Lower Endothelial Cell Density Research Articles

Longitudinal corneal endothelial cell loss after corrective surgery for late in-the-bag IOL dislocation: a randomized clinical trial.

To compare safety regarding longitudinal corneal endothelial cell loss (ECL) after IOL exchange vs IOL repositioning for late in-the-bag IOL dislocation. Oslo University Hospital, Norway. Prospective, parallel group, randomized clinical trial. During a 3-year period, 104 patients were randomly assigned to groups receiving either IOL exchange with retropupillary fixation of an iris-claw IOL (n = 50) or IOL repositioning by scleral suturing (n = 54). All operations were performed by 1 surgeon with an anterior approach. Endothelial cell density (ECD) and central corneal thickness were measured preoperatively and at 6 months, 1 year, and 2 years postoperatively. A linear mixed model was applied for the longitudinal analysis, where patients with at least 1 ECD measurement were included (n = 44 exchange; n = 50 repositioning). The main outcome measure was 2-year longitudinal ECL in IOL exchange compared with IOL repositioning. The longitudinal ECL was similar between the IOL exchange (n = 44) and IOL repositioning (n = 50) groups during the 2 years of follow-up (17.5% vs 15.3%, P = .15). A subgroup analysis found no reason to advise against either method for patients with low preoperative ECD (<1500 cells/mm). The mean central corneal thickness was similar between the 2 groups and remained stable over 2 years of follow-up. This randomized clinical trial of late in-the-bag IOL dislocation surgery found that exchanging the IOL was as safe as repositioning in terms of 2-year longitudinal ECL.

Factors associated with endothelial cell density loss post Descemet membrane endothelial keratoplasty for bullous keratopathy in Asia.

To investigate the factors associated with endothelial survival after Descemet's membrane endothelial keratoplasty (DMEK) in eyes of Asian patients with bullous keratopathy (BK). In this retrospective, consecutive interventional case series, 72 eyes of 72 patients who underwent DMEK were evaluated. Best corrected visual acuity (BCVA) and corneal endothelial cell density (ECD) were assessed at 12 months postoperatively. Multiple regression analysis was performed to assess parameters such as age, sex, axial length, preoperative visual acuity, re-bubbling, the ratio of graft to cornea area, iris damage scores, types of filling gases, air or SF6 volume in the anterior chamber (AC) on postoperative day 1, and ECD loss rates at 12 months postoperatively. BCVA improved significantly at 12 months after DMEK (P < .001). The rate of ECD loss at 12 months after DMEK was 54.4 ± 16.1%. Multiple linear regression analysis showed that a larger ratio of graft to corneal area (P = 0.0061) and higher donor ECD (P = 0.042) were the primary factors for a lower ECD loss rate at 12 months after DMEK. A relatively larger graft size compared to the host cornea and more donor ECD might help endothelial survival in patients with BK. Moreover, for such patients, the surgeon should attempt to use a relatively larger graft size when performing DMEK, particularly in Asian eyes.

Corneal endothelium in paediatric patients with uveitis: a prospective longitudinal study

PurposeTo study the longitudinal effect of anterior chamber inflammation on the corneal endothelium in children.MethodsIn this prospective longitudinal observational study, children (aged <18 years) with anterior chamber inflammation and those...

Risk Factors for Corneal Endothelial Cell Loss in Patients with Pseudoexfoliation Syndrome

This study investigated corneal endothelial cell density (ECD) in pseudoexfoliation (PEX) syndrome patients and evaluated the clinical factors associated with ECD for 51 eyes of 41 phakic patients with pseudoexfoliation (PEX group) and 201 eyes of 117 patients with age-related cataracts (control group) as an age-matched control to the PEX group. Variable clinical factors, including ECD, central corneal thickness (CCT), anterior chamber depth (ACD), number of anti-glaucoma eye drops and severity of PEX, were examined using multivariate analyses. Severity of PEX was as follows: Mild in 28 eyes, Moderate in 16 eyes, and Severe in 7 eyes. The mean ECD was 2,548 ± 409 cells/mm2 in the PEX group and 2,757 ± 282 cells/mm2 in the control group, respectively, and ECD in the PEX group was significantly lower than that in the control group (P = 0.02). Multivariate analyses revealed that the severity of PEX [−176.8, 95% confidence interval (CI) (−244.5, −109.2), P < 0.01] was significantly associated with lower ECD. Accumulation of PEX materials contributed to early corneal endothelial decompensation.

