Low Corneal Endothelial Cell Density Research Articles

Influence of phacoemulsification on eyes with low corneal endothelial cell density

Objective To observe the damage of phacoemulsification and intraocular lens(IOL) implantation in eyes with low corneal endothelial cell density (ECD). Methods This is a prospective case-control study. Patients who accepted phacoemulsification and IOL implantation were divided into two groups according to age and nuclear hardness. The patients with corneal ECD between (600-1000)/mm2 were divided into the clinical trial group and those over 2300/mm2 into the control group. There were 35 eyes of 35 cases in each group. The ECD and central corneal thickness (CCT)were measured preoperatively and 3, 6 months postoperatively, and the percentage of cell loss and increase in CCT were compared between two groups. Results There was no significant difference in the percentage of corneal endothelial cell loss between two groups at 3 months postoperatively (χ2=1.97, P=0.16), and there was no significant difference at 6 months postoperatively(χ2=0.50, P=0.48). The percentage of increase in CCT was significantly greater in the clinical trial group than in the control group at 3 months postoperatively(χ2=10.83, P=0.00), although there was no significant difference at 6 months postoperatively(χ2=1.27, P=0.26). Conclusion Corneal endothelial cell damage after phacoemulsification and IOL implantation in eyes with low ECD is slight and comparable to that in healthy eyes. The increase of CCT may be temporary after phacoemulsification, but then most recovers considerably by 6 months postoperatively. Key words: Phacoemulsification; Implantation, lens, intraocular; Corneal endothelial cell; Density, low; Influence

Corneal thickness differences between type 2 diabetes and non-diabetes subjects during preoperative laser surgery examination

AimsTo evaluate the differences in corneal thickness between type 2 diabetes subjects with HbA1c under 7.0% and non-diabetes subjects during their preoperative laser surgery examinations. MethodsThe mean of five consecutive corneal thickness measurements at the central and mid-peripheral cornea was obtained by means of noncontact scanning-slit corneal topography (Orbscan Topography System II; Orbscan, Inc., Salt Lake City, UT, USA) in 35 myopic non-insulin dependent type 2 diabetes subjects (17 males and 18 females) and 48 healthy myopic controls (23 males and 25 females). ResultsThe corneal thickness values at the central and mid-peripheral cornea were significantly higher in the diabetic group (p<.001). The diabetic subjects presented the highest thickness value in the superior cornea (n=22; 62.9%) followed by the nasal (n=9; 25.7%) and the temporal (n=4; 11.4%) cornea, but never in the inferior cornea. The control subjects presented the highest thickness value in the superior cornea (n=19; 39.6%) followed by the nasal (n=18; 37.5%), the inferior (n=6; 12.5%), and the temporal (n=3; 6.3%) cornea. The central corneal thickness (CCT) of the diabetes patients was not statistically correlated with their HbA1c (r2=.078; p=.104), body mass index (r2=.007; p=.633), and time from diagnosis of diabetes (r2=.025; p=.363), but it was correlated with their corneal endothelial cell density values (r2=.543; p<.001). ConclusionsDiabetes subjects with HbA1c under 7.0% who are candidates for laser refractive surgery present thicker corneas than their age-matched control subjects. In these patients, there is a correlation between their CCT values and their corneal endothelial cell density values, so when higher CCT values were found, lower corneal endothelial cell density values were observed.

Long-Term Results after Cataract Surgery in Patients with Low Corneal Endothelial Cell Density

Long-Term Results after Cataract Surgery in Patients with Low Corneal Endothelial Cell Density

The New Zealand National Eye Bank Study

To evaluate trends in the acquisition, storage, and utilization of donated corneal tissue in New Zealand, 2000 to 2009. The New Zealand National Eye Bank records were analyzed for the decade January 2000 to December 2009. Variables analyzed included donor demographics (age, sex, and ethnicity), donor source, donor cause of death, death-to-preservation interval (DPI), corneal storage time, tissue contamination, endothelial assessment, cornea suitability for transplantation, and corneal tissue utilization. A total of 1268 eye donors were identified during the 10-year period. Overall, 36% (n = 457) were female and 64% male (n = 813). Median donor age was 67 years, and 23% of donors were younger than 50 years (range, 5-90 years). There was a decrease in donor age over the decade (P = 0.006). The median DPI was 18.5 hours. No relationship was identified between cornea suitability for transplantation and DPI (P = 0.28) or donor gender (P = 0.54). There was a low microbial contamination rate (1%). Human immunodeficiency virus, hepatitis B, or hepatitis C serology was positive in 48 donors (4%). Overall, 90% of corneas were suitable for transplantation with a high utilization rate (88%). A novel association was identified between male sex and lower corneal endothelial cell density (P = 0.03). This New Zealand National Eye Bank analysis identified trends in the acquisition, storage, and utilization of donated corneal tissue throughout New Zealand over the past decade and provides valuable additional information to the international eye bank data.

