Mean Corneal Endothelial Cell Density Research Articles

Compared to Trabeculectomy, Ex-Press® Surgery Significantly Decreased the Loss of Corneal Endothelial Cell Density in Low-Intraocular-Pressure Glaucoma: 3-Year Follow-Up.

We compared the corneal endothelial cell loss between trabeculectomy (Trab) and Ex-Press® surgery (EXP) for low-intraocular pressure (IOP) glaucoma patients. This was a single-facility retrospective study. We analyzed the cases of patients with primary open-angle glaucoma (POAG) and pre-operative IOP ≤ 21 mmHg who had undergone Trab or EXP surgery and were followed for >3 years. Noncontact specular microscopy was used to determine the corneal endothelial cell density (CED) before and after Trab or EXP surgery. We measured the CED at 12, 24, and 36 months post-surgery. We compared the CED values and CED survival ratio after both surgeries using paired t-tests. We included 39 eyes that underwent Trab and 36 eyes that underwent EXP surgery. In the Trab group, the mean CED value had decreased from 2333 ± 399 at baseline to 2066 ± 587 cells/mm2 after 3 years. In the EXP group, the mean CED value had decreased from 2320 ± 393 at baseline to 2229 ± 460 cells/mm2 after 3 years. The survival ratio of CED at >3 years was 89.3 ± 14.2% (Trab group) and 95.6 ± 11.1% (EXP group); compared to the Trab surgery, the EXP surgery thus significantly decreased the CED loss (p = 0.037). No case resulted in bullous keratopathy. Compared to trabeculectomy, Ex-Press® surgery appears to be a safer surgical method with regard to the endothelial cell loss risk.

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

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

LONG-TERM OUTCOME OF TRANSSCLERAL FOUR-POINT FIXATION OF AKREOS INTRAOCULAR LENS WITH CLOSED CONTINUOUS-LOOP SUTURE.

To report the long-term clinical outcomes of transscleral four-point fixation of Akreos intraocular lens using a closed continuous-loop suture technique. This was a retrospective, multicenter, interventional case series. Primary outcome measures were best-corrected visual acuity, intraocular pressure, corneal endothelial cell density, and complications with a minimum of 1-year follow-up. One hundred and ninety-two eyes of 177 patients from two surgical hospital sites were identified. The mean best-corrected visual acuity improved from 0.88 ± 0.74 logarithm of the minimum angle of resolution (Snellen 20/152) preoperatively to 0.42 ± 0.52 logarithm of the minimum angle of resolution (Snellen 20/53) postoperatively ( P < 0.001). The mean preoperative intraocular pressure was 17.51 ± 8.67 mmHg, and the mean postoperative intraocular pressure at final follow-up was 15.08 ± 4.18 mmHg ( P = 0.001). The mean corneal endothelial cell density significantly reduced from 2,259 ± 729 cells/mm 2 to 2077 ± 659 cells/mm 2 , representing a cell loss of 5.73% ( P < 0.001). The intraocular lens was fixed well during follow-up. There were no intraoperative complications noted. Postoperative complications included transient ocular hypertension in 15 eyes (7.81%), hypotony in two eyes (1.04%), retinal detachment in one eye (0.52%), and macular edema in one eye (0.52%). The transscleral four-point fixation Akreos intraocular lens using the closed continuous-loop suture technique was effective and safe with satisfactory visual acuity with a minimum of 1-year follow-up.

Local application of silver nitrate as an adjuvant treatment before deep lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment.

The purpose of this study is to evaluate the efficacy and safety of the local application of silver nitrate (LASN) as an adjuvant treatment before deep lamellar keratoplasty (DLKP) for fungal keratitis responding poorly to medical treatment. A total of 12 patients (12 eyes) with fungal keratitis responding poorly to medical treatment (for at least 2 weeks) were included. LASN was performed using 2% silver nitrate, the ulcer was cleaned and debrided, and then, the silver nitrate cotton stick was applied to the surface of the ulcer for a few seconds. The effect of LASN was recorded. The number of hyphae before and after treatment was determined by confocal microscope. After the condition of the ulcer improved, DLKP was performed. Fungal recurrence, best-corrected visual acuity (BCVA), loose sutures, and endothelial cell density (ECD) were recorded in detail. Clinical resolution of corneal infiltration and edema was observed, and the ulcer boundary became clear in all 12 patients after 7-9 days of LASN. Confocal microscopy showed that the number of hyphae was significantly reduced. Ocular pain peaked on days 1 and 2 after treatment, and 9 patients (75%, day 1) and 1 patient (8.3%, day 2) required oral pain medication. During the follow-up period after DLKP, no fungal recurrence and loose sutures were observed. After the operation, the BCVA of all patients improved. The mean corneal ECD was 2,166.83 ± 119.75 cells/mm2. The LASN was safe and effective and can be well tolerated by patients. Eye pain can be relieved quickly. LASN as an adjuvant treatment before DLKP might be a promising therapeutic strategy.