Femtosecond laser-assisted Descemet's stripping endothelial keratoplasty: a prospective study of 6-month visual outcomes, corneal thickness and endothelial cell loss.

To report 6-month outcomes of visual acuity, the corneal thickness and endothelial cell density (ECD) in patients undergoing femtosecond laser-assisted Descemet's stripping endothelial keratoplasty (FS-DSEK). This prospective, consecutive, interventional series examined 25 eyes of 25 patients who underwent FS-DSEK for Fuchs endothelial dystrophy and bullous keratopathy. The pre-cut corneal endothelial graft thickness (CET) was 150µm. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), donor CET, recipient corneal stromal thickness (CST) and ECD were assessed at 1week and 1, 2, 3 and 6months postoperatively. The mean BCVA at 6months was 0.76 ± 0.35 logMAR units, improving from 1.54 ± 0.52 logMAR. CCT decreased significantly, from 759.8 ± 152.4µm at 1week to 631.7 ± 79.7µm at 6months (P = 0.001) postoperatively. CET recovered to 153.4 ± 33.7µm (P = 0.076) at 6months as pre-cut status. The CST decreased from 561.5 ± 96.3µm at 1week to 479.7 ± 57.9µm at 6months (P < 0.001). Preoperatively, the donor ECD was 2747.6 ± 255.4 cells/mm2, and the ECD decreased to 1729.1 ± 562.9 cells/mm2 at 6months, for a peak ECD loss of 36.86%. A greater decrease in CST observed from 1week to 6months postoperatively correlated with a lower ECD loss (P = 0.019) and a lower preoperative ECD (P = 0.012). However, a thinner CET correlated with a higher preoperative ECD (P = 0.028). FS-DSEK is a safe and effective surgical alternative for corneal endothelial decompensation. The donor ECD and its changes could be used as predictive factors for the improvement of CST and CET.

Ocular Phenotype of Relaxin Gene Knockout (Rln-/-) Mice

ABSTRACT Purpose: To test if relaxin deficiency affects ocular structure and function we investigated expression of relaxin (Rln) and RXFP receptors (Rxfp1, Rxfp2), and compared ocular phenotypes in relaxin gene knockout (Rln−/− ) and wild type (Rln+/+ ) mice. Materials and Methods: Rln, Rxfp1 and Rxfp2 mRNA expression was detected in ocular tissues of Rln+/+ mice using RT-PCR. The eyes of 11 Rln−/− and 5 Rln+/+ male mice were investigated. Corneal and retinal thickness was assessed using optical coherence tomography. Intraocular pressure was measured using a rebound tonometer. Retinal, choroidal and sclera morphology and thickness were evaluated histologically. Eyes were collected and fixed for immunofluorescence staining or used for RNA extraction to evaluate mRNA expression using real-time PCR. Results: Rln mRNA was expressed only in the retina, whereas Rxfp1 transcripts were detected in the retina, cornea and sclera/choroid. Rxfp2 was only present in the cornea. None of these genes were expressed in the lacrimal gland, eyelid or lens. Intraocular pressure was higher and central cornea of Rln−/− mice was significantly thicker and had significantly larger endothelial cells and a lower endothelial cell density than Rln+/+ mice. Immunohistochemistry demonstrated no significant difference in AQP3 and AQP5 staining in the cornea or other regions between wildtype and Rln−/− mice. mRNA expression of Aqp4 was significantly higher in Rln−/− than in Rln+/+ corneas, whereas Col1a2, Mmp9, Timp1 and Timp2 were significantly decreased. Expression of Aqp1, Aqp4, Aqp5, Vim and Tjp1 was significantly decreased in Rln−/− compared to Rln+/+ uvea. No significant differences in these genes were detected in the retina. Retinal, choroidal and scleral thicknesses were not different and morphology appeared normal. Conclusion: The findings indicate that loss of Rln affects expression of several genes in the uvea and cornea and results in thicker corneas with altered endothelial cells. Many of the gene changes suggest alterations in extracellular matrix and fluid transport between cells.

