Percentage Of Hexagonal Cells Research Articles

Effects of mitomycin C at different exposure time on the morphology of corneal endothelial cells in LASEK surgery

AIM: To investigate the effects of mitomycin C (MMC) on corneal endothelial cells at different exposure time during laser-assisted subepithelial keratomileusis (LASEK). METHODS: Patients who received LASEK were included and divided into Group T1 (15s≤t≤45s) and T2 (5s<t≤70s) based on the exposure time of MMC with corneal stroma. Cell density (CD) of corneal endothelial cells in central and peripheral cornea, average cell area (ACA), area standard deviation (SD), coefficient of variation (CV) and percentage of hexagonal cells (HEX) before surgery and at 1wk, 1, 3 and 6mo after surgery were compared between and within the groups. RESULTS: A total of 196 eyes of 98 patients were included with 98 eyes in Group T1 and 98 eyes in Group T2. With the exception of peripheral ACA, central CV and HEX in Group T1 and T2, which significantly changed at 1wk after the surgery (P<0.05), there was no significant difference in central and peripheral parameters within both groups or between the groups (P>0.05). CONCLUSION: Although transient acute changes in central CV and HEX and peripheral ACA were observed, there is no significant effect on the long-term corneal health status when MMC is applied in a reasonable time range in LASEK surgery.

Effect of Repeated Intravitreal Ranibizumab and Aflibercept Injections on the Cornea in Patients with Age-Related Macular Degeneration.

Purpose To assess the effect of repeated intravitreal ranibizumab injections (RI) and aflibercept injections (AI) on the corneal endothelium and central corneal thickness (CCT) in patients with age-related macular degeneration (AMD). Materials and Methods In the retrospective study, 110 eyes of 106 patients, aged 52 to 93 years, were analyzed. Fifty eyes were treated only with RI (I group), and 60 eyes were treated only with AI (II group). Every patient received one intravitreal injection of 0.5 mg of ranibizumab once a month or 2 mg of aflibercept for 3 subsequent months. Each patient received only 3 injections during the whole observation period. Corneal analysis was obtained with the specular microscope. Examinations were performed before initial treatment, after each injection, and 6 months after the first injection. Analysis included corneal endothelial cell density (ECD), hexagonal cell percentage (% Hex), coefficient of variation (CoV), and CCT. Results There was a statistically significant ECD loss, regardless of the type of the anti-VEGF agent. The mean ECD value in the I group was 2397 ± 459 cells/mm2 before RI, 2389 ± 459 cells/mm2 after the first RI, 2386 ± 467 cells/mm2 after the second RI, 2378 ± 475 cells/mm2 after the third RI, and 2357 ± 460 cells/mm2 6 months after the first RI. The mean ECD value in the II group was 2448 ± 493 cells/mm2 before treatment, 2456 ± 498 cells/mm2 after the first AI, 2426 ± 496 cells/mm2 after the second AI, 2402 ± 488 cells/mm2 after the third AI, and 2348 ± 473 cells/mm2 6 months after the first AI. In comparison with the group treated with RI, the group treated with AI presented a greater ECD loss at each measuring point. The percentage of hexagonal cells was decreased in both groups. There was a slight increase in polymegathism in both treated groups. Ranibizumab proved to cause a small increase in CCT, while CCT remained unchanged in the aflibercept group. Conclusions Repeated intravitreal injections of 0.5 mg of ranibizumab or 2 mg of aflibercept can influence the morphology of the corneal endothelium but not CCT.

Analysis of Corneal Densitometry and Endothelial Cell Function in Fuchs Uveitis Syndrome.

To evaluate corneal densitometry and endothelial cell properties in patients with unilateral Fuchs uveitis syndrome (FUS), and to compare results with unaffected contralateral eyes and healthy control subjects. A total of 90 participants were included in this prospective cross-sectional study. Forty-five affected eyes of patients with FUS were regarded as group 1 (FUSa), 45 fellow eyes were regarded as group 2 (FUSf), and 45 healthy-control eyes were regarded as group 3. Corneal densitometry was measured with densitometry software of Scheimpflug Corneal Topography (Pentacam HR, Oculus GmbH, Wetzlar, Germany), whereas endothelial cell measurement was evaluated with specular microscopy (Tomey, EM4000, GmbH, Germany). The mean corneal densitometry values were higher in the midstromal (zones; 2-6, 6-10 mm), posterior (all zones), and total thickness (zones; 2-6, 6-10 mm) layers in the FUSa compared with FUSf and control eyes (P<0.05 for all comparisons). The mean values of average cell area and cell size characteristics (minimum, maximum, SD, and coefficient of variation) were higher; endothelial cell density and percentage of hexagonal cells were lower in the FUSa than in the other two groups (P<0.05 for all comparisons). There was a significantly strong correlation between specular microscopy parameters and posterior corneal densitometry values in the FUSa group. Impairment of endothelial cell function in affected eyes of patients with FUS resulted in increased values of corneal densitometry, especially posterior layer.

