Mean Central Corneal Thickness Research Articles

The effect of sodium hyaluronate on dry eye and corneal epithelial thickness following cataract surgery.

To evaluate the effects of sodium hyaluronate drops on dry eye parameters and corneal epithelial thickness following cataract surgery. The study included 84 patients who underwent uncomplicated phacoemulsification. In Group A, 0.15% sodium hyaluronate drops were added to the postoperative antibiotic/anti-inflammatory treatment. In Group B, only antibiotic/anti-inflammatory treatment was applied. Preoperatively and at 1week and 1month postoperatively, all the patients were evaluated in respect of tear break-up time (TBUT), the Schirmer test under anesthesia, the corneal fluorescein staining (CFS) score, mean central corneal thickness (CCT) and mean central corneal epithelial thickness (CCET), and the two groups were compared. A statistically significant difference was determined between the two groups at postoperative 1month in respect of TBUT, Schirmer test, CFS score, and CCET (p < 0.01). In Group A, a statistically significant increase was determined in the TBUT and Schirmer values at 1month postoperatively (p < 0.01, p = 0.01, respectively) and in Group B, these values were decreased compared to preoperatively (p < 0.01). The CCET was determined to be significantly thinner in Group B 1month postoperatively (p < 0.01). A significant increase in CCT was observed in both groups at postoperative 1week (p < 0.01) and preoperative values were reached at 1month postoperatively. In the patient group using sodium hyaluronate, significant differences were determined in all dry eye parameters and CCET. The use of hyaluronate sodium drops after cataract surgery was seen to improve dry eye parameters and contribute to a healthy ocular surface by ensuring continuity of the corneal epithelium.

Corneal endothelial cell morphology in children with autosomal recessive Alport syndrome: a longitudinal study

ABSTRACT Purpose To evaluate the corneal endothelial cell morphology in children with autosomal recessive Alport syndrome (ARAS). Methods This is a longitudinal, prospective cohort study that evaluated pediatric patients with genetically diagnosed ARAS. Fifty-eight eyes of 29 pediatric patients (12 patients, 17 controls) underwent a full ophthalmic examination. Corneal endothelial cell density (ECD) (cells/mm²), coefficient variation (CV) of cell area (polymegathism), the percentage of hexagonal cells (HEX) (pleomorphism), and central corneal thickness (CCT) were analyzed automatically using a noncontact specular microscopy. Results The mean ECD was 2904 ± 355.48 cell/mm² in the ARAS group and 3263.20 ± 261.71 cell/mm² in the control group (p = 0.004). In the ARAS group, the mean CV was 46.53 ± 10.43, which was significantly higher than that in controls (p = 0.026). The mean HEX was 48.86 ± 14.71 in the ARAS group and 59.06 ± 10.64 in the control group (p = 0.038). The mean CCT was 565.26 ± 39.77 µm in the ARAS group and 579.66 ± 31.65 µm in the control group (p = 0.282). The comparison of endothelial cell characteristic of the ARAS group with 1-year follow-up is as follows: The mean ECD decreased from 2904 ± 355.48 cell/mm² to 2735 ± 241.58 cell/mm² (p = 0.003). The mean CV increased from 46.53 ± 10.43 to 47.93 ± 10.50 (p = 0.471). The mean HEX decreased from 48.86 ± 14.71 to 48.50 ± 10.06 (p = 0.916). The mean CCT decreased from 565.26 ± 39.77 µm to 542.86 ± 40.39 µm (p = 0.000). Conclusion Measurement of ECD and percentage of hexagonality can also be used as an indicator of the health of the corneal endothelium. In this study, the mean ECD and HEX were significantly lower in ARAS group than in age-matched pediatric controls. Polymegathism, which reflects cellular stress, was statistically significantly higher in ARAS group. The mean ECD and CCT decreased significantly at 1-year follow-up. This study may demostrated that endothelial damages and stress in ARAS patients appear in childhood and show a rapid increase with age.