Outcomes of cataract surgery in eyes with a low corneal endothelial cell density

Outcomes of cataract surgery in eyes with a low corneal endothelial cell density

Surgical effect of phacoemulsification for cataract patient with low endothelial cell density

Objective To evaluate surgical effect of phacoemulsification (Phaco) technique for cataract patient with low corneal endothelial cell density,and to discuss the methods to reduce the corneal endothelial cell lossing.Methods Cataract patients (35 eyes) with corneal endothelial cell density lower than 1000/mm2 underwent Phaco and intraocular lens implantation( Phaco + IOL).The changes of visual acuity,corneal endothelial cell counting and the surgical complications were observed.Results The visual actiuy improved in all eyes 3 months after the operation.The best corrected visual acuity(BCVA) higher than 0.3 in 32 eyes(91.4％ ) and higher than 0.5 in 19 eyes (57.1％ ).No corneal decompensation was observed.The loss ratio of corneal endothelial cells density was 6％ -11％ ( mean 8.5％ ).Conclusion Some cataract patients with corneal endothelial cell density lower than 1000/mm2 can gain better visual acuity with Phaco + IOL. Key words: Cataract; Phacoemulsification; Cornea; Corneal endothelial cell; Low density

Outcomes of cataract surgery in eyes with a low corneal endothelial cell density

To evaluate the surgical outcomes of cataract surgery in eyes with a low preoperative corneal endothelial cell density (ECD) and analyze factors affecting the prognosis. Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan. Noncomparative case series. Eyes with a preoperative ECD of less than 1000 cells/mm(2) that had cataract surgery between 2006 and 2010 were identified. Standard phacoemulsification with intraocular lenses was performed using the soft-shell technique. The rate of endothelial cell loss, incidence of bullous keratopathy, and risk factors were retrospectively assessed. Sixty-one eyes (53 patients) with a low preoperative ECD were identified. Preoperative diagnoses or factors regarded as causing endothelial cell loss included Fuchs dystrophy (20 eyes), laser iridotomy (16 eyes), keratoplasty (10 eyes), traumatic injury (3 eyes), trabeculectomy (3 eyes), corneal endotheliitis (2 eyes), and other (7 eyes). The corrected distance visual acuity improved from 0.59 ± 0.49 logMAR preoperatively to 0.32 ± 0.48 logMAR postoperatively (P<.001). The mean ECD was 693 ± 172 cells/mm(2) and 611 ± 203 cells/mm(2), respectively (P=.001). The mean rate of endothelial cell loss was 11.5% ± 23.4%. Greater ECD loss was associated with a shorter axial length (AL) (<23.0 mm) and diabetes mellitus. Bullous keratopathy developed in 9 eyes (14.8%) and was associated with posterior capsule rupture. The results suggest that modern techniques for cataract surgery provide excellent visual rehabilitation in many patients with a low preoperative ECD. Shorter AL, diabetes mellitus, and posterior capsule rupture were risk factors for greater ECD loss and bullous keratopathy.

