Mean Preoperative Endothelial Cell Count Research Articles

Impact of the ratio between graft and host corneal size on immune rejection, re-bubbling rate and postoperative endothelial cell loss in 457 eyes after Descemet membrane endothelial keratoplasty (DMEK)

The aim of this study was to assess the impact of the ratio between the graft and host corneal size (RGH) on postoperative complications, such as immune reactions, re-bubbling rate and endothelial cell loss (ECL) after Descemet membrane endothelial keratoplasty (DMEK). Retrospectively, 457 patient eyes were included which had undergone surgery between 2016 and 2019 in the Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar using DMEK or triple DMEK, diagnosed as Fuchs' endothelial dystrophy (n = 431), pseudophakic bullous keratopathy (n = 9) and others (n = 17). The follow-up period extended until the end of 2020.Main outcome measures included immune reaction (IR), re-bubbling rate and the postoperative endothelial cell loss (ECL) at 6weeks, 6months and 12months and whether these measures depended on the RGH. The RGH in this study ranged from 0.35 to 0.62 (0.46 ± 0.04). There were 33(7.2%) postoperative IRs (DMEK n = 25; triple DMEK n = 8). The average RGH without IR (0.46 ± 0.04) was significantly (p = 0.038) smaller than in the group with IR (0.47 ± 0.05). Re-bubbling was necessary in 159 of 457 (34.8%) patient eyes. The RGH in patient eyes with re-bubbling (0.47 ± 0.04) was significantly (p = 0.014) higher than that in eyes without re-bubbling (0.45 ± 0.04). The mean preoperative endothelial cell count (ECD) was 2603 ± 251 cells/mm2 (min: 2161, max: 3500 cells/mm2). It was shown that alarger RGH had no positive influence on endothelial cell loss (r = 0.001; p = 0.974). Our results suggest that alarger graft diameter compared to host corneal size is associated with an increased rate of immune reactions and ahigher re-bubbling rate after DMEK. Otherwise, alarger RGH had no positive influence on endothelial cell loss after DMEK. Accordingly, the graft size for DMEK should not be unnecessarily large, especially in eyes with Fuchs' endothelial dystrophy.

Anterior Chamber Iris-Fixated Phakic Intraocular Lens Implantation for Treatment of High Anisometropia in Children: Long-term Results.

To evaluate the long-term efficacy of anterior chamber iris-fixated phakic intraocular lens (PIOL) implantation in the treatment of high myopic (> -9.00 diopters [D]) or hyperopic (> +6.00 D) anisometropia in children with intolerance to spectacles or contact lenses. A total of 58 children with anisometropic myopia (range: -9.25 to -18.50 diopters [D]) and 13 children with anisometropic hyperopia (range: +6.00 to +8.50 D) underwent unilateral iris-claw PIOL implantation from 2008 to 2018. The mean age was 6.7 years. The mean follow-up was 38.5 months. Target refraction was emmetropia. The cycloplegic refraction (mean spherical equivalent) improved from -12.47 D (range: -9.25 to -18.50 D) to -0.73 D (range: +0.75 to -1.50 D) in myopic eyes and reduced from +7.15 D (range: +6.00 to +8.50 D) to +0.94 D (range: -0.50 to + 1.75 D) in hyperopic eyes. Eighty-four percent of eyes were corrected to within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity (UDVA) improved from 1.74 ± 0.36 to 0.45 ± 0.28 logarithm of the minimum angle of resolution (logMAR) (P = .0014). The mean corrected distance visual acuity (CDVA) changed from 0.68 ± 0.32 to 0.27 ± 0.15 logMAR (P = .02179). The safety index was 2.18 and the efficacy index was 1.51. The mean preoperative endothelial cell count of 2,874.7 cells/mm2 changed to 2,685.3 cells/mm2 at 2 to 6 years postoperatively. Binocular vision quality was improved in 55 patients. No patient had serious complications or lost any Snellen lines of CDVA. Iris-fixated PIOL implantation is an effective and safe method in the treatment of high anisome-tropic myopia and hyperopia and amblyopia in pediatric patients who are noncompliant with spectacles or contact lenses. [J Pediatr Ophthalmol Strabismus. 2023;60(3):203-209.].