The Effect of Tobacco Smoking on Corneal Endothelium and Central Corneal Thickness

We aimed to study the impact of tobacco smoking towards central corneal thickness, morphology, and corneal endothelial cell density (ECD) in healthy subjects. This cross-sectional study recruited consecutive patients who visited the Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre, from April 2017 to August 2018 who were active smokers and non-smokers. Active smokers were further divided into heavy and light smokers according to the number of pack-years smoked. The nicotine dependency level was measured using the Fagerstrom test and divided into low, moderate, and severe dependency. Non-contact specular microscopy was performed. Parameters studied included the ECD, percentage of hexagonality (HEX), coefficient of variation of cell size (COV), and central corneal thickness (CCT). A total of 84 eyes from 84 subjects were included, with 42 in the smoker and 42 in the non-smoker groups. The mean age was 38.3 ± 6.7 and 39.2 ± 10.7 years in the smoker and non-smoker groups, respectively. The mean ECD, HEX, and COV were 2783 ± 316 vs. 2877 ± 333 cells/mm2, 55.0 ± 6.7% vs. 55.0 ± 7.7% and 32.7 ± 4.4% vs. 32.2 ± 4.1% in the smoker and non-smoker group, respectively. However, none were statistically significant (p&gt;0.05). The mean CCT was also not statistically different, with 532.6 ± 30.8 μm in the smoker group and 530.5 ± 30.8 μm in the non-smoker group. No statistically significant difference was found between light and heavy smokers and addiction levels. There was a statistically significant but weak negative correlation between ECD and duration of smoking (r = -.370, p = 0.016) and a weak positive correlation between COV and number of pack-years smoked (r = .344, p = 0.025). Smoking did not significantly affect corneal ECD, cellular morphology, or CCT.

Phacoemulsification versus Laser Peripheral Iridotomy for Treating Primary Angle Closure Glaucoma: A Systematic Review and Meta-Analysis.

Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification and laser peripheral iridotomy (LPI) effectively control IOP elevation and widen the angle. This systematic review and meta-analysis compared Phacoemulsification and LPI Effectiveness for PACG. We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared Phacoemulsification and LPI for individuals with PACG. We sought to evaluate the following outcomes: mean IOP, number of glaucoma medications, visual acuity (VA), visual field (VF) progression, peripheral anterior synechiae (PAS), Shaffer gonioscopy grading, central corneal thickness (CCT), central endothelial cell density (CECD), and poor response to surgery. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes. 5 RCTs that enrolled 917 participants were deemed eligible. The phacoemulsification group showed statistically significance lower mean CCT and CECD and lower risk of poor response to surgery compared to LPI (SMD = -1.10; 95% -1.50, -0.70; P<0.001, SMD -366.12; 95% -652.59, -79.65; P=0.01, and RR 0.35; 95% 0.23, 0.54; P<0.001 respectively). There were no significant improvement in IOP and number of medications between both groups (SMD = -0.74; 95% CI = -2.26, 0.78; P=0.34, and SMD -17.58; 95% CI = -50.28, 15.12; P=0.29 respectively). Finally, there were also no significant differences in VA, VF progression, PAS, and mean Shaffer gonioscopy grading between both groups. Phacoemulsification showed statistically significant lower mean corneal thickness, central endothelial cell density, and lower risk of poor response to surgery compared to LPI. However, there were no significant differences in mean IOP, number of medications, VA, VF progression, PAS, and mean Shaffer gonioscopy grading between Phacoemulsification and LPI.

Tissue Saving by Reducing and Using Variable Optic Zone (VOZ) to Correct Myopia by Refractive Lenticule Extraction

