Noncontact Specular Microscopy Research Articles

Qualitative and quantitative changes of corneal endothelial cells and central corneal thickness in pseudoexfoliation syndrome and pseudoexfoliation glaucoma

Background: Pseudoexfoliation syndrome (PXS) is age-related systemic microfibrillopathy, caused by gradual deposition of extracellular grey and white material over various tissues. PXS is frequently associated with secondary open angle glaucoma. In Pseudoexfoliation eyes, corneal endothelial changes have been reported. The present study analysed corneal endothelial morphometry and central corneal thickness in PXS and pseudoexfoliation glaucoma. Objective: To evaluate qualitative and quantitative changes of corneal endothelial cells and central corneal thickness in pseudoexfoliative(PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open-angle glaucoma(POAG). Materials and Methods: A total of 80 patients were included in this study: 20 eyes with PXS, 20 eyes with pseudoexfoliation glaucoma(PXG), 20 eyes with POAG, and 20 normal eyes. Corneal endothelial cell density(ECD), coefficient of variation(CV) in cell size, percentage of hexagonal cells and central corneal thickness were measured using a non-contact specular microscope. Results: ECD (p-value

Comparison of corneal endothelial cell parameters in four different groups by specular microscope

Background: Corneal endothelial cell is important for corneal function and viability. The advent of specular microscopy has greatly improved the study of human corneal endothelial morphology and allowed quantification of endothelial changes. Objective: To compare the corneal endothelial cell parameters in four groups (i.e., young subjects, elderly persons, cataract patients, and primary open-angle glaucoma patients) measured by specular microscopy. Materials and Methods: This prospective, randomized, single-site clinical study included a total of 120 patients who were selected and divided into 4 groups of 30 patients each. Endothelial cell density (ECD), average cell size, and percentage of hexagonality (6A%) were measured by noncontact specular microscope. Result: In our study, of 120 patients, 74 (61.66%) were male while 46 (38.33%) female subjects. In group A, ECD, average cell size, and percentage of hexagonality were 2,797.43 ± 171.96 cells/mm2, 324.63 ± 40.61 µm2, and 66.43 ± 2.56%, respectively. The values in group B were 2,364.10 ± 81.56 cells/mm2, 362.27 ± 22.30 µm2, and 59.40 ± 3.54%, respectively. In group C, these values were 2,534.37 ± 125.34 cells/mm2, 414.93 ± 37.45 µm2, and 60.13 ± 2.52%, respectively. While in group D, these values were 2,311.30 ± 100.87 cells/mm2, 436.13 ± 41.47 µm2, and 59.93 ± 2.55%, respectively. Conclusion: From this study, it can be concluded that ECD is at its peak value in young age and significantly reduces with age and not influenced by cataract and glaucoma. Hexagonality of corneal endothelium is significantly high in young males when compared with young female subjects. Young subjects showed small average size of endothelial cell.

Changes in Corneal Endothelial Cell after Ahmed Glaucoma Valve Implantation and Trabeculectomy: 1-Year Follow-up.

PurposeTo compare changes in corneal endothelial cell density (CECD) after Ahmed glaucoma valve (AGV) implantation and trabeculectomy.MethodsChanges in corneal endothelium in patients that underwent AGV implantation or trabeculectomy were prospectively evaluated. Corneal specular microscopy was performed at the central cornea using a non-contact specular microscope before surgery and 6 months and 12 months after surgery. The CECD, hexagonality of the endothelial cells, and the coefficient of variation of the cell areas were compared between the two groups.ResultsForty eyes of 40 patients with AGV implantation and 28 eyes of 28 patients with trabeculectomy were studied. Intraocular pressure in the AGV implantation group was significantly higher than that in the trabeculectomy group (p < 0.001), but there was no significant difference in other clinical variables between the two groups. In the AGV implantation group, the mean CECD significantly decreased by 9.4% at 6 months and 12.3% at 12 months compared with baseline values (both, p < 0.001), while it decreased by 1.9% at 6 months and 3.2% at 12 months in the trabeculectomy group (p = 0.027 and p = 0.015, respectively). The changes at 6 months and 12 months in the AGV implantation group were significantly higher than those in the trabeculectomy group (p = 0.030 and p = 0.027, respectively). In the AGV implantation group, there was a significant decrease in the CECD between baseline and 6 months and between 6 months and 12 months (p < 0.001 and p = 0.005, respectively). However, in the trabeculectomy group, a significant decrease was observed only between baseline and 6 months (p = 0.027).ConclusionsBoth the AGV implantation group and the trabeculectomy group showed statistically significant decreases in the CECD 1 year after surgery. The decrease in CECD in the AVG implantation group was greater and persisted longer than that in the trabeculectomy group.