Effects of Netarsudil on the Corneal Endothelium: Three-Month Findings from a Phase 3 Trial

To describe the changes in endothelial cell density (ECD), the coefficient of variation (CV), and the percent of hexagonal cells (%HEX) after 3 months of therapy with netarsudil (Rhopressa; Aerie Pharmaceuticals Inc, Durham, NC) 0.02% dosed once daily (QD) or twice daily (BID) and to compare these changes with those seen with timolol 0.5% BID in eyes with ocular hypertension (OHTN) or open-angle glaucoma (OAG). Post hoc analysis of data from a phase 3 evaluation of the intraocular pressure (IOP)-lowering efficacy and safety of netarsudil 0.02% versus timolol 0.5%. A subset of study subjects underwent corneal endothelial cell imaging by specular microscopy at baseline and after 3 months of therapy. Images were evaluated in a masked fashion at an independent reading center. The ECD, CV, and %HEX were determined using a standardized protocol for image analysis. Changes in ECD, CV, and %HEX from baseline to 3 months were compared between treatment groups using 2-sample t tests. Data from 386 subjects from whom analyzable specular microscopy images were obtained at both baseline and month 3 were included in this analysis. Mean ECD, CV, and %HEX values were comparable between groups at baseline. There were no statistically significant between-group differences in changes from baseline to month 3 in ECD, CV, or %HEX between either of the netarsudil groups and the timolol group. Within groups, CV declined in a statistically significant fashion from baseline to month 3 in all 3 groups by 1.4% to 2.1% (P < 0.001), and %HEX increased by a statistically significant amount (0.7%, P= 0.030) in the timolol group. These small changes were unlikely to be of clinical significance. No statistically significant changes in ECD were seen in any group. Netarsudil 0.02% showed no clinically significant effects on ECD, CV, or %HEX when dosed QD or BID for 3 months in eyes with OHTN or OAG.

Effect of corneal cross-linking on endothelial cell density and morphology in the peripheral cornea

BackgroundTo compare the endothelial cell density and morphology in the peripheral cornea before and after corneal cross-linking (CXL).MethodsThis study evaluated thirty-one eyes of 31 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 6 months postoperatively, we compared the corneal endothelial cell density (ECD), the coefficient of variation in cell size (CV), and the percentage of hexagonal cells (HEX), in the peripheral regions of the cornea, using a non-contact specular microscope (EM-3000, Tomey).ResultsAll keratoconic eyes in this series were measurable in the peripheral regions. No significant differences were found in the peripheral ECD preoperatively and 6 months postoperatively at each point (Wilcoxon signed-rank test, superior, p = 0.16, nasal superior, p = 0.12, temporal superior, p = 0.17, inferior, p = 0.37, nasal inferior, p = 0.28, temporal inferior, p = 0.17). The mean percentage of the ECD loss was 1.3, 1.3, 1.0, 1.4, 0.7, and 1.4%, respectively. No significant differences in the peripheral CV or HEX were found preoperatively and 6 months postoperatively at each point.ConclusionsStandard CXL does not cause significant changes in endothelial cell density, polymegethism, or polymorphism, in the peripheral regions of the cornea. It is suggested that CXL is a minimally invasive surgical approach for progressive keratoconus, even in terms of peripheral endothelial cells.Trial registrationUniversity Hospital Medical Information Network Clinical Trial Registry (000031162).

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

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

Effects of Netarsudil and Latanoprost Alone and in Fixed Combination on Corneal Endothelium and Corneal Thickness: Post-Hoc Analysis of MERCURY-2.

