more susceptible to corneal ECD loss.

Corneal endothelial damage in phacoemulsification using an anterior chamber maintainer compared with using an ophthalmic viscosurgical device.

To compare the effects of phacoemulsification surgery (PE) using an anterior chamber maintainer (ACM) and conventional PE using an ophthalmic viscosurgical device (OVD) on corneal endothelial cells. Department of Ophthalmology, Celal Bayar University, Manisa, Turkey. Prospective randomized controlled trial. Eyes in the OVD group (n = 50) underwent conventional PE, whereas eyes in the ACM group (n = 50) underwent PE using an ACM. Endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX), and noncontact central corneal thickness (CCT) measurements were performed by specular microscopy before and at 1 month, 3 months, and 6 months after PE. This study included 100 eyes of 97 patients undergoing PE. The mean age was 64.7 ± 10.6 years in the OVD group, 64.0 ± 12.6 years in the ACM group (P > .05). The groups did not differ significantly in preoperative ECD, CV, HEX, and CCT or total PE time (P > .05 for all). ECD was significantly lower in the ACM group compared with the OVD group at postoperative 1 month, 3 months, and 6 months (P = .002, P = .002, and P = .001, respectively). Similarly, ECD loss compared with preoperative value was greater in the ACM group at all postoperative timepoints (P = .003, P = .001, and P = .001, respectively). CV increased and HEX decreased in both groups postoperatively (P > .05 for both). CCT showed a transient increase of less than 10 μm at postoperative 1 month in both groups (P = .296). PE with ACM was associated with greater corneal ECD loss compared with conventional PE. ACM should not be used during PE in patients with limited corneal endothelial reserve.

Effect of trabeculectomy on corneal endothelial cell loss

AimTo investigate changes in corneal endothelial cell density (CECD) after trabeculectomy.MethodsThis prospective, observational study followed 117 eyes of 117 patients for 2 years after trabeculectomy. The central cornea was examined...

Large gene deletion and changes in corneal endothelial cells in a family with choroideremia.

We provided the first report of an association between changes in corneal endothelial cells, retina, and choriocapillaris in a choroideremia family. Four members of an Asian choroideremia family, comprising two affected patients and two carriers, were evaluated. All participants underwent complete eye examinations, including visual acuity (VA), slit-lamp examination, ophthalmoscopy, perimetry, and electrophysiology tests. In addition, images of corneal endothelium were captured with a noncontact specular microscope. Genomic DNA amplification and whole-genome cytogenic array analysis were used to confirm the diagnosis of choroideremia and determine the molecular basis of the phenotype. In the affected patients, funduscopy revealed characteristic features of RPE and chorioretinal atrophy. The slit-lamp biomicroscopy disclosed unexpected pigmented punctate lesions in the corneal endothelium in one of them. Surprisingly, specular microscopy detected decreased endothelial cell density (ECD) with features of pleomorphism and polymegethism. Genomic DNA analysis revealed large deletion (~4.5 mega base pairs) of the entire CHM gene and encompassed region. In carriers, funduscopy revealed stippling pigmentary change despite normal electrophysiological results. Specular microscopy also disclosed reduced ECD with features of pleomorphism and polymegethism. To our knowledge, this is the first description of corneal changes in choroideremia patients. The loss of corneal ECD is conspicuous and is accompanied by pleomorphism and polymegethism in this family. The observed changes in corneal endothelium may be associated with larger encompassed regions of the CHM gene defect or dysfunction in the blood-aqueous barrier. It warrants further investigation and clarification of the pathophysiology and associations between retinal and corneal changes in choroideremia.

Comparison of phacoemulsification surgery with 2.2 mm or 2.75 mm corneal incision

Objective To compare the intraoperative ultrasound energy and the change of corneal endothelial cell density (CED) in 2.2 mm or 2.75 mm corneal incision phacoemulsification.Methods A prospective,randomized and controlled clinical study was conducted on 134 patients with 167 cataract eyes which were randomly divided into two groups:2.2 mm group (70 eyes of 57 patients) and 2.75 mm group (97 eyes of 77 patients).The hard degree of the nucleus was recorded.The CED was measured preoperatively,1 month and 3 months postoperatively.It was compared between the two groups.The phaco time and average energy in the surgery were recorded to calculate the effective phaco time (EPT).The intraoperative EPT was compared between the two groups.Results There was no statistically significant difference in nuclear hardness or in EPT between the two groups,but there was a positive correlation between them in both the two groups.Postoperative CED was reduced in 2.2 mm and 2.75 mm group as follows:(2510.88 ±268.81) mm-2 preoperatively and (2378.84 ± 369.93) mm-2 at 3 months postoperatively (P ＜ 0.05) in 2.2 mm group; (2524.62 ± 251.69) mm-2 preoperatively and (2388.08 ± 360.51) mm-2 at 3 months postoperatively (P ＜0.01) in 2.75 mm group.The CED trended to be stabilized 1 month postoperatively.There were no statistically significant difference in the changes of CED between the two groups (P ＞ 0.05).Conclusion Comparing with 2.75 mm incision,2.2 mm coaxial clear corneal incision is shorter in length and thus making more difficulty in the operation.However,intraoperative ultrasound energy has not increased in 2.2 mm incision system.The EPT is correlated with nucleus hardness.There is no statistically significant difference in postoperative CED loss between the two groups. Key words: Cataract; Phacoemulsification ; Incision, 2.2 mm, 2.75 mm; Cell, endothelial,corneal; Energy, ultrasonic