Anterior Segment Characteristics of Fuchs Uveitis Syndrome

Purpose: To evaluate the differences in the biometric parameters of the anterior segment in Fuchs' uveitis syndrome (FUS).Methods: 30 eyes of 15 consecutive patients with unilateral FUS were examined. Anterior segment parameters were measured by rotating Scheimpflug imaging camera. Central endothelial cell count was measured by noncontact specular microscopy.Results: The central cornea was thinner (p < 0.001), the iridocorneal angle was significantly larger (p < 0.010), anterior chamber depth was deeper in the eyes with FUS (p < 0.006). The iris bowing was different between the affected eye and the healthy eye. The mean endothelial cell density of eyes with FUS was significantly lower than control eyes (p < 0.001).Conclusions: Scheimpflug imaging method is a useful tool to analyze the anterior segment parameters in FUS. Endothelial cell loss, as well as decreased percentage of endothelial hexagonal cells, is obtained by noncontact specular microscopy in patients with FUS.

Corneal endothelial cell analysis using two non-contact specular microscopes in healthy subjects

To compare specular microscopy values obtained using the Perseus (CSO, Italy) and the Nidek CEM-530 (NIDEK Co., Ltd. Japan) specular microscopes. This prospective study used specular microscopy to examine sixty eyes from thirty healthy subjects (29.83±9.41years; range 18-79years). This was done with both the Nidek CEM-530 and the Perseus on three occasions and results were evaluated by one independent observer. Measurement differences between instruments and agreement between devices were determined. The endothelial cell sample was larger with the Perseus than with the CEM-530 (235.92±38.26 vs. 184.38±43.88, respectively) with a statistically significant difference (P=0.001). Mean endothelial cell density (ECD) with the Perseus and CEM-530 was 2692.75±306.66 and 2556.47±257.38cells/mm(2) (P=0.001), respectively; mean coefficient of variation (CV) was 33.43±4.29 and 28.70±3.82 (P=0.001), respectively, and hexagonality 56.66±6.19% and 68.50±3.64 (P=0.001), respectively. The mean of the differences (Perseus minus CEM-530) for ECD was 136.27±106.16 cells/mm(2) (95% CI 108.85-163.70 cells/mm(2)); 4.73±2.70% (95% CI 4.03-5.41) in CV; and -11.83±5.05 for percentage of hexagonal cells. Both instruments showed significant differences in the measurement of all cell forms, predominantly higher values were found with the Perseus vs the CEM-530, except 4-sided cells. Endothelial cell density, coefficient of variation, and percentage of hexagonal cells between the Perseus and CEM-530 differ statistically. This shows that these instruments should not be used interchangeably.

Upgrading wide field contact specular microscope

PurposeNon‐contact specular microscopes (SM) developed 25 years ago highly facilitated image acquisition while eliminating contaminations risk. Nevertheless their very small field of observation (SM Topcon SP2000: 0.1 mm2) constitute major limitations for the assessment corneas.AimTo upgrade a wide field contact SM with a digital camera and dedicated software.MethodsThe original camera film was replaced by a digital camera (Canon EOS 6D with full‐frame 35 mm sensor) connected to a computer. The new camera was fixed on the SM (Konan SP5500, ×40 zoom) with 3D print custom adaptor and uses its optics. After acquisition of wide field images (0.6 mm2), they were processed using a segmentation algorithm (watershed with markers method). Software, using several libraries (ITK, OpenCV, Qt, MySQL), has been developed allowing the acquisition of images (camera control), image processing, and storage of results in a database.ResultsA segmented image showing only cell borders in black over white background and document which presents ECD number (1000 cells counted) and cell's characteristics showing quality of cells (regarding their size). Stored in a database, these results are available for operators.ConclusionsThe upgraded wide field contact SM counts a great number of cells. Consequently, it estimates the ECD with less bias than other methods. Also, it can be used for the assessment of heterogeneous endothelium like in Fuchs corneal endothelial diseases for which noncontact SM are obviously unsuited. GRANT: ANR 2012 CORIMMO project.