Purpose: The lenticular diameter was reduced to below standard 6.5 mm, in a stepwise manner up to 5.2 mm and report on the Residual Stromal Thickness (RST), refractive outcomes and subjective scotopic visual quality of patients compared to those who underwent Small Incision Lenticule Extraction (SMILE) with the conventional 6.5 mm lenticular diameter. Study Design: Retrospective study Methods: Patients undergoing SMILE in the first year of the study were subjected to lenticular diameter of standard 6.5 mm for lenticule extraction. In the second year, using the same nomogram, the lenticular diameter was gradually reduced from 6.4 to 6 mm, with 0.1 mm decrements in each subset. In the last 6 months, all cases were performed using the same nomogram but with lenticular diameter below 6 mm, again with 0.1 mm decrements in each subset. Results: We included 100 eyes of 55 patients with a mean age of 26.18+ 6.6 years (median=25 years, IQR= 22 to 28 years). The mean preoperative best corrected visual acuity (BCVA) was 0.03+ 0.07 logMAR (range = 0 to 0.3 logMAR) and the mean preoperative spherical equivalent was -5.5D + 2.05D (median = -5.5D, IQR= -7.10 to -3.75D). The mean keratometry was 44.12D + 1.3D (range = 41.5 to 48D) and mean central corneal thickness was 532.24+ 29.8 µ (median = 533 µ IQR= 511 to 552 µ, range = 449 to 629 µ). The pupillary size in the study group was 3.80+ 0.82 mm (median= 3.84 mm, IQR= 3.3 to 4.3mm). At 1 month follow up; the best corrected distance visual acuity (UCDVA) across groups was 0.02 + 0.06 logMAR (median = 0 logMAR, range = 0 – 0.3 logMAR). There were no differences in UCDVA and contrast sensitivity between groups with respect to the lenticular diameter. Univariate linear regression analysis showed that age, spherical equivalent, preoperative pachymetry and lenticular diameter size were significantly associated with residual stromal thickness. Conclusion: We found that SMILE performed with a lenticular diameter of &lt; 6 mm was effective in delivering excellent refractive correction and improving the corneal biomechanical strength by virtue of significantly greater RST.

Central Corneal Thickness and Endothelial Cell Changes in Diabetics and Age-Matched Non-diabetics in a Tertiary Care Hospital in Central India.

Background Diabetes has become an epidemic, significantly impacting ocular health as one of its end-organ responses. Among the various ocular complications, alterations in corneal morphology stand out. Central corneal thickness (CCT) and endothelial cell function are vital parameters in assessing intraocular pressure, conducting pre-refractive surgery evaluations, and maintaining corneal transparency. Understanding these changes in diabetic individuals compared to non-diabetics is crucial for managing ocular health in this population. Aim and objective This study evaluates and compares CCT and endothelial cell changes between diabetic individuals and age-matched non-diabetics. By analyzing these parameters, the study seeks to provide insights into the impact of diabetes on corneal morphology and its implications for ocular health. Methods The study recruited 124 patients from the Ophthalmology Outpatient Department (OPD) at Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi. A cross-sectional research design was employed to collect data over six months. Patients were carefully selected, and informed consent was obtained from all participants. CCT and endothelial cell parameters were assessed using specular microscopy, a non-invasive imaging technique. Statistical analysis was done using the software Statistical Package for the Social Sciences (SPSS) for inferential statistics, such as t-tests and ANOVA, and comparing parameters between diabetic and non-diabetic groups.Findings were interpreted based on both statistical significance and clinical relevance. Results In diabetic patients, the mean CCT was 547.91 µm, while it was 523.62 µm in non-diabetic individuals.The T statistic for this variable was 5.14, indicating a17 significant differencebetween the two groups. Similarly, significant differences were found between diabetics and non-diabetics for endothelial cell density, coefficient of variation, and hexagonality, as evidenced by their respective T statistics of 7.46, 5.17, and 4.91. Endothelial cell density averaged 2375 cells/mm2 in diabetics and 2666.95 cells/mm2 in non-diabetics. Additionally, the coefficient of variation was higher among people with diabetes (40.87%) compared to non-diabetics (35.09%). Hexagonality, a measure of endothelial cell shape, was lower in diabetic corneas (40.48%) than in non-diabetic corneas (46.46%). Conclusion The study observed significant differences in corneal morphology, including central thickness and endothelial cell changes, between diabetic and non-diabetic individuals. These findings underscore the impact of diabetes on ocular health and emphasize the importance of monitoring corneal parameters in diabetic patients. Understanding these changes can aid in better management and treatment strategies for ocular complications associated with diabetes.