IntroductionTo describe the changes in endothelial cell density (ECD), the coefficient of variation (CV), the percentage of hexagonal cells (%HEX), and central corneal thickness (CCT) following 3 months of therapy with netarsudil 0.02%/latanoprost 0.005% fixed combination, and to compare these changes with those seen with netarsudil 0.02% or latanoprost 0.005% in eyes with ocular hypertension or open-angle glaucoma.MethodsA subset of subjects enrolled in a Phase 3 evaluation of the intraocular pressure-lowering efficacy and safety of netarsudil 0.02%/latanoprost 0.005% fixed combination once daily (QD) versus each of its individual components underwent corneal endothelial cell imaging by specular microscopy and ultrasound pachymetry at baseline and following 3 months of therapy. Images were evaluated in masked fashion at an independent reading center. Changes from baseline to 3 months in ECD, CV, %HEX, and CCT were compared between treatment groups.ResultsData from 415 subjects obtained at both baseline and Month 3 were included in this post hoc analysis. Changes from baseline to Month 3 in ECD, CV, and %HEX were clinically insignificant in all three groups, and the changes in the netarsudil/latanoprost fixed combination group demonstrated no statistical difference from those seen in the netarsudil and latanoprost groups. Mean CCT decreased more in the fixed combination group (− 6.4 µm) than in either the netarsudil group (− 3.3 µm, p = 0.0248) or the latanoprost group (− 1.2 µm, p < 0.0001).ConclusionsNetarsudil 0.2%/latanoprost 0.005% fixed combination QD for 3 months in eyes with ocular hypertension or open-angle glaucoma had no clinically significant effects on endothelial cell density or morphology. The significant decrease in CCT in the fixed combination group compared to the two individual component groups may indicate that the potential effects of each drug on CCT are additive, although the magnitude of the observed effects is likely of negligible clinical significance.Clinicaltrials.gov IdentifierNCT02674854.

Assessment of Corneal Endothelium among Diabetic Patients in a Multispecialty Hospital in Tamil Nadu

Introduction: Corneal damage is the common issue affecting 70% of diabetic patients. Diabetic cornea has functional abnormalities such as decreased corneal Endothelial Cell Density (ECD), thicker corneas with increased endothelial permeability, lesser corneal sensitivity, and elevated corneal auto-fluorescence. Aim: To study the corneal endothelial characteristics among diabetic patients and to identify the factors associated with endothelial damage and compare the corneal changes based on the duration of diabetes mellitus and glycaemic control. Materials and Methods: The hospital based cross-sectional study was conducted in 155 patients (100 diabetic and 55 control) from 24th September 2016 to 29th March 2018. The corneal endothelial morphological features were evaluated using a non-contact EM-3000 specular microscope. The morphological characteristics of endothelial cell like the ECD, Coefficient of Variation (CV), Central Corneal Thickness (CCT), and percentage of hexagonal cells were compared between diabetic patients and the control population. Age, gender, blood pressure, duration of diabetes, fasting and Postprandial Blood Sugar (PPBS) HbA1c value, blood urea, and serum creatinine, Intra Ocular Pressure (IOP) were also recorded, and the endothelial cell characteristics were compared between the diabetic groups according to the duration (&lt; or ≥ 3 years) and HbA1c% (&lt; or ≥ 7%). An independent t-test was performed to compare the means of endothelial characteristics between study subjects and the control group and also between duration of diabetes and HbA1C levels. A p-value of less than 0.05 was considered statistically significant. The data were analysed using a SPSS statistical program. Results: Baseline characteristics like Fasting Blood Sugar (FBS), PPBS, HbA1c, Systolic and Diastolic Blood Pressure (SBP and DBP) were significantly higher in diabetic group than control. A significant difference in corneal thickness (p=0.01) and hexagonality (p&lt;0.001) were also observed between both the groups. The diabetic group showed a reduction in cell density and a higher coefficient variation of cell size however the differences were not statistically significant, There was no significant difference in the ECD, CCT, CV, and hexagonality irrespective to HbA1c level and duration of diabetes. Conclusion: Patients with diabetes had a significant increase in corneal thickness, and a higher frequency of pleomorphism compared to control subjects. In terms of ECD and co-efficient variation, no difference was observed between groups.

Quantitative and Morphological Corneal Endothelial Changes After Selective Laser Trabeculoplasty and Retinal Photocoagulation.