Changes in choroidal thickness and corneal parameters in diabetic eyes.

To evaluate the effect of diabetes mellitus (DM) on central corneal thickness (CCT), corneal endothelial parameters (endothelial cell density [ECD], average size [AVE], hexagonality [A6], polymegathism [SD]), and subfoveal choroidal thickness (SFCT), and to determine whether these parameters depend on the duration of DM and hemoglobin A1c (HbA1c) level. A total of 62 patients with type 2 DM and 65 healthy subjects were examined using a noncontact specular microscope, A-scan ultrasound, and spectral-domain optical coherence tomography. The study parameters included medical history, age, eye axial length, CCT, ECD, AVE, A6, SD, and SFCT. The duration of DM and HbA1c level of the 2 latest tests were noted. The SFCT (258.0 ± 74.4 µm) and ECD (2721.8 ± 264.1 cells/mm2) were significantly lower, and the CCT (566.7 ± 35.7 µm) higher, in diabetic patients than in the control group (313.1 ± 88.5 µm, 2967.3 ± 220.6 cells/mm2, 550.0 ± 56.4 µm, respectively) (p&lt;0.05). There were no differences in age, sex, or axial length between the diabetic and control groups (p&gt;0.05). Diabetic retinopathy and macular edema did not influence SFCT significantly (p&gt;0.05). No differences in endothelial parameters between groups and no correlations among HbA1c, duration of DM, and any of the examined parameters were found (p&gt;0.05). Diabetic patients have thicker corneas, lower ECD, and thinner subfoveal choroid than healthy subjects.

Trabeculectomy Versus EX-PRESS Shunt Versus Ahmed Valve Implant: Short-term Effects on Corneal Endothelial Cells

To evaluate short-term changes in corneal endothelial cells after trabeculectomy, EX-PRESS device implantation, and Ahmed valve implantation for the treatment of primary open-angle glaucoma. Prospective, interventional, comparative case series with contralateral eye control study. We prospectively evaluated the changes in number, density, and shape of the corneal endothelium cells in 128 eyes of 64 patients divided into 3 groups depending on the treatment received. Corneal specular microscopy was performed with a noncontact specular microscope preoperatively and at 1 and 3months after surgery. The changes at each time point were compared with those of the control group, which consisted of 32 contralateral glaucomatous eyes receiving antiglaucoma medications without any previous glaucoma surgery. In the subjects who underwent trabeculectomy, corneal endothelial cell density (ECD) significantly decreased by 3.5% (P= .012, paired t test) at 1month and 4.2% (P= .007) at 3months after surgery, compared to the baseline values. In the Ahmed valve group ECD did not change at 1month after surgery and had a significant 3.5% decrease at 3months (P= .04). In the patients who underwent EX-PRESS implantation and in the control group ECD did not change either at 1month or at 3months after surgery (P > .05). EX-PRESS shunt, compared to trabeculectomy and Ahmed valve, seems to be a safer procedure regarding the risk of endothelial cell loss. For this reason, it may be the treatment of choice in patients with significant low corneal ECD before surgery or other risk factors forcorneal damage.

The Effect of Smoking on Corneal Endothelial Cells

ABSTRACTPurpose: To investigate the effect of chronic cigarette smoking on the endothelial cells of the cornea via non-contact specular microscopy. Method: In this prospective, cross-sectional study, 25 eyes of 25 chronic smokers and 21 eyes of 21 age-matched, healthy non-smokers were enrolled. The Fagerström Test for Nicotine Dependence on Cigarettes was used to determine the nicotine dependency level. The level of cotinine, a major metabolite of nicotine, was measured in urine samples from the control group to detect whether they were passively affected by cigarette smoke. All participants underwent measurement of tear break-up time (TBUT), central corneal thickness (CCT), and axial length. Endothelial cell density and endothelial cell morphology were evaluated by non-contact specular microscopy. Results: On average, the cigarette smokers consumed 19.2 ± 8.3 cigarettes per day and had been smoking for 14.5 ± 6.8 years. The mean TBUT value was significantly lower in the smoker group compared to the non-smoker group (p < 0.05). No statistically significant difference was found in the mean CCT, mean endothelial cell density, or parameters of endothelial cell morphology between smokers and non-smokers. Conclusion: This study showed that cigarette smoking seems to affect the TBUT value but no effects were found on the parameters of corneal endothelial cells.