Cataract surgery in eyes with low corneal endothelial cell density

To compare corneal endothelial damage after cataract surgery in eyes with low endothelial cell density (ECD) and eyes with normal ECD. Hayashi Eye Hospital, Fukuoka, Japan. Case-control study. Cataract surgery was performed in eyes with a low ECD (500 to 1000 cells/mm(2)) (low-density group) and control eyes with a normal ECD. The ECD and central corneal thickness (CCT) were measured preoperatively and 1 and 3 months postoperatively, and the percentage cell loss and increase in CCT were compared. The low-density group and control group each comprised 50 eyes. In the low-density group, 39 eyes had nonprogressive endothelial pathology and 11 had Fuchs dystrophy. The mean ECD was significantly less and the CCT significantly greater in the low-density group than in the control group throughout the follow-up (P ≤.0066). However, no significant difference in the percentage of cell loss was found between groups at 1 or 3 months (5.1%, low-density group; 4.2%, control group) (P ≥.1477). The percentage increase in CCT was significantly greater in the low-density group than in the control group at 1 month (P<.0001), although there was no significant difference at 3 months (0.4% and -0.4%, respectively) (P=.2172). Corneal endothelial damage after cataract surgery in eyes with low ECD was slight and comparable to that in healthy eyes, which suggests that cataract surgery alone (without corneal transplantation) should be performed first.

Corneal Endothelial Morphology in Eyes Implanted With Anterior Chamber Aqueous Shunts

To investigate risk factors for lower corneal endothelial cell density after anterior chamber aqueous shunt implantation. Forty eyes implanted with aqueous shunts were examined using anterior segment optical coherence tomography to document shunt position and specular microscopy for central corneal endothelial cell density (CCED) and peripheral (in the vicinity of the tube) corneal endothelial cell density (PCED). Other clinical parameters relating to shunt implantation were also recorded and analyzed. Mean CCED and PCED were 1537 ± 681 cells per square millimeter and 1310 ± 586 cells per square millimeter. The median follow-up was 36 months (range: 24-72 months) after shunt implantation. There was a significant association among the time from shunt implantation (β coefficient = -0.325; P = 0.040), the degree of peripheral anterior synechiae (PAS) in clock hours (β = -0.439; P = 0.004), and the number of previous operations (β = -0.316; P = 0.047) with CCED, whereas the degree of PAS was the only factor associated with PCED (β = -0.391; P = 0.013) on univariate analysis. Multiple linear regression analysis revealed that the degree of PAS was the only factor associated with CCED (β = -0.351; P = 0.023). There was no correlation between shunt position parameters and corneal cell density. The association between lower corneal cell density and aqueous shunt implantation appeared to be multifactorial, with the degree of PAS to be the most significant. Anterior segment optical coherence tomography is a promising technique for quantifying tube position in the anterior chamber after aqueous shunt implantation.

Corneal Endothelial Morphologic Features in Toxic Anterior Segment Syndrome

To investigate the clinical and laboratory findings of toxic anterior segment syndrome (TASS) following cataract surgery with intraocular lens (IOL) implantation, with emphasis on the morphologic features of the corneal endothelium. A single-center retrospective observational case-control design was used. The sample consisted of 15 patients (mean age 60.3 +/- 11.2 years) with a diagnosis of TASS following unilateral cataract surgery with IOL implantation. In all cases, cataract surgery with IOL implantation had already been performed in the fellow pseudophakic eye without complications. Data on the corneal endothelial morphologic features in both eyes were collected from the files as follows: endothelial cell density, coefficient of variation of cell size, and percentage of hexagonal cells. Values in the eyes with TASS (study group) were compared with the fellow eyes (control group). Between-group differences were analyzed with Student's t test at a significance level of 5%. The eyes with TASS were characterized by a significantly lower endothelial cell density than the control eyes (2302 +/- 220 cells/mm vs. 2853 +/- 145 cells/mm), higher mean cell area (coefficient of variation; 38 +/- 1.4 vs. 24 +/- 2.5), and lower mean percentage of hexagonal cells (22 +/- 1.5% vs. 48 +/- 3.2%; P < 0.01 for all). Common presenting symptoms and signs were blurred vision (60%), anterior segment inflammation (100%), and cell deposition (20%). TASS following cataract surgery with intraocular lens implantation is associated with a low corneal endothelial cell density.

Corneal endothelial cell density reduction: a complication of retinal photocoagulation with an indirect ophthalmoscopy contact lens

To investigate the influence of retinal photocoagulation with an indirect ophthalmoscopy contact lens on corneal endothelial cells. Seventeen eyes of 17 patients were evaluated, and corneal endothelial cells were measured twice: just before retinal photocoagulation using an indirect ophthalmoscopy contact lens and 33.2 +/- 10.2 days after surgery. A statistically significant reduction was found in corneal endothelial cell numbers before versus after surgery (P = 0.0003). Our results show corneal endothelial cells to be decreased by retinal photocoagulation with an indirect ophthalmoscopy contact lens. When a patient with a low corneal endothelial cell density receives retinal photocoagulation using an indirect contact lens, it is important to be aware of the potential for further loss.