Assessment of Corneal Endothelial changes in type II Diabetes Mellitus by Non-Contact Specular Microscope

Abstract Introduction Numerous studies were dedicated to explaining the effect of type II diabetes on corneal endothelium. There seemed to be a conflict in the results of the studies, some highlighted that diabetes did not affect the corneal endothelium but rather the corneal thickness. While others disagreed stating that there was damage to the endothelium. The rest cited low endothelial cell density only in poor glycaemic control. This prospective analytical study will extensively investigate the effect of diabetes on the corneal endothelium using non-contact specular microscopy. Aim Prospective analysis of the effect of type II diabetes mellitus on the corneal endothelium performed by specular microscopic examination using KONAN Non-Contact Specular Microscope CC-5000 Cellchek; with regards to cell count, density, size, morphology and comparing them to normal subjects of the same age group. The aim of the study is to completely understand the changes that occur to the corneal endothelium in diabetic patients. Patients and Methods This is a cross-sectional study, in which 30 Diabetic eyes and 30 Control eyes were examined using non-contact specular microscope. Patients were recruited from the Specialized Eye Hospital Kobry El Kobba Military Medical Complex. Results The study included 17 males and 13 females in the non-diabetic control group while in the diabetic group it included 16 males and 14 females. By comparing the demographic data of the two study groups, no significant difference (p &amp;gt; 0.05) was found. The same results were obtained in data regarding the age. Comparing both groups regarding the cell count, density and average cell size showed a highly significant difference (p &amp;lt; 0.05). While comparing the coefficient of variation and the percentage of hexagonal cells in both groups showed a significant difference (p &amp;gt; 0.05). Conclusion Diabetes has been implicated in the morbidity of the corneal endothelium. Our study concluded that it appears that diabetes has a significant impact on the corneal endothelial anatomy, causing endothelial cell loss and a decrease in cell density producing compensatory polymegathism. Triggering a disturbance in the physiological functions of the endothelium when under stress e.g. trauma, surgery or intraocular inflammation. However, under normal physiological conditions we found out that there was no abnormality or impairment in the corneal endothelial functions; in keeping the corneal deturgesence (relatively dehydrated, 70% hydration). Therefore, we concluded from the results that special caution should be taken in diabetic patients to whom any stress is applied on the corneal endothelium so that they do not develop corneal decompensation leading to significant morbidity.

Efficacy of double-incision extracapsular cataract extraction in the treatment of hard-nucleus cataract with low corneal endothelial cell density

Objective: To discuss the efficacy and security of double-incision extracapsular cataract extraction (ECCE) in the treatment of hard-nucleus cataract with low corneal endothelial cell density. Methods: This was a retrospective case series study. Forty-six patients (47 eyes) with hard-nucleus cataract and low corneal endothelial cell density were enrolled at Shandong Eye Hospital from June 2009 to December 2018, including 22 males and 24 females, aged 50 to 74 (63.8±6.3) years. Preoperative corneal endothelial cell density was less than 1 000 cells/mm(2), and the cataract nuclear hardness was equal to or greater than grade IV. According to the surgical methods, the patients were divided into the single-incision ECCE group (24 eyes) and the double-incision ECCE group (23 eyes). The surgical procedures for the double-incision group were as follows. First, a superior scleral pre-incision was made. Then the conventional capsulorhexis was conducted through a 2.6 mm transparent corneal tunnel incision at the temporal or the nasal side, after which the hydro-dissection was performed. Next, the surgeon cut the pre-incision at the sclera, delivered the lens nucleus, sutured the scleral incision and removed the residual cortical materials from the corneal incision. Finally, a foldable intraocular lens was implanted, and the viscoelastic substance was removed. The intraoperative anterior chamber condition and the postoperative corneal edema condition were monitored. During the 6 month follow-up after surgeries, the endothelium cell density, visual acuity and astigmatism in the two groups were compared. The χ(2) test was used to compare the counting data, and the t test was used to compare the measurement data. Results: There was no statistically significant difference (t=1.12, P=0.28) in the preoperative corneal endothelial cell density between the double-incision and single-incision ECCE groups, which was (827±164) cells/mm(2) and (802±121) cells/mm(2), respectively. At 6 months after operation, in the double-incision and single-incision groups, the endothelial cell density was (793±147) cells/mm(2) and (706±101) cells/mm(2), respectively, and the difference was statistically significant (t=4.37, P<0.01). The percentage of corneal endothelial cell loss was 4.16%±3.12% and 11.69%±2.96%, respectively, and the difference was also statistically significant (t=9.52, P<0.01). The hexagon loss rate of corneal endothelial cells was 9.67%±6.11% and 28.33%±8.39%, respectively, and the difference was statistically significant (t=5.52, P<0.05). In the follow-up of 6 months, none of the eyes in the double-incision ECCE group suffered corneal endothelial decompensation compared with 3 eyes in the single-incision ECCE group. There were no statistically significant differences in postoperative astigmatism and surgically induced astigmatism between the two groups (t=-0.71, 0.15; P>0.05). Conclusions: The double-incision ECCE, in which the lens nucleus is delivered through a scleral incision and other procedures are conducted through a corneal tunnel incision, is safe and effective for cataract patients with hard nucleus and low corneal endothelial cell density. (Chin J Ophthalmol, 2020, 56: 126-130).