A comparative study of central corneal thickness in patients with diabetes and without diabetes mellitus

Diabetes mellitus (DM) is becoming increasingly and seriously prevalent lifestyle health problem worldwide. Up to 70% of diabetic patients can develop corneal changes and are also difficult to manage. Several studies were done to find out the morphological changes in cornea in type 2 DM, but the results are highly variable. Central corneal thickness (CCT) is widely considered as a constant parameter, so are measured only once during follow up in our daily clinical practice. Here we study the effect of diabetes over CCT, for a better understanding of the impact of diabetes over CCT.A comparative observational study of one and half years done among 106 diabetes and 106 non diabetic patients between 35 to 75 years old, attending ophthalmology OPD. CCT of both eyes was measured and mean CCT and was compared between diabetic and non-diabetic groups, among different subgroups of diabetic subjects and other parameters.CCT was thicker among diabetic groups (553.4434um) than non-diabetic groups (549.8491) but was not statistically significant according to our study. But there was statistically significant (p value 0.000165) thickening with increasing grades of diabetic retinopathy (DR) (mild DR (535.4524), moderate DR (543) and PDR (591.5)). Our study concludes that DM is associated with thicker cornea; hence CCT values can vary with time in DM. So repeated CCT measurements for corrected IOP values is advised and warranted in DM patients for proper management of IOP.

Comparison of Endothelial Cell Loss after Phacoemulsification Surgery between Patients with Diabetes Mellitus and Non-Diabetic Patients at Kariadi Hospital: A Prospective Study

Abstract&#x0D; Introduction &amp; Objectives : To compare the endothelial cell loss after phacoemulsification surgery in patients with DM and non- DM patients&#x0D; Methods : This was a prospective study conducted at Kariadi Hospital, Semarang, Indonesia. A total of 20 eyes of 20 patients (10 DM and 10 non-DM) who underwent phacoemulsification surgery were included in this study. The central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured preoperatively and on day-7 postoperatively. The percentage of endothelial cell loss (%ECL) was calculated and compared between the two groups.&#x0D; Results : The mean pre-operative and post-operative CCT was similar in both groups (DM =546.6±44.26μm, non-DM=516.7±42.2μm, p=0.949 ;DM=562.8±46.1μm, non-DM=533.7±46.6μm, p=0.997). The mean percentage of endothelial cell loss was slightly higher in the DM group compared to the non- DM group but not significant (6.66±2.36% vs. 2.31±1.72%, p=0.566). There were no significant differences between the CV and HEX on pre-operative and day-7 after surgery&#x0D; Conclusion : Patients with DM have a slightly higher percentage of endothelial cell loss after phacoemulsification surgery compared to non-DM patients. The mean CCT, CV and HEX pre-operation and day-7 were quite similar in both groups. These findings suggest that patients with DM may require more careful monitoring and follow-up after phacoemulsification surgery.

Corneal Collagen Cross-Linking (CXL) in Pediatric Keratoconus: Changes in Visual Acuity and Biomechanical Properties

Abstract&#x0D; Introduction &amp; Objectives : Keratoconus is a progressive disease that changes the mechanical shape of the cornea due to thinning of the stromal layer of the cornea. Therefore, early detection and correct management should be able to slow the progression of the disease. This study aimed to compare changes in visual acuity and biomechanic properties of cornea in patients who underwent Corneal Collagen Cross- Linking (CXL) in Dr. Sardjito General Hospital&#x0D; Methods : This is a prospective study that included all pediatric keratoconus patients without any underlying disease that underwent CXL between July 2022 to December 2022. Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), Central Corneal Thickness (CCT) and Intraocular Pressure (IOP) were evaluated preoperatively, 2 weeks, and 6 weeks following CXL.&#x0D; Results : Mean age of patients was 11 (range 6-18 y.o). UCVA were 1.00±0.34 logMAR preoperatively, 0.95±0.35 and 0.88±0.37 logMAR at 2 and 6 weeks after CXL (P=0.27 and P=0.02, respectively). BCVA were 0.37±0.28 logMAR preoperatively, 0.46±0.28 and 0.35±0.21 logMAR at 2 and 6 weeks after CXL (P=0.05 and P=0.46, respectively). Mean IOP were 15.21±3.99 preoperatively, 14.45±2.73 and 15.21±3.68 at 2 weeks and 6 weeks after CXL (P=0.33 and P=1.00, respectively). Mean CCT were 503.09±49.43 preoperatively, 508.18±47.68 and 506.82±48.41 at 2 weeks and 6 weeks after CXL (P=0.01 and P=0.11, respectively). No complications occurred during the observation period.&#x0D; Conclusion : UCVA and BCVA were improved after CXL. Analysis showed no significant change for IOP and CCT after CXL procedure. Overall, CXL was safe and significantly improve UCVA and BCVA in pediatric keratoconus.