A prospective study of endothelial cell count in diabetic and non-diabetic patients after cataract surgery

Introduction: To assess and compare the changes in endothelial cell count in diabetic and non-diabetic patients after routine phacoemulsi?cation and small incision cataract surgery. Materials and Methods: Total 130 eyes of 130 patients was taken in the study were age and sex matched. Out of which 65 eyes of 65 patients of Type 2 diabetes mellitus and 65 eyes of 65 non-diabetic patients of cataract underwent cataract surgery. Out of which 65 patient for phacoemulsification surgery and 65 patients for small incision cataract surgery were evaluated. In all the patients specular microscopy for the corneal endothelial cell count and central corneal thickness was done pre-operatively. And post operatively at one week, six weeks and 12 weeks was done. The variation in the endothelial size and shape and percentage of hexagonal cells were assessed. A Comparative analysis of endotheial cell count and percentage of endothelial cell loss between two groups was performed. Also there was comparison of endothelial cell loss between phacoemulcification and small incision cataract surgery was done. Results: The mean pre-operative endothelial cell count in the Non-diabetic group was higher than the diabetic group (p Conclusions: In diabetic patients there was higher endothelial cell loss when compared with nondiabetic patients after cataract surgery. The changes were seen even in the presence of good glycemic control. Keywords: Cataract surgery, Diabetes mellitus, Endothelial cell loss.

Corneal Endothelial Change after Phacoemulsification

Background: Phacoemulsification is the modern method of sight restoring surgery for cataract and it is becoming popular day by day. We planned this study to find out any significant cell loss during this procedure leading to corneal endothelial decompression.Objective: To compare the preoperative and postoperative cell counts after phacoemulsification surgery.Materials and Methods: This prospective study was carried out at the National Institute of Ophthalmology and Hospital, Dhaka from July to September, 2008 to see the corneal endothelial change after phacoemulsification. A total of 60 cases with lental opacity, who underwent phacoemulsification surgery, were studied with specular microscope. The endothelial cell count was measured with specular microscope before and after cataract surgery. Postoperative cases were followed up to one and half months after surgery. A single group of patients were studied and their preoperative and postoperative values were compared. The inclusion and exclusion criteria were maintained properly.Results: The mean preoperative endothelial cell count was 2745.35 ± 395.27 (SD) per mm2 which gradually decreased to 2545.23 ± 348.83 (SD) per mm2 at the end of one and half months after surgery; mean cell loss was 200.12 ± 46.44 (7.29%).Conclusion: This study reveals that a moderate loss of endothelial cell after phacoemulsification does not hamper the corneal transparency and visual function as depicted from visual acuity records in follow-up periods, provided the endothelium is healthy and the number is above the threshold limit.J Enam Med Col 2016; 6(3): 134-139

Resultados funcionales de la procuración corneal con fines de trasplante realizado por un licenciado en Optometría

IntroductionIn Mexico, availability of donated corneas is very low. In recent years there has been a decrease in corneal tissue importation creating a need in tissue harvesting among public hospitals. Due to a shortage of available ophthalmologists, trained optometrist could cover adequately this rising need. AimsTo analyze quality of corneal tissue harvested by a trained optometrist and to identify long term functional results in visual acuity and graft rejection rate in patients receiving those corneal tissues. MethodsPatients who received corneal tissues harvested by a single optometrist from January 2011 to November 2012 were included. Endothelial density was measured with specular microscopy. Initial and final visual acuity was measured using Snellen chart. Graft rejection presence was identified in all transplanted patients. Descriptive statistics was performed with Stata 10.0 Results25 corneas were harvested. 4 non-viable corneal tissues were discarded. 21 patients underwent corneal transplantation Mean preoperative endothelial cell count was 2834.76 cel/mm2 (SD±186.91). Three patients (3 tissues) (14.28%) had graft rejection. Mean preoperative visual acuity was 1.24 LogMar (SD±0.2923). All patients had visual acuity improvement in their last eye examination (p<.001) with a mean visual acuity of 0.52 LogMar (SD±0.3792). Mean follow-up was 34.85 months (SD±3.6). ConclusionsAll patients in this study had improvement in their final visual acuity. Corneal graft rejection rate was similar to frequency reported elsewhere. Trained optometrist could be ideal health professional to harvest donor corneas.