A new approach to extend the storage of donor corneas after 28days of corneal culture in an Italian eye bank.

This study aimed to evaluate the possibility to extend the storage of unused organ-cultured donor corneas. After 28 days of corneal culture in TISSUE-C (AL.CHI.MI.A. S.R.L., Italy) and 5-day storage in transport/deswelling medium CARRY-C (AL.CHI.MI.A. S.R.L., Italy), 25 corneas that were deemed suitable for transplantation were transferred in fresh TISSUE-C at 31°C for additional 7days and then in fresh CARRY-C at room temperature for 24h. Tissues were assessed for endothelial cell density (ECD), endothelial mortality and morphology after the standard and the extended corneal storage. In addition, the effect of donor age < 85years and ≥ 85years on corneal characteristics was assessed. After the extended storage, 6 out of 25 tested corneas (24%) showed ECD values below the acceptance limit (< 2000cells/mm2). 19 corneas (76%) were still suitable for transplantation and showed a 5.9% loss in ECD, which was not statistically significant (P = 0.0949) compared to standard storage period. The two donor age groups did not show statistically significant differences in any tested parameter, although a trend for lower ECD and higher mortality in Descemet's folds after standard storage was observed in the ≥ 85 age donor group. Thus, the attempt of the current study to provide new sight-restorative options for unused tissues and increasing the availability of corneas in case of shortage gave encouraging results. Although a higher vulnerability of corneas from very old donors could not be statistically demonstrated in the present study, higher sample size could be required for prolonging the shelf life of these tissues.

Quarter-Descemet Membrane Endothelial Keratoplasty: One- to Two-Year Clinical Outcomes.

To report clinical outcomes of the first Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) case series performed for central Fuchs endothelial corneal dystrophy. This is a prospective, interventional case series analyzing the clinical outcomes of 19 eyes of 19 patients with central Fuchs endothelial corneal dystrophy, that is, with guttae predominantly in the 6- to 7-mm optical zone, who underwent unilateral Quarter-DMEK at a tertiary referral center. Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative complications. Included eyes had up to 2 years of postoperative follow-up. At 6 months postoperatively, all eyes reached a BCVA of ≥20/40 (≥0.5): 18 of 19 eyes (95%) with ≥20/25 (≥0.8) and 9 of 19 eyes (42%) with ≥20/20 (≥1.0). Thereafter, BCVA remained stable up to 2 years postoperatively. The mean donor ECD decreased from 2842 ± 139 cells/mm (n = 19) before implantation to 913 ± 434 cells/mm (-68%) at 6 months (n = 19), 869 ± 313 cells/mm (-70%) at 12 months (n = 18), and 758 ± 225 cells/mm (-74%) at 24 months (n = 13) after Quarter-DMEK. Visually significant graft detachment requiring rebubbling occurred in 8 of 19 eyes (42%). Quarter-DMEK surgery yields visual outcomes similar to those of conventional DMEK and may potentially quadruple the availability of endothelial grafts. Further modifications of the graft preparation and the surgical technique may improve clinical outcomes in terms of lower ECD decrease and fewer graft detachments.