Purpose:Selective laser trabeculoplasty (SLT) and retinal photocoagulation (RP) are two common laser procedures often performed at a wavelength of 532 nm, and may affect the corneal endothelium. This study used corneal specular microscopy to determine the impact of these procedures on the corneal endothelium.Design:Retrospective cohort study in a private practice.Methods:There were 249 eyes from 136 consecutive patients who underwent SLT for open-angle glaucoma and 132 eyes from 74 patients who underwent RP included. Corneal specular microscopy was performed immediately before and after each procedure and at 1-month postprocedure. Microscopy data included quantitative measures, such as cell density and central corneal thickness, and morphological measures, including percentage of hexagonal cells and coefficient of variation in cell area.Results:There was a small (just over 1%) reduction in corneal endothelial cell count from pre-SLT to post-SLT (P = 0.008), and a statistically significant recovery at 1 month (P = 0.04). Central corneal thickness also transiently increased from pre-SLT to post-SLT (P = 0.03). Although polymegathism was unchanged, changes in pleomorphism were observed (P = 0.03). The only change in the RP group was an increase in polymegathism between pre-RP and post-RP (P = 0.001).Conclusions:SLT has measurable effects on both quantitative and morphological characteristics of the corneal endothelium, which seem to be transient. RP has fewer measurable effects, likely because, although the total laser energy is similar, it is delivered over a much longer time (3 ns versus 0.1 s). The changes observed in both procedures are minor and unlikely to be of clinical significance.

Corneal Endothelial Cell Changes after Pars Plana Vitrectomy: Silicone versus Non Silicone Filled Eyes

Background: The corneal complications of a successful vitreoretinal surgery are not the main interest of the surgeon operating on a difficult retinal detachment. However, the surgeon should pay attention to avoid corneal decompensation. Aim: To evaluate corneal endothelial cell changes in patients undergoing pars plana vitrectomy with and without silicon oil (SO) injection.Subjects and Methods: This prospective observational study includes 54 eyes divided into two equal groups: silicone-filled group (group one) and saline-filled group (group two). Endothelial cell densities (ECD), coefficient of variation (CV), central corneal thickness (CCT), and percentage of hexagonal cells at the corneal center were measured preoperatively and at the first week, the first month, and the third month postoperatively and compared between the two groups. All data were collected and statistically analyzed using SPSS program. Results: Three months after PPV, mean ECD in group one and in group two was highly significant (p

Clinical study on topography-guided laser ablation combined with accelerated corneal collagen cross-linking for early keratoconus

Objective: To study the safety and efficacy of topography-guided customized excimer laser subepithelial ablation combined with accelerated collagen cross-linking technique in treatment of early keratoconus. Methods: Ninteen patients(20 eyes) (13 males 14 eyes, and 6 females 6 eyes), aged 12 to 44 years (24.7±8.0) were diagnosed as keratoconus by three-dimensional corneal topography and tomography, clinical history and examinations, and classified as KC1~KC3. Based on the classical excimer laser subepithelial keratomileusis (LASEK) method, topography guided laser ablation was performed with an excimer laser system (WaveLight EX500). After laser ablation, the corneal stromal bed was immersed with 0.1% riboflavin for 10 minutes, and then was irradiated by ultraviolet light (Avedro KXL) at 30 mW/cm(2) for 4 minutes. All the patients were followed up for more than 12 months. The uncorrected visual acuity (UCVA), diopter, best corrected visual acuity (BSCVA), corneal topography, central corneal endothelial cell density (ECD), hexagonal cell percentage (HEX), coefficient of variation (CV) and other indicators were observed. For normal distribution variables, Dunnett-t test was used before and after operation, and Wilcoxon test was used for variables with abnormal distribution. And the complications were recorded. Results: There was no loss of BSCVA at 12 months postoperatively, 20% of the eyes had no change of BSCVA, and 15% of the eyes gained 1 line of BSCVA, 15% of the eyes gained 2 lines of BSCVA, 50% of the eyes gained 3 lines and more of BSCVA. There was no significant difference in UCVA, BSCVA, manifest refractive spherical equivalent (MRSE) and the cylinder at 3 months postoperatively (P>0.05). The BSCVA were significantly improved at 6 and 12 months postoperatively compared with those before operation (t=3.095, 3.079, <0.05). Although there was no significant difference in UCVA and MRSE, the cylinder was significantly reduced at 6 and 12 months postoperatively (t=-2.890, -2.435, P<0.05). Apex curvature (Kapex) and mean pupil power (MPP) within 4.5mm of central cornea decreased significantly (Z=-2.903, P<0.01; Z=-2.667, P<0.01). Even though the thinnest corneal thickness decreased from pre-operational (461.9±31.1) μm to post-operational (416.6±27.0) μm (Z=-3.059, P<0.01), the cornea became regular with keratometric asymmetry index of anterior corneal surface decreased (Z=-2.667, P<0.01). The corneal optical quality parameters were improved. There was no significant difference in ECD, HEX and CV at 12 months postoperatively (P>0.05). Twelve months after operation, grade 0, 0.5, 1 and 2 haze were seen on 20%, 55%, 20% and 5% corneas respectively. Conclusions: The topography guided excimer laser ablation combined with accelerated corneal collagen cross linking is safe and effective in treatment of early stage keratoconus. It can significantly improve corneal regularity while preventing keratoconus progression, so as to improve the best corrected visual acuity postoperatively. (Chin J Ophthalmol, 2019, 55: 904-910).