Nuclear Grades based on Lens Opacities Classification System III associated with Phacoemulsification Parameters and Postoperative Central Corneal Thickness

Abstract&#x0D; Introduction &amp; Objectives : To determine association of nuclear cataract grades based on Lens Opacities Classification System (LOCS) III with phacoemulsification parameters and postoperative Central Corneal Thickness (CCT) and visual acuity.&#x0D; Methods : This was a prospective observational study in patient with uncomplicated senile cataract who gave consent and underwent phacoemulsification. Institutional Ethics Committee clearance was taken for the study. Preoperative nuclear cataract was evaluated using Lens Opacities Classification System (LOCS) III. Only nuclear grading NO and NC was obtained. All procedures was performed using peristaltic phaco machine and in the bag IOL implantation. Phacoemulsification parameters (US Total Time and CDE) were noted and compared in different grades of cataract. CCT change was recorded at day one after surgery.&#x0D; Results : Forty-six patients were evaluated. The mean USTT was 120.85 (56-252) seconds, mean CDE was 21.10 (5.70 – 43.38), and mean CCT change after surgery was 81.54(27 – 240). Nuclear grading of LOCS also had linear correlation with US Total Time (NO p&lt;0.001, r=0.734; NC p&lt;0.001, r=0.790) and CDE (NO p&lt;0.001, r=0.728; NC p&lt;0.001, r=0.685). There was significant correlation between CCT change with postoperative VA (p=0.002, r=0.443) and CDE (p&lt;0.001, r= 0.553). CCT change also correlate with nuclear opacity (p=0.012, r=0.367) and nuclear color (p=0.035, r=0.312).&#x0D; Conclusion : Nuclear grading of LOCS III related to the amount of time and energy used in phacoemulsification, and also CCT change after surgery as a qualitative measurement of corneal edema. Increasing postoperative CCT affected patient's visual acuity after cataract surgery.

Changes in confocal microscopy in glaucoma patients after intraocular pressure reduction with medical therapy.

Topical glaucoma medication is the first line of management to reduce intraocular pressure (IOP) in patients with glaucoma. In this study, we intended to compare the ultrastructural findings of the cornea in patients with glaucoma before and after the reduction of the IOP through confocal microscopy. Ten patients (19 eyes) with newly diagnosed glaucoma were recruited from the glaucoma services of our tertiary care center. Demographic parameters were noted, and basic ocular examination, specular microscopy (Topcon SP3000P, Tokyo, Japan), and ultrasonic pachymetry (300 AP, Sonomed Escalon, Stoneham, MA, USA) were performed. In vivo confocal microscopy of corneal sections was performed using the z-ring Confoscan 4.0 (Nidek, Inc., Freemont, CA) at baseline and after 3 months of starting glaucoma medications. The mean age of the patients was 53.53 ± 9.34 years. There was a statistically significant reduction (P < 0.0001) of IOP from 30.21 ± 7.42 mmHg (baseline) to 16.42 ± 4.14 mmHg (3 months). The mean central corneal thickness at baseline was 533.42 ± 3.96 μm, and it further decreased to 521.94 ± 42.45 μm at the end of 3 months (P = 0.006). No significant change was noted in the mean epithelial cell density, mean keratocyte density in anterior and posterior stroma, and the mean endothelial cell density and cell area (P >0.5). There was no significant percentage change in these parameters before and after the lowering of the IOP. A short-term (3 months) decrease in IOP using topical glaucoma medications caused a significant reduction in corneal thickness but did not have any significant ultrastructural changes in cornea measured using confocal microscopy.

Do intravitreal anti-VEGF injections have an effect on corneal endothelial remodeling in children with premature retinopathy?