Risk factors for explantation of iris-fixated phakic intraocular lenses

To determine risk factors for explantation of iris-fixated phakic intraocular lenses (pIOLs) with a maximum 17-year follow-up. University Eye Clinic Maastricht, Maastricht UMC+, the Netherlands. Prospective case series. Eyes that had implantation of 1 of various iris-fixated pIOL models from 1998 to 2016 were evaluated. Primary outcome measures were the rate and proportion of pIOL explantations and the survival time (ie, time to pIOL explantation) in general and specifically as a result of cataract formation or endothelial cell loss (ECL). The study comprised 1037 eyes. The mean follow-up was 69.3months±52.8 (SD) and the mean preoperative age, 40.2±10.9years. The overall explantation rate was 12% after a mean of 166.1months±3.0 (standard error). Phakic IOL explantations were performed in 59% of eyes because of cataract formation and in 32% because of ECL. Shorter survival was seen with a higher preoperative age (hazard ratio [HR], 1.07/y; P<.001), longer axial length (AL) (HR, 1.10/mm; P=.009), and smaller anterior chamber depth (ACD) (HR, 4.47/mm; P<.001). Factors for shorter survival resulting from cataract were older preoperative age, longer AL, and larger ACD. Risk factors contributing to shorter survival resulting from ECL were a smaller ACD, lower endothelial cell density, and implantation with an Artisan hyperopia (toric) or Artiflex myopia (toric) IOL. The explantation rate of iris-fixated pIOLs was 12% after almost 14 years of follow-up, with 59% of pIOL explantations caused by cataract formation and 32% caused by ECL. An older preoperative age, longer AL, and smaller ACD were risk factors for a shorter survival.

Update on Descemet membrane endothelial keratoplasty.

To provide an update on new perspectives on Descemet membrane endothelial keratoplasty (DMEK). Preloaded DMEK grafts allow optimization of DMEK surgery time and reduce costs of the procedure, which is allowing the procedure to become more easily performed as reflected in the increasing number of cases. The surgical technique in the United States differs from the technique in Europe, but outcomes have been similar. Hemi-DMEK and quarter-DMEK have shown similar outcomes to conventional DMEK with respect to corneal transparency and visual acuity. Three-year follow-up of hemi-DMEK has also shown stability in endothelial cell count while maintaining corneal transparency. DMEK is becoming more accepted as the procedure of choice for treating endothelial failure. However, challenges with the surgical technique have limited wider implementation of this lamellar corneal transplantation. Preloaded DMEK provides one solution for the surgical challenges associated with the procedure while also reducing costs. Variations in the surgical technique for DMEK, including hemi-DMEK and quarter-DMEK, allow for central corneal clarity similar to traditional DMEK, but both result in lower endothelial cell density (ECD).

Representation of Central Endothelial Cell Density by Analysis of Single Best Specular Microscopy Image Regardless of Cell Size Variance.

PurposeThe purpose of this study is to evaluate whether a single best image can represent central endothelial cell density (ECD) in corneas of differing cell size coefficient of variance (CV).MethodsFour hundred one healthy eyes but with variant CV values were enrolled. For each eye, three nonoverlapping central cornea endothelium images were obtained with Konan NSP-9900 specular microscope. ECD and CV were evaluated by two independent graders using the well-established Center method. Only corneas with high image quality rating (IQR) and ECD >800 cell/mm2 by both graders were included in the study. The study sample was stratified into five CV levels (CV ≤ 35; ≥36; ≥38; ≥40; and ≥45). In each CV level, the ECD agreement, ECD variance, and the correlation between the ECD variation and CV values were analyzed. In addition, the ECD intragrader reproducibility and interframe differences were also analyzed for all levels except CV ≤ 35.ResultsThe study sample includes a total of 278 eyes. High ECD agreement for the two independent graders (intraclass correlation coefficient [ICC] > 0.99), high ECD intragrader reproducibility (ICC > 0.95), low ECD variance (2.0% ± 1.6%, overall), no correlation between the ECD variation and the CV value (P > 0.05), and no significant ECD difference among frames (P > 0.05) was found in any studied CV levels.ConclusionsCV does not appear to be associated with ECD variance in the central cornea.Translational RelevanceThis finding highlights that in healthy corneas but with high CV values, ECD can be reliably analyzed using one single image of best quality.