Corneal Changes in Children after Unilateral Cataract Surgery in the Infant Aphakia Treatment Study

We report endothelial cell (EC) characteristics and central corneal thickness (CCT) from the Infant Aphakia Treatment Study (IATS) patients at the 5-year examination. Randomized, controlled trial of the treatment of unilateral cataract with aphakic contact lens (CL) versus primary intraocular lens (IOL) implant. A total of 114 infants with unilateral cataract. The EC density, coefficient of variation (CV), and percent hexagonal cells were measured by noncontact specular microscopy. The CCT was measured using contact pachymetry. Fellow eyes served as controls. Mean differences between treated and fellow eyes of CL and IOL groups were compared with a paired t test. A 1-way analysis of variance model and the Tukey-Kramer multiple comparison procedure were used to assess the effect of a diagnosis of glaucoma or glaucoma suspect. A total of 105 subjects (52 with CLs, 53 with IOLs) had specular microscopy or corneal thickness data recorded. Mean EC densities were higher in aphakic eyes compared with fellow eyes (3921 vs. 3495 cells/mm2, P<0.0001). Mean CV was higher (27 vs. 24, P=0.0002) and mean percent hexagonal cells was lower (72% vs. 76%, P=0.002) in aphakic eyes compared with fellow eyes. Mean CCT of aphakic eyes was higher than in controls (637 vs. 563 μm, P<0.0001). There was no difference in EC density in eyes treated with IOLs compared with fellow eyes (3445 and 3487 cells/mm2, P=0.68). Means for CV (25 vs. 24, P=0.07) and percent hexagonal cells (74 vs. 76%, P=0.27) were also not significantly different. Mean CCT was higher in eyes with IOLs (605 vs. 571 μm, P<0.0001) compared with fellow eyes. Compared with treated eyes without glaucoma or glaucoma suspect, treated eyes with glaucoma had lower EC density (3289 vs. 3783 cells/mm2, P=0.03) and treated eyes with glaucoma suspect had greater mean corneal thickness (660 vs. 612 μm, P=0.0036). Cataract extraction during infancy with IOL implantation was not associated with a reduced EC count in treated compared with fellow eyes, although CCT was increased. Extended-wear aphakic CLs may cause corneal polymegathism with increased EC density and CCT. Glaucoma diagnosis was associated with reduced EC counts and increased CCT.

Changes in central corneal thickness and refractive error after thin-flap laser in situ keratomileusis in Chinese eyes.

BackgroundRefractive stability is influenced by alterations in corneal curvature and corneal thickness after laser in situ keratomileusis (LASIK). The aim of this study was to analyze the changes of central corneal thickness (CCT) and refractive error following thin-flap LASIK surgery in Chinese eyes.MethodsOne hundred and fifty-eight myopic patients (302 eyes) who underwent thin-flap LASIK surgery were prospectively evaluated. CCT was measured by non-contact specular microscopy before, and 1 day, 1 week, and 1, 3, and 6 months following surgery. Age, refractive error, and optic zone diameter were also recorded.ResultsPreoperatively, the mean CCT was 531.6 ± 24.3 μm. At 1 day, 1 week, and 1, 3, and 6 months after surgery, mean CCTs were 431.4 ± 38.4 μm, 422.6 ± 3 7.8 μm, 427.2 ± 38.0 μm, 434.4 ± 38.2 μm, and 435.6 ± 38.0 μm, respectively. Significant changes were detected in CCT values at each time point after thin-flap LASIK treatment (P < 0.05). The mean preoperative spherical equivalent (SE) was −5.73 ± 2.30 diopters (D). At 1 day, 1 week, and 1, 3, and 6 months after surgery, it was 0.26 ± 0.58 D, 0.54 ± 0.52 D, 0.49 ± 0.53 D, 0.45 ± 0.49 D, and 0.37 ± 0.42 D, respectively. The spherical equivalent refraction at 6 months postsurgery was close to the predicted value (0.34 ± 0.30 D). The changes in CCT within 6 months (4.06 ± 9.99 μm) were negatively correlated with age, preoperative refractive error, and optical zone diameter, respectively (r = −0.180, P < 0.05; r = −0.187, P < 0.001; r = −0.171, P < 0.05, respectively). No significant correlation was found between CCT changes and SE changes at different time points, postoperatively.ConclusionsCCTs decreased significantly at 1 day after surgery, and continued to decline at 1 week after surgery, then increased over time. From postoperative 1 week, SE over time continually shifted to the myopic side.