Deep anterior lamellar keratoplasty with dehydrated, 4 °C-stored, and rehydrated lenticules

To retrospectively evaluate the outcomes of 124 consecutive deep anterior lamellar keratoplasties (DALK) performed by using dehydrated, 4 °C stored, and rehydrated lenticules. A total of 124 eyes of 109 patients, which had undergone DALK from August 11, 2000, to December 13, 2007, were included in our retrospective study; 88 cases were male and 36 female, with a mean age of 39.45±15.52 years (range 6-85). A total of 109 (87.9%) had keratoconus, 7 (5.6%) had deep or superficial corneal scar, 3 (2.4%) had epikeratophakia, 3 (2.4%) had pellucid degeneration, 1 (0.8%) a malignant pterygium, and 1 (0.8%) had a severe alkali burn. All the patients underwent ophthalmic examinations, including best-corrected visual acuity (BCVA), central ultrasound pachymetry, computerized topography, specular microscope endothelial cell count, and confocal microscopy. The mean follow-up was 23.9±3.4 months. The mean preoperative BCVA was 0.16±0.18; the postoperative BCVA was 0.68±0.20 after 2 years. The mean preoperative central corneal thickness (CCT) was 439.4±10.5 µm; after 2 years, it was 532.1±9.7 µm. The mean preoperative endothelial cell count (ECC) was 2301.3±180.2 cells/mm2; after 2 years it was 1986.0±169.5 with a decrease of 13.7%. Baring of Descemet membrane (DM) during DALK was achieved in 112 (90.32%) eyes; 4 eyes (3.26%) had a large perforation of the DM with consequent PK. Small intraoperative perforation of DM during DALK occurred in 18 cases (14.52%). The results showed that the method of preservation and distribution of dehydrated, 4 °C stored, and rehydrated lenticules is safe, cheap, and simple. Furthermore, it does not appear to influence the outcomes of the DALK surgery.

Segurança da ceratectomia fotorrefrativa com mitomicina-C para o tratamento de hipermetropia após ceratotomia radial

To evaluate the safety of photorefractive keratectomy (PRK) with mitomycin-C (MMC) in eyes with hyperopia after radial keratotomy. Sixty eyes of 36 consecutive patients treated with corneal wavefront-guided PRK using an Esiris-Schwind excimer laser were prospectively evaluated. Corneal epithelium was mechanically removed, followed by photoablation and use of 0.02% MMC for 20 or 40 seconds. In 16 eyes (26.7%), MMC was applied for 40 seconds. These eyes underwent ablations deeper than 100 micron or had previous corneal sutures. Patients were followed up for 12 months. The mean spherical equivalent (SE) before PRK was +4.27 D +/- 2.18, and the mean best corrected visual acuity (BCVA) was 0.174 +/- 0.139 (logMAR). The planned laser SE correction was +4.74 D +/- 2.11, resulting in an ablation depth of 78 +/- 28 microm (from 33 to 148). No intraoperative complications were observed. At one year, mean SE was +0.04 D +/- 1.03 (p<0.001) and mean BCVA was 0.079 +/- 0.105 (p<0.001). There was a gain of 2 or more lines of BCVA in 20 eyes (33.3%) and only one eye (1.7%) lost 2 lines. Correlation analysis showed that the improvement in BCVA was inversely related to preoperative BCVA (r=-0.694; p<0.001). Five eyes developed peripheral haze grade 2 or 3 and one eye had central trace haze. No significant correlation was found between central or peripheral haze and the number of radial incisions, depth of the ablation or postoperative BCVA. Mean preoperative endothelial cell count was 2,681 +/- 455 cel/ mm(2) and after one year was 2,481 +/- 378 cel/mm(2) (p=0.124). One eye developed keratectasia due to the progressive widening of an inferior radial incision, which was later sutured. PRK with MMC was safe after one year of follow-up for the reduction of hyperopia after radial keratotomy. A major improvement in BCVA was obtained with a small incidence of haze and other complications.

Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery: Six-week results of a randomized control trial

To compare endothelial cell loss in cataract surgery by phacoemulsification and by manual small-incision cataract surgery (SICS). Tertiary care ophthalmic center, India. A complete ophthalmologic examination and endothelial specular microscopy were performed preoperatively and 1 and 6 weeks postoperatively in patients having cataract surgery. The endothelial cell count (ECC) was calculated manually and automatically using an LSM 12000 specular microscope. Patients were randomly allocated to have SICS or phacoemulsification using a random number table. Phacoemulsification was performed using the stop-and-chop technique and SICS, by viscoexpression. The study evaluated 200 patients, 100 in each group. The mean preoperative ECC by the manual counting method was 2950.7 cells/mm(2) in the phacoemulsification group and 2852.5 cells/mm(2) in the SICS group and by the automated counting method, 3053.7 cells/mm(2) and 2975.3 cells/mm(2), respectively. The difference at 6 weeks was 543.4 cells/mm(2) and 505.9 cells/mm(2), respectively, by the manual method (P = .44) and 474.2 cells/mm(2) and 456.1 cells/mm(2), respectively, by the automated method (P = .98). The corrected distance visual acuity at 6 weeks was better than 6/18 in 98.5% of eyes in the phacoemulsification group and 97.3% of eyes in the SICS group. There were no clinically or statistically significant differences in ECC loss or visual acuity between phacoemulsification and SICS, although there was a small difference in the astigmatic shift.

Endothelial Cell Loss During Pterygium Surgery: Importance of Timing of Mitomycin C Application

To determine if the timing of mitomycin C (MMC) application during pterygium surgery affects endothelial cell loss. A retrospective, nonrandomized, case-series design was used. The study group included 40 patients who underwent pterygium surgery with the bare sclera technique. MMC 0.02% was applied intraoperatively for 5 minutes, either before (16 patients) or after (24 patients) excision of the head of the pterygium. Endothelial images were acquired at the center of the cornea with a specular microscope before surgery and at 3 intervals during follow-up (average of 3 measurements each). Differences in cell loss from baseline were analyzed by paired t test. In the group in which MMC was applied post excision, mean preoperative endothelial cell count was 2254 +/- 128 cells per square millimeter. Mean postoperative values were 1775 +/- 63 cells per square millimeter at 1 week (percentage cell loss, 21.25% +/- 2.8%), 1707 +/- 41 cells per square millimeter at 1 month (24.26% +/- 1.8%), and 1780 +/- 72 cells per square millimeter at 3 months (21.05% +/- 3.2%). The difference in cell count from the preoperative value was significant at all time points (P < 0.02). In the group in which MMC was applied before excision, mean preoperative endothelial cell count was 2352 +/- 118 cells per square millimeter, and mean postoperative values were 2345 +/- 120 cell per square millimeter at 1 week, 2260 +/- 162 cells per square millimeter at 1 month, and 2230 +/- 144 cells per square millimeter at 3 months. No endothelial cell loss was documented in this group. The endothelial cell loss associated with the use of MMC during pterygium surgery might be avoided by applying MMC before excision of the pterygium head, so that it does not come into contact with the corneal surface.