Corneal thickness and endothelial changes in long-term hydroxychloroquine use

Objective: To determine possible associations between long-term HCQ use and corneal changes in patients who used HCQ for at least 3 years.Materials and methods: The study included 62 healthy controls and 62 consecutive patients who used HCQ for the treatment of rheumatologic disease and were referred to the ophthalmology department between August 2018 and November 2018 for HCQ retinal toxicity screening. Central corneal thickness (CCT), corneal endothelial cell density (ECD), the coefficient of variation (CV) of cell size, and the percentage of hexagonal cells (HEX%) were measured to evaluate changes in the cornea.Results: The mean age of the patient group and control group was 50.10 ± 10.91 and 50.53 ± 10.67 years, respectively. The mean ECD was 2742 ± 347 (cells/mm2) in the patient group and 2875 ± 188 cells/mm2 in the control group. There was a significant difference between groups (p = 0.01). The mean CCT was 567.05 ± 32.35 µm in the patient group and 540.15 ± 38.50 µm in the control group. CCT was significantly higher in the patient group compared with control group (p < 0.001). There was no significant difference between groups in terms of mean CV and HEX values (p > 0.05).Conclusions: Patients using long-term HCQ demonstrated lower ECD and higher CCT than the control group. However, the CV of cell sizes and the HEX % values were not significantly different from the controls.

Surgical Technique of Late Spontaneous IOL-Capsular Bag Complex Dislocation with Low Corneal Endothelial Cell Density: A Case Report

Introduction: IOL-capsular bag complex dislocation is a rare but serious complication of phacoemulsification surgery. Technique to repair this complication should be based on various clinical parameters including quality of corneal endothelial cells and the type of dislocated IOL.&#x0D; Case Presentation: We present a case of a 67-year-old male with left eye spontaneous one-piece foldable IOL-capsular bag complex dislocation to vitreous cavity 4 years after phacoemulsification surgery. Visual acuity of the left eye was 1/60, pupil was round with 3 mm diameter and IOP was 15 mmHg. Noncontact specular microscopy examination showed that the corneal endothelial cell density was 1100 cells/mm2. It was managed with 23-gauge posterior vitrectomy, IOL evacuation to anterior chamber, releasing the capsular bag and repositioning the IOL into posterior chamber by sutured scleral fixation.&#x0D; Result: Follow-up at 6thmonth, best corrected visual acuity of the left eye achieved 6/6, IOL at central position and the last corneal endothelial cell density was 1076 cells/mm2.&#x0D; Conclusions: Late spontaneous IOL-capsular bag complex dislocation with low corneal endothelial cell density can be safely managed with proper surgical technique. Vitrectomy and sutured scleral fixation of the previously dislocated IOL were effective in managing such case. Longer follow-up should be done to assure the stability of IOL position and the quality of corneal endothelial cells.

Postoperative Endothelial Cell Density Is Associated with Late Endothelial Graft Failure after Descemet Stripping Automated Endothelial Keratoplasty