Corneal endothelial cell density decreases with age in emmetropic eyes.

To analyze the corneal endothelial cell density in healthy adult emmetropic subjects. We analyzed the corneal endothelial cell density of a group made up of 225 emmetropic subjects (n=225). As age-matched control groups we analyzed two other groups, one made up of myopic subjects (n=209) and the other made up of hyperopic subjects (n=203). We recorded the mean of three consecutive measurements of the corneal endothelial cell density using the Topcon SP-2000P non-contact specular microscope (Topcon Corp., Tokyo, Japan). The mean age was 38.6+/-11.8 years, 40.7+/-12.2 years, and 39.2+/-10.5 years for emmetropic, myopic and hyperopic subjects respectively (p=0.994). No significant differences (p=0.920) in endothelial cell density values were found between emmetropic (2985+/-245 cells/mm2), myopic (2936+/-258 cells/mm2) and hyperopic eyes (2946+/-253 cells/mm2). Lower corneal endothelial cell density values were found in older emmetropic (p<0.001), myopic (p<0.001), and hyperopic subjects (p<0.001). A significant correlation between endothelial cell density and age was found in emmetropic (r=-0.958; p<0.001), myopic (r= -0.954; p<0.001) and hyperopic subjects (r= -0.948; p<0.001). In healthy emmetropic subjects there is a reduction in corneal endothelial cell density with age although there are no differences in corneal endothelial cell density values between emmetropic, myopic and hyperopic subjects.

Risk factors for development of diffuse lamellar keratitis after laser in situ keratomileusis

PURPOSE To investigate the risk factors and mechanisms of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK). METHODS In 5708 eyes of 2927 patients who underwent LASIK, the patient's background, clinical findings, and surgical data were retrospectively evaluated and compared with patients who had DLK and those who did not (non-DLK group). RESULTS DLK occurred in 46 of 5708 eyes (0.81%). DLK occurred more frequently in eyes operated with the MK-2000 microkeratome (1.1%) than with the LSK-One microkeratome (0.6%; P = .039). Corneal endothelial cell density (2686.8 +/- 235.3/mm2) was significantly lower in eyes that developed DLK than in eyes without DLK (2783.8 +/- 275.5/mm2; P = .017). The width of palpebral fissure in a normal state and the maximum opening position were significantly larger in the DLK group (10.3 +/- 1.9 mm and 18.1 +/- 7.2 mm, respectively) than the non-DLK group (8.3 +/- 1.6 mm with P < .001; 11.5 +/- 2.0 mm with P = .012). CONCLUSIONS The type of microkeratome, lower corneal endothelial cell density, and larger palpebral fissure were potential risk factors for DLK after LASIK. These factors may be associated with delayed wound healing of the corneal flap margin, resulting in poor sealing of the flap, which may induce the influx of inflammatory cells.

Corneal Endothelial Cell Density in Glaucoma

We studied corneal endothelial cell density in patients with glaucoma. One hundred two patients with glaucoma were compared with 52 patients without glaucoma of the same age group. Exclusion criteria included history of either corneal disease, ocular inflammation, trauma, or surgery other than peripheral iridectomy. The following data were extracted from the patient files: glaucoma type and duration, laser treatments, glaucoma medications, and documented intraocular pressure (IOP) measurements. Specular microscopies were performed on central corneas, endothelial images were analyzed by computerized planimetry, and cell counts were calculated. Corneal endothelial cell counts were significantly lower in patients with glaucoma (2,154 +/- 419 cells/mm2) than in controls (2,560 +/- 360 cells/mm2; t test, p < 0.0001). In the glaucoma group, cell counts were inversely proportional to the means of IOPs. Patients receiving three or four glaucoma medications had lower cell counts than those receiving one or two medications. Cell counts were significantly lower both in primary angle-closure glaucoma and in primary open-angle glaucoma. This study suggests that patients with glaucoma may have lower corneal endothelial cell density than those without glaucoma of the same age group. The proposed mechanisms are direct damage from IOP, congenital alteration of the corneal endothelium in patients with glaucoma, glaucoma medication toxicity, or a combination of these.