Risk factors for corneal endothelial cell loss after phacoemulsification.

The purpose of this study was to evaluate the changes in corneal endothelial cell density (CECD) occurring after cataract phacoemulsification surgery and identify factors associated with cell loss. This was a retrospective study involving patients who underwent cataract phacoemulsification surgery between January 1, 2018, and December 31, 2018, at two private hospitals. Demographic data and biometric parameters were obtained preoperatively. Ultrasound metrics were recorded for each operation, including total on time (TOT), total equivalent power in position 3, and cumulative dissipated energy (CDE). Using corneal specular microscopy, CECD was measured preoperatively and postoperatively at 12, 24, and 36 months. Factors associated with decreased CECD were identified. This study included 223 eyes of 133 patients. The mean CECD was 2530.03 ± 285.42 cells/mm2 preoperatively and significantly decreased to 2364.22 ± 386.98 cells/mm2 at 12 months (P < 0.001), 2292.32 ± 319.72 cells/mm2 at 24 months (P < 0.001), and 2242.85 ± 363.65 cells/mm2 at 36 months (P < 0.001). The amount of cell loss was associated with age, gender, preoperative CECD, preoperative anterior chamber depth, lens thickness, TOT, and CDE. Using multivariate analysis, age, preoperative CECD, and TOT were identified as independent predictors for CECD loss 12 months after surgery. The greatest decrease in CECD occurred during the first year after cataract surgery, and the amount of cell loss was influenced by both baseline patient characteristics and ultrasound metrics. Longer-term prospective studies in a larger cohort may yield more information.

Comparison of patient experiences and clinical outcomes between an illuminated chopper and a conventional chopper under a surgical microscope.

To compare patient experiences and cooperation and the clinical outcomes illuminated chopper vs conventional chopper during cataract surgery. 4 tertiary institutions in Korea. Prospective, randomized, paired-eye, controlled pilot study. 152 eyes of 76 patients who underwent bilateral cataract surgeries were enrolled in this study. The surgical method was randomly assigned to each patient's eye (1 eye using the illuminated chopper with a light source and the other using the conventional chopper under the microscope light). Patient suffering scores (the degree of strong light perception, glare, inability to fixate, anxiety, discomfort, and fear) from 0 to 10 (10 being the most severe level); cooperation score from 0 to 3 (3 being the best cooperation); operating time; and corneal endothelial cell density (ECD) preoperatively and postoperatively were compared between the 2 groups. The mean patient suffering score of all 6 parameters in the iChopper group was significantly smaller than those in the control group (all P < .05). The mean patient cooperation score of the iChopper group (2.3 ± 0.8) was significantly greater than that of the control (1.6 ± 0.9; P < .001). There was no significant difference in the mean operating time and corneal ECD at each visit between the groups, albeit the mean corneal ECD was significantly decreased from baseline to 1 month after cataract surgery in both groups. Phacoemulsification using the illuminated chopper provides less glare and anxiety and better cooperation during cataract surgery without increasing the operating time and damaging corneal endothelium compared with the conventional chopper.

Changes in corneal endothelial cell density after trabeculectomy.