To determine whether preoperative endothelial cell density (ECD) and postoperative ECD after Descemet stripping automated endothelial keratoplasty (DSAEK) are associated with late endothelial graft failure (LEGF) in the Cornea Preservation Time Study (CPTS). Cohort study within a multicenter, randomized clinical trial. A total of 1007 individuals (1223 study eyes), mean age 70 years, undergoing DSAEK for Fuchs' dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (PACE) (6% of eyes) and followed for up to 5 years. Central ECD was determined by a central image analysis reading center. Preoperative ECD was determined for 1209 eyes that did not fail and 14 eyes that experienced LEGF. The ECD at 6 and 12 months after DSAEK, the change in ECD from preoperative to 6 and 12 months, surgeon-reported operative complications, and postoperative graft dislocation were investigated for an association with LEGFs unrelated to other postoperative events. Univariable and multivariable Cox proportional hazards regression models were used to assess associations. Late endothelial graft failure and its associations with pre- and postoperative ECD and operative complications. The cumulative probability of LEGF was 1.3% (95% confidence interval [CI], 0.8%-2.4%). Median (interquartile range [IQR]) preoperative ECDs were similar for eyes with LEGF (2523; 2367-3161) cells/mm2) and eyes without failure (2727; 2508-2973) cells/mm2) (P= 0.34). The ECD at 6 months was associated with LEGF (P< 0.001) in time-to-event analyses, whereas preoperative ECD was not (P= 0.55). The cumulative incidence (95% CI) of LEGF was 6.5% (3.0%, 14.0%) for 97 grafts with a 6-month ECD less than 1200 cells/mm2, 0.3% (0.0%, 2.4%) for 310 grafts with a 6-month ECD between 1200 and 2000 cells/mm2, and 0.6% (0.1%, 2.7%) for 589 grafts with a 6-month ECD greater than 2000 cells/mm2. In multivariable analyses, ECD at 6 months and operative complications were both associated with LEGF (P= 0.002 and P= 0.01, respectively), whereas graft dislocation was not (P= 0.61). In eyes undergoing DSAEK, preoperative ECD is unrelated to LEGF, whereas lower ECD at 6 months is associated with LEGF. Early endothelial cell loss after DSAEK and intraoperative complications should be minimized to improve graft survival.

Changes in corneal endothelial density following scleral buckling surgery for rhegmatogenous retinal detachment: a retrospective cross-sectional study

BackgroundTo investigate the effect of scleral buckling (SB) on the morphology and density of human corneal endothelial cells (HCEC).MethodsIn this retrospective cross-sectional study, 26 patients who had undergone SB due to rhegmatogenous retinal detachment were enrolled, in which 15 patients received encircling while the other 11 segment types of SB. The postoperative status of affected eye, preoperative status of affected eye, and the contralateral healthy eye was served as the study, control and contralateral groups. The images of the corneal endothelium was obtained by specular microscopy at least three months postoperatively and analyzed.ResultsPostoperative best-corrected visual acuity of the study group was worse than that of another two groups (P < 0.001) while intraocular pressure and biometry data were similar. The mean cell area and standard deviation were larger in the study group while the coefficient of variation revealed no difference. The study group manifested a lower endothelial cell density than that of the control and the contralateral (P < 0.001) groups. Concerning the percentage of hexagonal cells, the study group showed a lower hexagonality than the control group (P = 0.04). No difference of the endothelial morphology was found between the segmental subgroup and the encircling subgroup, nor was a significant difference about endothelial cell loss found in the study group with different measurement interval.ConclusionsScleral buckling leads to short-term decreased endothelial cell density and hexagonality, while the rest of morphological features remain unchanged. Moreover, both the segmental and encircling SB procedures yield similar postoperative HCEC status.

Morphological features of the corneal endothelium in patients with pseudoexfoliative glaucoma

Purpose. To study the main morphological features of the corneal endothelium in patients with pseudoexfoliative glaucoma (PEG).&#x0D; Methods. We included 193 subjects aged from 55 to 75 years. The main study group (PEG) included 96 patients (192 eyes), the primary open angle glaucoma (POAG) group included 36 patients (72 eyes) with POAG, the PEX group included 31 patients (62 eyes) with pseudoexfoliation syndrome without glaucoma. The control group consisted of 30 healthy subjects (60 eyes). Main corneal endothelium parameters were evaluated using a non-contact endothelial microscope EM-935 (Haag Streit, Switzerland). Data were analyzed by STATISTICA 9 software for Windows.&#x0D; Results. The patients with PEG had lower endothelial cell density (ECD) in comparison to the control group (p 0.01), and PEX group (p 0.05). The polymegatism level in patients with PEG and POAG was higher than in the control group (p 0.001, and p 0.01, correspondingly). In patients with moderate and advanced PEG, the ECD was significantly lower (p 0.01), and the polymegatism level was significantly higher (p 0.01) than the same parameters in patients with early PEG. The lowest ECD and the highest polymegatism percentage were observed in PEG patients with more pronounced PEX manifestations, p 0.05. No effect of IOP-lowering eye drops on the corneal endothelium parameters was revealed, p 0.05.&#x0D; Conclusions. Significant morphological changes of the corneal endothelium (decreased endothelial cell density, increased polymegatism percentage) were revealed in patients with PEG. It was established that the severity of these changes is associated with the PEG and PEX severity. No effect of IOP-lowering eye drops on the corneal endothelium parameters was detected.