Trinucleotide Repeat Expansion in theTCF4Gene in Fuchs' Endothelial Corneal Dystrophy in Japanese

The purpose of this study was to evaluate the association between the intronic expansion of a trinucleotide repeat (TNR) in the TCF4 gene and Fuchs' endothelial corneal dystrophy (FECD) in a Japanese population. Forty-seven Japanese FECD patients and 96 age-matched controls were recruited. FECD patients and controls were examined by slit-lamp and noncontact specular microscopy. The repeat length was determined by direct sequencing and short tandem repeat assay of PCR-amplified DNA and Southern blotting of unamplified DNA. A TNR expansion, defined as >50 CTG repeats in the TCF4 gene was identified in 12 of 47 FECD cases (26%) and 0 of 96 controls (0%; P < 0.001). Sensitivity and specificity in this study were 26% and 100%, respectively. The clinical characteristics of FECD patients with TNR expansion were not distinct from those without TNR expansion. These findings show for the first time in a Japanese population the association of the TNR expansion in TCF4 with FECD. In contrast to Caucasian cohorts in whom the TNR expansion is present in most patients with FECD, a CTG expansion is present in a minority of Japanese subjects, indicating other genetic variants as common causes of phenotypically identical disease in this population.

The pattern of early corneal endothelial cell recovery following cataract surgery: cellular migration or enlargement?

To evaluate whether cellular migration or enlargement is the main mechanism of initial endothelial cell recovery following cataract surgery. A prospective observational study, of 24 patients aged 50-80years who were diagnosed with moderate cataract and received uncomplicated cataract surgery with a 2.75mm temporal clear corneal incision, was performed in Seoul National University Bundang Hospital. Endothelial cell density (ECD) and area (ECA) were obtained in central and four paracentral (superior, inferior, nasal, and temporal) areas using non-contact specular microscopy. ECD, ECA, ECD% (ECD% = ECD in each area/the sum total of ECD in five areas), and the coefficient of variation of ECA (CV) in each location were investigated pre- and 1day, 1week, and 4weeks postoperatively. ECD significantly decreased 1day, 1week, and 4weeks postoperatively (p = 0.010, 0.015, and 0.003 respectively), and ECA increased (p = 0.008, 0.013, and 0.002 respectively) in only the temporal area. Postoperative ECD% decreased, and CV increased in only the temporal area significantly, when compared to preoperative values. There were no significant postoperative changes of ECD, ECA, ECD%, and CV in other areas. Postoperative changes of ECD, ECA, ECD%, and CV were limited to the temporal area adjacent to the primary corneal incision. Cellular enlargement, rather than migration, may have the major effect on early endothelial cell recovery after cataract surgery.