Glaucoma is a leading cause of blindness worldwide for which trabeculectomy is the most effective surgical intervention for advanced disease. However, trabeculectomy has been associated with alterations to corneal endothelium, including a decrease in corneal endothelial cell density (CECD). The purpose of this study was to investigate changes in CECD after trabeculectomy, and identify factors contributing to cell loss, such as pre-operative biometry and lens status. This retrospective study included 72 eyes of 60 patients who underwent trabeculectomy between January 2018 and June 2021 at two private hospitals. Demographic and clinical data were obtained at baseline. Corneal specular microscopy was performed pre-operatively and at 6 months after surgery. CECD was evaluated and compared between groups to quantify changes to corneal endothelium and identify significant factors affecting decreases in cell density. Mean CECD was 2284.66 ± 375.59 pre-operatively and 2129.52 ± 401.96 after 6 months (p < 0.001). A greater decrease in CECD (p = 0.005) was observed in phakic eyes (235.45 ± 118.32) compared to pseudophakic eyes (137.82 ± 107.30). The amount of cell loss was negatively correlated with pre-operative central corneal thickness (p = 0.009) and anterior chamber (AC) depth (p = 0.033). There were no significant correlations between changes to CECD and patient age, gender, number of pre-operative glaucoma medications and number of post-operative antifibrotic agents. Significant decreases in CECD occurred after trabeculectomy. Less corneal endothelial cell loss occurred in pseudophakic eyes. Hence, if patients need trabeculectomy and cataract surgery, it may be better to perform cataract surgery first. Longer term studies should derive more information.

Corneal Endothelial Cell Loss after Ciliary Sulcus Placement of Ahmed Glaucoma Valve in Patients with Noninfectious Uveitic Glaucoma.

This study was performed to investigate the corneal endothelial cell density (CECD) reduction and treatment efficacy in patients with uveitic glaucoma treated by the ciliary sulcus placement of the Ahmed glaucoma valve (AGV). This retrospective study included 27 eyes of 27 patients with noninfectious uveitis who underwent the sulcus placement of the AGV. Each patient underwent a clinical assessment including a CECD measurement before surgery and at 3, 6, 9, and 12 months after surgery. The mean CECD was 2431.4 ± 367.5 cells/mm2 at preoperative baseline and 2360.5 ± 391.3 cells/mm2 at 12 months (p = 0.074), with a reduction rate of 2.73 ± 9.29%. The CECD reduction was significantly greater in patients with unilateral uveitis than that with bilateral uveitis. The rate of successful intraocular pressure control was 88% at 12 months, and the number of intraocular pressure-lowering medications was significantly reduced (p < 0.001). The current study showed that the implantation of an Ahmed tube into the ciliary sulcus provided stable intraocular pressure control in patients with glaucoma secondary to noninfectious uveitis, and CECD reduction was moderate in most patients at 12 months.

Fuchs heterokromik iridosiklit hastalarında kornea biyomekaniği ve kornea değerlendirilmesi

Amaç: Bu çalışmanın amacı Fuchs heterokromik iridosiklit (FHİ) tanılı gözler ile sağlıklı diğer gözlerin kornealarının ve kornea biyomekanik özelliklerinin karşılaştırılmasıdır. Gereç ve Yöntem: Fuchs heterokromik iridosiklit tanılı 14 göz (Grup 1) ve sağlıklı diğer gözler (Grup 2) çalışmaya dâhil edildi. Tüm hastalara detaylı bir oftalmolojik bakıyı takiben Ocular Response Analyzer korneal biyomekanik özellikler ve speküler mikroskobi ile santral korneal kalınlık (SKK), korneal endotelyal hücre dansitesi (KEHD) değerlendirildi. Bulgular: En iyi düzeltilmiş görme keskinliği ve intraoküler basınç istatistiksel olarak benzerdi (p değerleri sırasıyla 0,077 ve 0,557). Korneal biyomekanik parametreleri olan korneal histerezis, korneal resiztans faktör, IOPcc ve IOPg değerleri her iki grupta istatistiksel olarak benzerdi (p değerleri sırasıyla; 0,521, 0,817, 0,980 ve 0,980 idi). Ortalama santral korneal kalınlık Grup 1’de 555,57±42,95 (467-626) mikron ve Grup 2’de 556,5±37,04 (480-623) mikron olarak saptandı (p=0,959). Ortalama korneal endotel hücre dansitesi Grup 1’de 2313±420,22 (1271-2717) ve Grup 2’de 2404,42±326,75 (1566-2834) hücre/mm2 saptandı (p=0,626). Sonuç: Sağlıklı gözler ile Fuchs Heterokromik İridosiklit tanılı gözler karşılaştırıldığında kornea biyomekanik parametreleri ve korneal endotel hücre dansitesi arasında anlamlı fark saptanmamıştır. Bu sonuçlar literatürdeki birçok çalışma ile çelişmekte olup daha geniş vaka serileri ile yeni çalışmalara ihtiyaç vardır.