This study was carried out to investigate the effects of retinopathy of prematurity (ROP) and intravitreal antivascular endothelial growth factor (VEGF) injections on the corneal endothelium in the childhood period of patients who have had ROP. The material of comparative case-control clinical study consisted of patients followed up with ROP between February 2013 and February 2023. The eyes in the study group were divided into two subgroups consisting of those who received intravitreal anti-VEGF injections (subgroup 1) and those who were followed up only (subgroup 2). Central corneal endothelial cell density (ECD), coefficient of variation (CV), central corneal thickness (CCT), and pleomorphism parameters in the childhood period were evaluated by corneal specular microscopy and compared with age-matched healthy control subjects. There were 84 eyes of 42 patients with ROP in the study group and 80 eyes of 40 healthy children in the control group. Mean CCT was significantly higher in subgroup 1 and the control group than in subgroup 2 (p = 0.037), and mean ECD was significantly higher in subgroup 2 than in subgroup 1 and the control group (p < 0.001). There was no significant difference between subgroup 1 and the control group in mean ECD and CCT values (p = 1.000 for both cases). Considering that ROP patients who received intravitreal anti-VEGF injections had more advanced-stage ROP than ROP patients who were followed up only, these findings suggest that intravitreal anti-VEGF applications in ROP cases may lead to corneal endothelial parameters similar to those of healthy eyes.

The effect of 1% tropicamide on central corneal thickness and intraocular pressure

Background: Dilating the eye with tropicamide may alter the intraocular pressure (IOP) because of an obstruction of the iridocorneal angle, resulting in decreased aqueous outflow drainage. Also, the repeated application of eyedrops and instrumentation could lead to increased central corneal thickness (CCT), consequently affecting IOP.Aim: This study aimed to determine the effect of 1% tropicamide on CCT and IOP post-mydriasis among the University of Limpopo optometry students.Setting: The data were collected at the optometry clinic of the University of Limpopo.Methods: A within-subject experimental study was conducted on 59 healthy subjects aged 18 years – 28 years. A computer assisted simple random probability sampling was used to identify a sample of participants from the study population (N = 200). Baseline and post-mydriasis IOP (20 min, 30 min, and 45 min intervals) were measured with a Goldmann applanation tonometer. Central corneal thickness and IOP were analysed using means, correlations and paired t-tests.Results: The mean CCT pre-mydriasis was 504.68 μm, and post-dilation was 507.90 μm, 510.08 μm and 509.25 μm at 20 min, 30 min, and 45 min, P = 026, p = 0.033, P = 0.004, respectively. Moreover, the mean IOP pre-mydriasis was 15.97 mmHg, and post-dilation was 16.85 mmHg, 16.46 mmHg and 16.85 mmHg over 20 min, 30 min, and 45 min of followed-up time, p = 0.140, p = 0.432, and p = 0.183, respectively.Conclusion: Measuring IOP post-dilation is still valid; however, CCT should be measured before the instillation of tropicamide.Contribution: This study analysed the effect of 1% tropicamide on CCT and IOP post-mydriasis in a clinical South African context.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

Retrospective Analysis of a New Intrastromal Dissection Technique Using the Retinal Reflex for Deep Anterior Lamellar Keratoplasty.

The purpose of this study was to describe a new surgical technique for deep anterior lamellar keratoplasty. All pupils in the recipient eyes were dilated preoperatively. Vertical grooving was performed using a crescent blade with a width of 5 mm and a depth of one-third to half corneal thickness on the temporal side of the limbus. Stromal dissection was performed as close as possible to Descemet membrane by observing the gap between the gold line by retinal reflex and the front edge of the crescent blade. Lamellar dissection was performed along the lamellar plane using corneal dissectors. The ophthalmic viscoelastic device was injected into the intrastromal pocket to separate the anterior and posterior stroma and an anterior corneal lamella was excised. A donor cornea was sutured into the recipient bed. In 18 eyes, none of the patients had Descemet membrane rupture during surgery. The mean postoperative residual stromal thickness was 80 ± 31 μm. The mean central corneal thickness after surgery was 660 ± 69 μm. At the last follow-up, the cornea was cleared in all 18 eyes on slit-lamp examination. We estimated the residual stromal thickness based on the gap between the gold line by the retinal reflex and crescent blade, and intrastromal lamellar dissection was performed using a smooth corneal dissector. Consequently, the surface of stromal dissection was smooth, and the residual stromal thickness was even.