Potential contraindications to scleral lens wear.

Research and reviews have resulted in clear indications for scleral lens (SL) wear. Those indications include visual rehabilitation; therapeutic use in managing ocular surface diseases, lid and orbit disorders; and refractive correction to enhance visual quality, comfort and quality of life. In some cases, the use of SLs may be contraindicated: the presence of low endothelial cell density; Fuchs' endothelial corneal dystrophy; glaucoma (because of the risk of an increase in intraocular pressure and the existence and location of draining devices and blebs); or overnight wear. While the literature provides an extensive description of the indications for scleral lens wear, the authors recognize that there is no paper reporting the contraindications to their use. The aim of this review is to illustrate the conditions for which SL wear is potentially contraindicated or requires caution. Improved knowledge of SL limits should reduce the risk of adverse events and increase the likelihood of fitting success.

Donor, Recipient, and Operative Factors Associated With Increased Endothelial Cell Loss in the Cornea Preservation Time Study

Determining factors associated with endothelial cell loss after Descemet stripping automated endothelial keratoplasty (DSAEK) could improve long-term graft survival. To evaluate the associations of donor, recipient, and operative factors with endothelial cell density (ECD) 3 years after DSAEK in the Cornea Preservation Time Study. This cohort study was a secondary analysis of data collected in a multicenter, double-masked, randomized clinical trial. Forty US clinical sites with 70 surgeons participated, with donor corneas provided by 23 US eye banks. Individuals undergoing DSAEK for Fuchs dystrophy or pseudophakic/aphakic corneal edema were included. The DSAEK procedure, with random assignment of a donor cornea with a preservation time of 0 to 7 days or 8 to 14 days. Endothelial cell density at 3 years as determined by a reading center from eye bank and clinical specular or confocal central endothelial images. The study included 1090 participants (median age, 70 years) with 1330 affected eyes (240 bilateral cases [22.0%]), who underwent DSAEK for Fuchs dystrophy (1255 eyes [94.4%]) or pseudophakic/aphakic corneal edema (PACE) (75 eyes [5.6%]). Of these, 801 eyes (60.2%) belonged to women and 1207 (90.8%) to white individuals. A total of 749 participants (913 eyes; 164 [21.9%] bilateral cases) had functioning grafts with acceptable endothelial images preoperatively and at 3 years postoperatively and were included in this analysis. Factors associated with a lower ECD at 3 years (estimated effect with 99% CI) in the final multivariable model included donors with diabetes (-103 [-196 to -9] cells/mm2), lower screening ECD (-234 [-331 to -137] per 500 cells/mm2), recipient diagnosis of PACE (-257 [-483 to -31] in cells/mm2), and operative complications (-324 [-516 to -133] in cells/mm2). Endothelial cell loss (ECL) from a preoperative measurement to a 3-year postoperative measurement was 47% (99% CI, 42%-52%) for participants receiving tissue from donors with diabetes vs 43% (99% CI, 39%-48%) without diabetes; it was 53% (99% CI, 44%-62%) for participants diagnosed with PACE vs 44% (99% CI, 39%-49%) for those diagnosed with Fuchs dystrophy, and 55% (99% CI, 48%-63%) in participants who experienced operative complications vs 44% (99% CI, 39%-48%) in those who did not. No other donor, recipient, or operative factors were significantly associated with 3-year ECD. Donor diabetes, lower screening ECD, a PACE diagnosis in the recipient, and operative complications were associated with lower ECD at 3 years after DSAEK surgery and may be associated with long-term graft success. While causation cannot be inferred, further studies on the association of donor diabetes and PACE in recipients with lower 3-year ECD warrant further study.