A cross sectional study on evaluating the corneal endothelial cell density and central corneal thickness in eyes with primary glaucoma.

This study aims at evaluating glaucoma-induced damage to the corneal endothelium and the effect of central corneal thickness (CCT) on the intra-ocular pressure (IOP) measurement in patients newly diagnosed with primary glaucoma. It is a hospital-based cross-sectional study involving 60 newly diagnosed primary glaucoma patients >18 years. They underwent fundus examination, four-mirror gonioscopy, and perimetry for confirming the diagnosis. Evaluation and analysis of corneal endothelial cell density and CCT were performed. Chi square test was performed to find out the association between glaucoma, corneal endothelial cell density, and CCT. Evaluation of 60 patients revealed that by age distribution, the corneal endothelial cell density was lower in the 51-65 year age group and an age-related decrease in corneal endothelial cell density and CCT was found in newly diagnosed primary glaucoma patients. The mean CCT was 525 micrometers in patients with IOP between 20 to 40 mm Hg and 528 micrometers in patients with IOP between 41 to 60 mm Hg. The mean corneal endothelial cell density was 2361 cells/mm2 in primary open-angle glaucoma (POAG) and 2284 cells/mm2 in primary angle-closure glaucoma (PACG). The mean CCT was 525 micrometers in POAG and 528 micrometers in PACG. The corneal endothelial cell density was lower in patients with PACG when compared with POAG, and the average CCT showed no significant difference in POAG and PACG patients. However, CCT was increased in patients with a higher intra-ocular pressure. The corneal endothelial cell density was lower in patients with a high intra-ocular pressure.

Clinical Outcomes after Phacoemulsification in Brunescent Cataract

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

Myopia, corneal endothelial cell density and morphology in a Japanese population-based cross-sectional study: the JPHC-NEXT Eye Study

This population-based cross-sectional study was performed to determine the mean corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX), and their associations with myopia in Japanese adults living in Chikusei city. Of 7109 participants with available data, 5713 (2331 male and 3382 female) participants were eligible for analysis. After assessing the relationship between participant characteristics and spherical equivalent refraction (SER), the association of SER with the abnormal value of ECD (< 2000 cells/mm), CV (≥ 0.40), and HEX (≤ 50%) were determined using the logistic regression models adjusting for potential confounders (age, intraocular pressure, keratometric power, height, and antihypertensive drug use). In male participants, there was no statistically significant relationships between SER and endothelial parameters. In female participants, compared to emmetropia, SER ≤ − 6 D had significantly higher odds ratio (OR) of having the abnormal value of CV (OR = 2.07, 95% confidence interval [CI] 1.39–3.10) and HEX (OR = 2.04, 95% CI 1.29–3.23), adjusted for potential confounders, indicating that the high myopia was associated with the abnormal values of CV and HEX. Further adjustment for contact lenses wear partly attenuated these associations. Association between the SER and ECD was not detected.

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

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

Long-term Outcomes and Complications of the New Carlevale Sutureless Scleral Fixation Posterior Chamber IOL.

To evaluate the visual outcomes and possible complications of a new foldable sutureless scleral fixation intraocular lens (SSF-IOL), the Carlevale IOL (Soleko). The SSF-IOL, which has two T-shaped self-blocking plugs on each haptic, was inserted into the posterior chamber. Both haptics was grabbed through two sclerotomies and the two short arms were blocked under the scleral flap, without any suture. A complete clinical evaluation was done preoperatively and at 3, 6, and 12 months postoperatively. A total of 54 eyes of 50 consecutive patients were retrospectively analyzed. The mean corrected distance visual acuity was 0.93 ± 0.61 logMAR preoperatively and improved to 0.42 ± 0.34 logMAR at 3 months, 0.42 ± 0.37 logMAR at 6 months, and 0.38 ± 0.38 logMAR at 12 months postoperatively (all P < .0001). The mean corneal endothelial cell density decreased from 1,725.37 ± 528.06 to 1,612.81 ± 522.91 cells/mm2 at 12 months postoperatively (P < .0001). The mean IOL tilt value was 3.1 ± 1.1° at 12 months postoperatively. The authors observed 6 cases (11.1%) of intraoperative rupture of the IOL haptics, 4 cases (7.4%) of early hyphema, 4 cases (7.4%) of macular cystoid edema, 2 cases (3.7%) of haptic exposure under the conjunctiva, and 1 (1.8%) late retinal detachment. This newly introduced surgical technique provided promising results regarding efficacy and safety. Complications occurred in a few cases and were successfully managed. The Carlevale IOL seems to be a surgical solution combining the advantages of an easy and minimally invasive implantation with a good functional recovery with minimal complications. [J Refract Surg. 2021;37(2):126-132.].