Corneal and epithelial thickness mapping in diabetic patients using optical coherence tomography

Purpose To evaluate corneal and epithelial thickness using the anterior segment optical coherence tomography and to correlate these changes with major disease parameters, that is duration of the disease, status of control (glycated hemoglobin level), and stage of diabetic retinopathy. Patients and methods Corneal and epithelial thickness profile of 25 patients diagnosed with diabetes mellitus and 25 healthy individuals were measured by anterior segment optical coherence tomography. Full ophthalmological examination of all patients was done. The disease duration and the glycated hemoglobin levels were recorded. Results In diabetic patients, there was nonsignificant thinning in mean central epithelial thickness (P=0.14). The mean central corneal thickness is slightly thicker, however, it did not reach significance (P=0.051). There was statistically significant thickening in central stromal thickness (P=0.015). There was a significant negative correlation between the severity of retinopathy and superior epithelial thickness (P=0.037). The duration of the disease showed significant correlation with most of epithelial thickness values, however, HA1c level was not found to have any statistically significant effect on corneal and epithelial parameters. Conclusion Chronic metabolic stress of diabetes has an impact on corneal epithelium and stroma. Severity of diabetic retinopathy should be considered as a risk factor during corneal surgeries to avoid epithelial and stromal-associated complications.

Correlation of Central Corneal Thickness with Refractive Error, Corneal Curvature, and Axial Length: An Observational Study

Background: Various demographic and ocular factors influence central corneal thickness (CCT). Studies on the relationships between these parameters have shown conflicting results. We aim to investigate the correlation of CCT with different types of refractive error, axial length (AL), and corneal curvature. Materials and Methods: An observational study was undertaken in the Department of Ophthalmology, recruiting patients from 18 to 40 years of age with myopia (−0.5 D to −6 D) or hypermetropia (≤ +3 D) or emmetropia (−0.25 D to +0.25 D). All participants underwent comprehensive ophthalmic examination, including refraction, slit lamp examination and fundoscopy, followed by CCT, corneal curvature, and AL measurement. Result: A total of 1224 eyes of 612 patients (260 males and 352 females) were enrolled in the study. Out of them, 31.5% (n = 386) had emmetropia, 28.6% (n = 350) had hypermetropia, and 39.9% (n = 488) had myopia. The mean (±standard deviation [SD]) keratometry (K), CCT and AL were found to be 44.08 (±1.55) D, 528.46 (±29.78) μm, and 22.75 (±1.21) mm, respectively. With increasing age, CCT was found to be decreased (P &lt; 0.001). Compared to myopia, a significantly higher CCT was noted in hypermetropia (P &lt; 0.001). There was a negative correlation between CCT and corneal curvature among the entire study population, irrespective of their refractive status (P &lt; 0.001). This correlation was more significant among emmetropes and hypermetropes as compared to myopes. However, we found no correlation between CCT and AL in any groups. Conclusion: CCT is found to be thicker in hypermetropia and thinner in myopia as compared to emmetropia. With increasing age, the cornea tends to become steeper and thinner.

Effects of repeated intravitreal bevacizumab administration on anterior segment parameters and limbal stem cells