Performance comparison of the Alcon Legacy 20000 1.1 mm TurboSonics and 0.9 mm MicroTip

Purpose To compare the efficiencies of the operative procedures, the changes in postoperative corneal endothelial cell density (ECD), and incision performance after cataract surgery using 2 different phacoemulsification tips. Setting Wolfe Clinic, Marshalltown, Iowa, USA. Methods A randomized prospective study of 119 consecutive cases was conducted. All patients were adults having phacoemulsification using a modified in situ fracture technique. All cases were done by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine with normal vacuum cassettes and tubing. One of 2 45 degree phacoemulsification tips was used: the 1.1 mm TurboSonics (n = 65) or the 0.9 mm MicroTip (n = 54). Measurements at the time of surgery included metered phacoemulsification time and mean phacoemulsification power. Corneal keratometry and ECD by contact specular microscopy were determined preoperatively and 10 weeks postoperatively. Results The mean metered phacoemulsification time was statistically significantly different between the 2 groups: 1.1 mm TurboSonics = 1.25 minutes; 0.9 mm MicroTip = 1.66 minutes. The mean ultrasound power was also significantly different: 1.1 mm TurboSonics = 52.98%; 0.9 MicroTip = 49.07%. Loss of corneal ECD was not significantly different: 1.1 mm TurboSonic = 3.68%; 0.9 mm MicroTip = 5.79%. Mean diopters of induced incisional keratometric flattening was similar: 1.1 mm TurboSonics, 0.32 diopters (D) ±0.61 (SD); 0.9 mm MicroTip, 0.25 ± 0.49 D. There were no cases of anterior radial capsule tear, posterior capsule tear, vitreous loss, iris aspiration, suture closure, or incision leak. Conclusions Although a longer mean metered phacoemulsification time was required with the 0.9 mm MicroTip, corneal endothelial cell loss and incisional keratometric performance were not different from those of cases in which the larger 1.1 mm TurboSonics tip was used. Both tips can be used effectively and safely for phacoemulsification of the human cataract.

Performance comparison of the Alcon Legacy 20000 1.1 mm TurboSonics and 0.9 mm Aspiration Bypass System tips

Purpose To compare the efficiencies of the operative procedures and the reductions in postoperative corneal endothelial cell density (ECD) after cataract surgery using 2 different phacoemulsification tips and their associated cassettes and tubing. Setting Wolfe Clinic, Marshalltown, Iowa, USA. Methods A randomized prospective study of 100 consecutive cases was conducted. All patients were adults having phacoemulsification using a hybrid in situ fracture technique. All cases were performed by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine. One of 2 45 degree phacoemulsification tips and associated cassettes and tubing were used: the 1.1 mm TurboSonics with normal tubing ( n = 47) or the 0.9 mm Aspiration Bypass System (ABS) tip with high-vacuum cassettes and tubing ( n = 53). Measurements at the time of surgery included metered phacoemulsification time, percentage power used, total time spent in the phacoemulsification process, and milliliters of balanced salt solution (BSS®) used. Corneal ECD was determined preoperatively and 10 weeks postoperatively. An independent statistician performed 2-sample t tests or Wilcoxon rank sum tests on the data. Results There were no cases of anterior radial capsule tear, posterior capsule tear, vitreous loss, iris aspiration, incision leak, or suture closure. There was no correlation between amount of corneal ECD loss and any operative variable measured. Similar measurements for the 1.1 mm TurboSonics and the 0.9 mm ABS included, respectively, ECD loss 7.34% and 8.22%; metered phacoemulsification time 1.29 and 1.22 minutes; total time of the phacoemulsification process 113 and 105 seconds. There were statistically significant differences between the 1.1 mm TurboSonics tip and 0.9 mm ABS tip performance in mean power percentage overall (52% versus 48%) and overall BSS volume used (85 versus 76 mL). Conclusions The 0.9 mm ABS phacoemulsification tip used with the high-vacuum cassette and tubing provided the physical advantages of tip-size reduction while requiring similar ultrasonic power and BSS volumes as the 1.1 mm TurboSonics tip with standard cassette and tubing. Together, they provide a wider available dynamic range in which to integrate ultrasonic power, higher vacuum, and higher aspiration flow rates to improve the efficiency and ease of use than the standard 1.1 mm TurboSonics cataract operation.