27-gauge trocar-assisted sutureless intraocular lens fixation

BackgroundsHowever there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar.MethodsNineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o’clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications.ResultsThe 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm2 at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was − 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.ConclusionsIOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.

Corneal endothelial cell characteristics and central corneal thickness in patients with type 2 diabetes mellitus

Purpose: To evaluate the morphological features of corneal endothelium and central corneal thickness (CCT) in patients with type 2 diabetes mellitus (DM) and to correlate them with the duration of diabetes and patients glycemic status. Design: This was a prospective, cross-sectional, comparative, hospital-based study. Materials and Methods: The present study was conducted on 192 diabetics and 192 age- and sex-matched healthy controls. Corneal endothelial cell characteristics, CCT were measured using a specular microscope. Statistical comparisons were done between the case and controls using the appropriate parametric or nonparametric test. The associations between the various parameters were studied using the Pearson coefficient of correlation. Results: The mean corneal endothelial cell density (CECD) in the diabetic group (2521.3 ± 300.7 cells/mm2) was significantly lower compared to the nondiabetic group (2629.3 ± 221 cells/mm2) ( P 10 years when compared with those with a duration of <10 years was observed. Conclusion: Diabetic patients in our study had thicker corneas, decreased CECD, and hexagonality, more irregular cell size than that of age matched controls. However, duration of the disease and the glycemic control did not affect these parameters.

An Observational Study of Corneal Endothelial Alterations in Eyes with Unilateral Pseudoexfoliation

Introduction: Pseudoexfoliation (PXF) is an age-related generalised disorder of extracellular matrix primarily affecting eyes. It is characterised by deposition of pseudoexfoliative material in the anterior segment of eye. Also it is a bilateral condition but can have asymmetric presentation and can be clinically seen only in one eye. Alteration in endothelial cell morphology along with other alteration in anterior segment of the eye can compromise the surgical outcome. Aim: To evaluate the corneal endothelial cell density and morphology in patients with unilateral PXF. Materials and Methods: The present study was hospital-based cross-sectional observational study which included 55 patients with unilateral PXF, who came to the Department of Opthalmology, Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India between June 2020 to November 2020. Specular microscopy was performed on all eyes to evaluate cell density and morphology, coefficient of variation in cell size and percentage of hexagonal cells in corneal endothelium and compared with fellow normal eye. Statistical analysis was done by using descriptive and inferential statistics using students unpaired t-test, p-value &lt;0.05 was considered as level of significance. Results: The present study included 55 patients, of which 26 were males and 29 were females. Mean age of the patients was 63.85±7.05 years. Majority of patients were in the range of 61 to 70 years (56.36%). The mean corneal endothelial cell density in the PXF eye was 2299.54±84.95 cells/mm2, which was significantly lower as compared to fellow normal eye with p-value &lt;0.001. Mean coefficient of variation of cell size in PXF eye was 35.49±4.62, p-value=0.064 and hexagonality was 51.12±4.91, p-value=0.13. Both the parameters were statistically non significant on comparison of two eyes. Central corneal thickness was thicker in pseudoexfoliative eye of 551.29±33.11 microns (μm), than fellow eye but was statistically non significant. Conclusion: Eyes with PXF had alteration in endothelial cell morphology with decrease in cell density as compared to eyes without PXF clinically.

The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus.