Background: Macular edema (ME) is fluid accumulation in the macula caused by vascular leakage. Repeated intravitreal bevacizumab (IVB) injections are extensively used to treat ME of different origins, are well tolerated, and have few side effects. This study evaluated the effects of repeated IVB injections on the anterior segment parameters and limbal stem cells (LSCs) in eyes with ME.&#x0D; Methods: This before–after study involved patients with ME of different causes who underwent repeated IVB injections at the Imam Khomeini Ophthalmology Center in Kermanshah, Iran. Before and after repeated IVB injections, anterior segment parameters were measured using anterior segment optical coherence tomography, and the LSCs were assessed using impression cytology.&#x0D; Results: We enrolled 42 eyes of 42 patients with a mean (standard deviation [SD]) age of 59.6 (7.6) years, of whom 25 (59.5%) were men and 17 (40.5%) were women. The underlying diseases included diabetic ME in 30 eyes (71.4%), central (5 [11.9%]) or branch (3 [7.1%]) retinal vein occlusion, and choroidal neovascularization in 4 eyes (9.5%). The right eye was affected in 22 (52.4%) participants. The mean (SD) number of IVB injections was 4.3 (1.3). After repeated injections, the mean central corneal thickness (CCT) increased, whereas the mean anterior chamber angle (ACA) and anterior chamber depth (ACD) decreased (all P&lt;0.001). Three patients developed LSC deficiency after repeated IVB injections for diabetic ME.&#x0D; Conclusions: We observed a significant increase in the mean CCT and a decrease in the mean ACA and ACD after repeated IVB injections in our series. Three patients developed LSC deficiency after repeated IVB injections for diabetic ME management. The observed effect on LSC may cast doubt on the safety of repeated IVB injections; however, this finding must be verified in multicenter clinical trials with longer follow-up periods and larger study samples.

Comparison of central corneal thickness and endothelial cell count among diabetic retinopathy and non-diabetic cases

: Diabetes is associated with alterations in the structure and functions of corneal endothelial cells. Current research has been carried out to compare the central corneal thickness and endothelial cell density in patients with diabetic retinopathy (DR) and non-diabetic (ND) individuals. : A Cross Sectional comparative research was carried out in a tertiary eye care hospital, over the period of two years from April 2021 to March 2023. Among 160 study participants, 80 cases with diabetic retinopathy (DR) and 80 non-diabetic (ND) cases as age matched control have been selected. Thorough Ophthalmic assessment was done. We have included only retinopathy cases as they have longer duration of diabetis and poorer metabolic control, for better comparison of the endothelium parameters with non-diabetics. Specular microscopy has been done in all cases for endothelial cell count evaluation and thickness of cornea has been estimated by Pachymeter. Statistical analysis was carried out by students‘t’ test by comparing the variables between two groups. : P-value was not significant for the mean age and sex distribution in the two groups. Mean endothelial cell density was lesser (2512.12±260.23cells/mm2) in DR than in ND group (2699.10±95.68cells/mm2). Mean central corneal thickness was greater (522.65±36.56μm) in DR than in ND group (486.50±18.67μm) (P&amp;#60;0.05). Also, the Co-efficient of variation percentage was more whereas the percentage of hexagonality was found to be statistically less in DR than ND group. Among DR patients, endothelial cell density was significantly reduced and central corneal thickness considerably raised when compared with ND. Our results also suggest that poor metabolic control and advanced Diabetic Retinopathy are risk factors for developing keratopathy.

A study to determine the effect of hydroxychloroquine (HCQ) on central corneal thickness (CCT) in patients with rheumatoid arthritis (RA).

Corneal thinning is common in rheumatoid arthritis (RA), thereby affecting the central corneal thickness (CCT). Effect of hydroxychloroquine (HCQ) in RA has abounding literature on retinal toxicity, but there is lack of data on its corneal effects. A cross-sectional study was carried out to compare CCT in RA patients before treatment initiation (Group 1) with CCT in those on HCQ for ≥3 months (Group 2). Fifty patients were enrolled in each group. The mean age was 44.36 years with similar age, gender distribution and visual acuity in both groups. The mean CCT of patients in the cohort was 521.80 µm ± 32.57 µm and 523.94 µm ± 33.40 µm in the right eye (RE) and left eye (LE), respectively. Mean CCT in Group 1 was (RE) 522.80 µm/(LE) 524.26 µm and in Group 2 was (RE) 520.80 µm/(LE) 523.62 µm, and there was no significant difference in CCT between both the groups. Median duration of HCQ usage in Group 2 was 24 months, with the median cumulative dosage being 171 g and a majority having a dosage of 200 mg/day. There was no significant correlation between the duration/cumulative dosage of HCQ intake and CCT. No corneal deposits were identified in any patient. CCT of RA patients was similar to those reported in the Indian literature. However, there was no significant change in CCT or corneal deposits identified with an HCQ dosage of 200-400 mg/day. Longer follow-up would provide clarity on the impact of duration and cumulative dosage of HCQ on corneal changes and CCT.