Endothelial Cell Loss After Toric Iris-fixated Phakic Intraocular Lens Implantation: Three-year Follow-up

To study quantitative changes in endothelial cell count after implantation of the toric iris-fixated phakic intraocular lens. A prospective, non-randomized, self-controlled clinical trial was conducted of 40 eyes (28 myopic, 12 hyperopic) of 23 patients with high ametropia and astigmatism. Non-contact computer-assisted endothelial microscopy was performed before and 1, 2, and 3 years after surgery. In the myopic group, mean preoperative endothelial cell count was 3179 +/- 531 cells/mm2 (range: 1800 to 3900 cells/mm2). The mean intra-individual endothelial cell loss was -1.83 +/- 2.25% (range: -9.09% to 0%) in the first year; -1.83 +/- 2.95% (range: -7.74% to 3.80%) in the second year; and -3.20 +/- 4.43% (range: -14.25% to 1.91%) three years after surgery, compared to preoperative values. In the hyperopic group, mean preoperative endothelial cell count was 3107 +/- 125 cells/mm2 (range: 2932 to 3300 cells/mm2). The mean endothelial cell loss was -1.63 +/- 1.76% (range: -3.23% to 1.67%) in the first year; -0.05 +/- 1.25% (range: -1.65% to 1.75%) in the second year; and -2.88 +/- 2.03% (range: -5.33% to -0.13%) three years after surgery, compared to preoperative values. Annual cumulative cell loss was -1.9% for the myopic group and -1.6% for the hyperopic group, which is two to three times greater than physiological annual cell loss in normal eyes without surgery. An annual endothelial cell count analysis is highly recommended in every patient after iris-claw lens implantation to detect potential progressive cell loss at an early stage.

Initial results of endothelial cell counts after Artisan Lens for Phakic Eyes: An evaluation of the united states food and drug administration ophtec study

Purpose To evaluate the endothelial cell count change in eyes implanted with the iris-claw phakic Artisan lens for treatment of moderate to high myopia. Design Prospective, multicenter clinical trial. Participants The first 765 eyes enrolled at 25 North American sites in the United States Food and Drug Administration Ophtec clinical trial of the myopic Artisan IOL. Outcome analyses of endothelial cell count measurements were based on those obtained before surgery and at 6, 12, and 24 months after surgery performed between October 1998 and December 2001. Setting Multiple private and university practices. Methods Percentage change in endothelial cell count from baseline to 6, 12, and 24 months were analyzed using specular microscopy. Upper limit of detecting endothelial cell density change was estimated using 3 repeated counts at preoperative and postoperative time frames. Main outcome measures Percentage change in endothelial cell loss. Results The mean preoperative endothelial cell count was 2631±442 cells/mm 2. Percentage change from baseline at 6, 12, and 24 months was −0.09%±16.39%, −0.87%±16.35%, and −0.78%±17.41%. No statistically significative postoperative endothelial cell loss was found. The endothelial cell loss rate was higher among patients who wore spectacles before surgery and was correlated negatively with preoperative endothelial cell density ( P<0.001). No relationships were noted between endothelial cell loss and either patient age or implant power. A 4.1% repeatability of measurements was found based on the average of 3 repeated counts, whereas single cell count estimates were associated with a 23% accuracy in detecting endothelial cell density change. In a worst-case scenario, adjusting for measurement accuracy, 9% of all eyes were at higher risk of a 10% loss of cell density at 12 months after surgery, although eyes at higher risk were found to have high preoperative endothelial cell counts ( P<0.0001). Conclusions The Artisan iris-claw phakic intraocular lens did not result in significant loss of endothelial cell density up to 2 years after implantation of the myopic Artisan phakic lens.

Neodymium-YAG laser posterior capsulotomy. Central corneal endothelial cell density.

We determined central corneal endothelial cell densities in 39 eyes in a masked fashion before and after Q-switched neodymium-YAG laser posterior capsulotomy. The mean preoperative endothelial cell count was 1,840 cells per square millimeter (SD, 611 cells per square millimeter; range, 522 to 2,742 cells per square millimeter). The mean postoperative endothelial cell count was 1,798 cells per square millimeter (SD, 600 cells per square millimeter; range, 478 to 2,750 cells per square millimeter). The difference between the mean preoperative and postoperative cell density was 42 cells per square millimeter (2.3% cell loss). There was no significant correlation between central corneal endothelial cell loss and the laser energy used, pseudophakic status (posterior chamber intraocular lens vs no intraocular lens), size of capsulotomy, vitreocorneal touch, or preoperative corneal endothelial cell density.