Ophthalmic parameters in adult Shih Tzu dogs

Ocular surface diseases are often diagnosed in brachycephalic dogs. The ophthalmic parameters of the Shih Tzu dogs are evaluated in this study since this breed is among the most commonly affected by these diseases. In this study, ophthalmic parameters of this breed were partly studied under physical restraint. Schirmer tear test, breakup time test, aesthesiometry, biomicroscopy, non-contact specular microscopy, laser flaremetry, applanation tonometry, ultrasonography and ophthalmoscopy were carried in 48 eyes of 24 male and female dogs, aged from two to four years, weighing between 5 and 10kg. All dogs were from a breeding kennel. Descriptive statistics were applied to the data. Mean and standard error for Schirmer tear test was 26.145±0.803mm min-1; breakup time test, 13.668±0.538s; and aesthesiometry, 2.395±0.071cm. The biomicroscopy evaluation showed that 70.83% of the eyes had medial entropion; 42% caruncular trichiasis; 33% distichiasis, 27% mild paracentral corneal opacity; and 13% corneal melanosis. Mean and standard error for endothelial cell density was 2221.591±20.161cells mm-2; endothelial cell hexagonality, 63.770±1.805%; endothelial cell area, 451.895±4.179mm2; central corneal thickness, 0.490±0.007 mm; laser flaremetry, 1.720±0.216PC ms-1; applanation tonometry, 16.118±0.460mmHg; axial length, 20.255±0.134mm; lens thickness, 6.624±0.031mm; anterior chamber, 4.064±0.109mm; and vitreous chamber, 9.565±0.054mm. Ophthalmoscopy findings were not different from previous reports for other breeds. The results showed that the ophthalmic Shih Tzu parameters did not differ from other breeds according to data in the literature, except for the breakup time and Cochet-Bonnet aesthesiometry.

Effect of torsional mode phacoemulsification on cornea in eyes with/without pseudoexfoliation.

To evaluate the effect of torsional mode phacoemulsification on central corneal thickness, corneal endothelial cell density, and morphology in eyes with/without pseudoexfoliation (PEX) syndrome. Fourty-two consecutive patients with and 42 patients without PEX as a control group scheduled for cataract surgery was studied. Phacoemulsification, using OZiL IP system, was performed with quick chop technique. Using noncontact specular microscopy, the central endothelial cell density (ECD), coefficient of variation, percentage of hexagonal cells, and the central corneal thickness (CCT) were evaluated preoperatively and postoperatively at 1, 7 and 30d. The ECD in PEX syndrome was statistically significantly lower than that in the control group preoperatively and postoperatively (P≤0.001). Percentage change in ECD was statistically significantly higher in PEX than that in control group after surgery follow up (P≤0.04). There was no statistically significant difference between both groups comparing percentage of hexagonal cells and coefficient of variation in the cell size before and after the surgery. At 1 and 7d after surgery, percentage change in CCT was statistically significantly higher in PEX group than that in the control group (P≤0.041). Although torsional mode phacoemulsification and intraocular lens (IOL) implantation provided a safe and favorable surgical outcome in patients with/without PEX, torsional phacoemulsification led to significantly higher ECD loss in the PEX group than that in the control group during the whole follow up period. In addition, more corneal swelling in the PEX group than that in the control group during the early postoperative period has indicated that the corneal endothelium, in presence of PEX endotheliopathy, seems to be more susceptible to the effects of phacoemulsification surgery in eyes with PEX. The increased risk of anterior chamber manipulations in patients with PEX should be taken into account for an increased risk of bullous keratopathy.

Comparison of Central Corneal Thickness Measurement Using Non-Contact and Contact Pachymetry Devices in Normal Eyes

Purpose: To compare central corneal thickness (CCT) in normal population using contact and non-contact pachymetry devices and to assess the intra operator repeatability of measurement with each device. Materials and Methods: This prospective, cross sectional comparative study evaluated 30 healthy subjects fulfilling the inclusion criteria reporting in AFIO Rawalpindi. CCT was measured in both eyes of subjects using noncontact specular microscope, Dual Scheimpflug analyzer and contact ultrasound pachymeter by a single investigator at the same time of the day. Pearson’s correlation coefficient test was performed to ascertain correlation between pachymetry devices. Intra operator repeatability was analysed using within subjects coefficient of variation/repeatability (CoV) and intra class correlation coefficient (ICC). Results: Sixty eyes of 30 male subjects were analysed. Mean age of study population was 31.03 ± 10.30 years. Mean CCT values were 536.48 ± 35.77 µm, 498.62 ± 34.70 µm and 526 ± 37 µm with Dual Scheimpflug Analyzer , Specular microscope and Ultrasonic pachymeter respectively (p 0.90). Conclusion: All three devices showed excellent intra operator repeatability for CCT measurement making them reliable tools for CCT measurement. Key Words: Central Corneal Thickness, Pachymetry, Repeatability, Microscopy.