To evaluate the effect of long-term effects of hydroxychloroquine (HCQ) use on the corneal endothelium in patients with systemic lupus erythematosus (SLE). The study included 30 eyes of 15 patients who used HCQ for at least five years and were followed up in the rheumatology clinic for SLE and 29 eyes of 15 patients newly diagnosed with SLE who had not taken any medication. All patients underwent complete ophthalmologic examinations, central corneal thickness measurements, endothelial cell counts and endothelial morphological examinations by specular microscopy. The mean age was 41.25 ± 6.89years in group 1 and 41.81 ± 5.78years in group 2 (p = 0.737). The mean corneal endothelial cell density was 2662 ± 184cells/mm2 in group 1 and 2649 ± 315cells/mm2 in group 2 (p = 0.843). The percentage of cell hexagonality was 46.6 ± 11.8% in group 1 and 48.7 ± 13.8% in group 2 (p = 0.625). A difference was noted in endothelial cell variation in both groups, at 36.7 ± 6.9% in group 1 and 39.9 ± 6.2% in group 2 (p = 0.057) but not statistically significant. No difference was observed between the two groups in terms of central corneal thickness. The duration of HCQ use was negatively correlated with hexagonality (r = -0.564, p = 0.001) CONCLUSION: Long-term use of HCQ in SLE patients had no negative effect on endothelial cell density and cell variation, but a negative correlation existed between the duration of HCQ usage and hexagonality.

Clinical Outcomes of Endoscope-Assisted 30-Gauge Single-Needle Technique for Intrascleral Intraocular Lens Fixation

Introduction: We have developed an endoscope-assisted single-needle technique, which is an improvement of Yamane’s double-needle technique of the intrascleral intraocular lens (IOL) fixation techniques. In this surgical procedure, the IOL is manipulated in the vitreous cavity, and the IOL haptic is externalized from the eye one by one with the aid of an ophthalmic endoscope. The purpose of this study was to report the postoperative visual function and safety of this new technique. Methods: Overall, 19 consecutive eyes (16 patients; mean age, 75.1 ± 9.6 years; mean follow-up period, 5.7 months) that underwent intrascleral IOL fixation surgery with our new technique were included in the study. Manifest refraction, uncorrected/corrected visual acuity, and corneal endothelial cell density were measured before and after surgery. Tilt and decentration of IOL were analyzed using anterior segment optical coherence tomography. Results: The mean absolute prediction error (spherical equivalent) was 0.82 ± 0.52. The mean postoperative best-corrected visual acuity had significantly improved at the final visits (p = 0.02). No significant differences in the mean corneal endothelial cell density were observed between the first (2,232 ± 751 cells/mm²) and final (2,099 ± 649 cells/mm²) visits (p = 0.35). The mean IOL tilt was 8.1 ± 3.2°. There were no vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, during or after surgery. Conclusions: The endoscope-assisted single-needle technique is a safe and effective method of intrascleral IOL fixation surgery.

Twelve-month efficacy and safety of glaucoma filtration device for surgery in patients with normal-tension glaucoma

To assess the efficacy and safety of filtration surgery using the EX-PRESS glaucoma filtration device in patients with normal-tension glaucoma (NTG). Prospective, single-arm, multicenter interventional case series. Eyes with NTG underwent EX-PRESS implantation with or without cataract surgery. The efficacy and safety were assessed at 1day; 1 and 2weeks; and 1, 3, 6, and 12months after surgery. The main outcome measure was reduction in intraocular pressure (IOP) from baseline at 3, 6, and 12months after surgery. Safety assessments included adverse event incidence, postoperative inflammation, and corneal endothelial cell density. Thirty-two Japanese patients (37 eyes) with NTG were enrolled. The mean IOP decreased from 14.8 ± 2.3mmHg at baseline to 10.0 ± 3.1mmHg at 12months after surgery (mean reduction 4.9 ± 4.2mmHg [31.1%]; P < .0001). IOP-lowering medication use decreased from a mean of 3.3 medications per eye before surgery to 0.1 medications per eye at 12months after surgery. IOP reductions > 20% were achieved by 61.5% of the eyes at 12months. Adverse events were typical for filtration procedures, and none was deemed device-related. Postoperative inflammation was mild and self-limiting. The mean corneal endothelial cell density had decreased by 3.3% at 12months after surgery. The EX-PRESS glaucoma filtration device is safe and effective for filtration surgery in patients with NTG, providing mean IOP reduction consistent with recommendations based on the Collaborative NTG Study.