Large gene deletion and changes in corneal endothelial cells in a family with choroideremia.

We provided the first report of an association between changes in corneal endothelial cells, retina, and choriocapillaris in a choroideremia family. Four members of an Asian choroideremia family, comprising two affected patients and two carriers, were evaluated. All participants underwent complete eye examinations, including visual acuity (VA), slit-lamp examination, ophthalmoscopy, perimetry, and electrophysiology tests. In addition, images of corneal endothelium were captured with a noncontact specular microscope. Genomic DNA amplification and whole-genome cytogenic array analysis were used to confirm the diagnosis of choroideremia and determine the molecular basis of the phenotype. In the affected patients, funduscopy revealed characteristic features of RPE and chorioretinal atrophy. The slit-lamp biomicroscopy disclosed unexpected pigmented punctate lesions in the corneal endothelium in one of them. Surprisingly, specular microscopy detected decreased endothelial cell density (ECD) with features of pleomorphism and polymegethism. Genomic DNA analysis revealed large deletion (~4.5 mega base pairs) of the entire CHM gene and encompassed region. In carriers, funduscopy revealed stippling pigmentary change despite normal electrophysiological results. Specular microscopy also disclosed reduced ECD with features of pleomorphism and polymegethism. To our knowledge, this is the first description of corneal changes in choroideremia patients. The loss of corneal ECD is conspicuous and is accompanied by pleomorphism and polymegethism in this family. The observed changes in corneal endothelium may be associated with larger encompassed regions of the CHM gene defect or dysfunction in the blood-aqueous barrier. It warrants further investigation and clarification of the pathophysiology and associations between retinal and corneal changes in choroideremia.

Changes in the cornea related to sickle cell disease: a pilot investigation.

To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. The mean CCT value was 509.6 ± 20.7 μm in the study group and 520.8 ± 23.6 μm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm², 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm², 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.

Comparison of endothelial cell loss by specular microscopy between phacoemulsification and manual small-incision cataract surgery

Aim: To compare the endothelial cell loss between phacoemulsification and manual small-incision cataract surgery (SICS). Endothelial cell loss was also compared in phacoemulsification group by temporal clear corneal incision (CCI) and by superior scleral incision (SI) technique. Materials and Methods: A total of 200 eyes of 200 patients were included in the study. Cases were randomly divided into two equal groups. Group A had undergone phacoemulsification and Group B had under gone manual SICS. In Group A 50 cases were performed by temporal CCI and remaining 50 cases were performed by superior SI technique. Endothelial cell count was evaluated by using a noncontact specular microscope. Results: Mean endothelial cell loss (cells/mm 2 ) in Group A was 307.80 (12.33%), 397.79 (15.93%), and 421.69 (16.89%) on 1 week, 6 week, and 3 month postoperative period, respectively. In Group B, it was 270.86 (10.63%), 385.22 (15.12%), and 413.68 (16.24%) on 1 week, 6 week, and 3 month postoperative period, respectively. There was no clinical and statistically significant difference (P > 0.05) between the two groups. The mean endothelial cell loss in Group A by CCI was 340.68 (13.61%), 427.80 (17.08%), and 448.70 (17.92%) and by SI was 274.92 (11.05%), 367.78 (14.78%), and 394.68 (15.83%) on 1 week, 6 week, and 3 month postoperative period respectively. There was statistically significant difference in endothelial cell loss at 1 week (P 0.05). Conclusion: There was no clinically or statistically significant difference in endothelial cell loss or visual acuity between phacoemulsification and manual SICS at 3 month postoperative period.

Central Corneal Thickness Measured by Noncontact Specular Microscopy, Dual Rotating Scheimpflug Camera and Ultrasound Pachymetry

목적: 비접촉경면현미경, 이중샤임플러그전안부 사진기 및 초음파 각막두께측정계를 이용하여 중심각막두께의 측정치를 비교하고자 하였다. 대상과 방법: 정상인 70명 70안을 대상으로 비접촉경면현미경, 이중샤임플러그전안부 사진기 그리고 초음파 각막두께측정계로 측정한 중심각막두께를 비교하고 상관관계를 알아보았다. 결과: 비접촉경면현미경, 이중샤임플러그전안부 사진기...