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.

Noninvasive evaluation of anterior segment and tear film parameters and morphology of meibomian glands in a pediatric population with hypogonadism

PurposeTo compare the meibomian gland (MG), non-invasive tear film break-up time (NITFBUT), anterior segment measurements between healthy children and children with hypogonadism. MethodsA total of 80 eyes of 40 children with hypogonadism and 86 eyes of 43 age- and sex-matched healthy subjects were included in the study. The mean keratometry (Km), maximum keratometry (Kmax), central (CCT), thinnest (TCT) and apical (ACT) corneal thicknesses, corneal volume (CV), anterior chamber depth (ACD), irido-corneal angle (ICA), first and average non-invasive NITFBUT, MG loss, morphology of MGs, and MG distortion grade, specular endothelial cell density (CD), coefficient of variation (CoV), and percentage of hexagonal cells (HG) were analysed. ResultsThe mean CCT and TCT values were approximately 20 μm lower on average in patients with hypogonadism (p < 0.05). MG loss was present 56.1% of the healthy children, the ratio increased to 81.3% in children with hypogonadism (p < 0.001). The morphology and distortion grade did not show any significant differences between groups (p > 0.05). The mean NITFBUT value were similar between groups (p > 0.05). The mean CD value did not show any significant difference between groups, however it decreased in the hormone replacement therapy (HRT) group (p = 0.005). ConclusionsMG loss is a physiological process that is prominent in the condition of sex steroid deficiency, but does not cause tear film alterations in children. Future studies investigating sex and gender effect on the ocular surface system in an age-based fashion are required to clearly communicate influences in the arenas of ocular surface research.

Changes in corneal endothelial cell density in patients with primary open-angle glaucoma.

BACKGROUNDGlaucoma is a group of diseases characterized by a specific pattern of optic nerve neuropathy and retinopathy. Increasing evidence demonstrates glaucoma associated corneal endothelium loss. Direct-compression mechanism due to elevated intraocular pressure (IOP), cell toxicity after long term exposure to preservatives and glaucoma surgery have been reported to be the possible mechanism. Herein, we compare the specular endothelial microscopy in primary open-angle glaucoma (POAG) patients and healthy controls of the same age group to observe the corneal endothelium changes and the correlations to the mean IOP in a Chinese case control study.AIMTo investigate corneal endothelial cell density in Chinese patients with POAG.METHODSA case control study was performed on 60 eyes of 60 patients with POAG. Exclusion criteria included history of corneal diseases, intraocular diseases, contact lens use, ocular trauma or surgery (including intraocular surgery and laser treatment), congenital abnormalities or systemic diseases such as diabetes. Intraocular pressure was measured using Goldmann tonometry. Indirect specular microscopy (TOPCON SP-2000P) was performed on central corneas and endothelial images were acquired. Endothelial cell density, area and cell counts were analyzed.RESULTSEndothelial cell density was 2959 ± 236 cells/mm2 in healthy controls and 2757 ± 262 cells/mm2 in patients with POAG. The POAG eyes had significantly lower endothelial cell density compared to healthy control eyes (P < 0.001). In the POAG group, endothelial cell density was 2686 ± 233 cells/mm2 in the patients receiving medication and 2856 ± 272 cells/mm2 in the untreated subgroup. The eyes receiving medication had significantly lower endothelial cell density compared to untreated eyes. There was a negative correlation between cell density and mean IOP (r = −0.286, P = 0.004), positive correlation between the average cell area and mean IOP (r = 0.228, P = 0.022), maximum cell area and mean IOP (r = 0.218, P = 0.029) and minimum cell area and mean IOP (r = 0.290, P = 0.003). The percentage of hexagonal cells was not correlated with mean IOP.CONCLUSIONPatients with POAG have lower corneal endothelial cell density than healthy controls of the same age. This may be attributed to mechanical damage from elevated IOP and toxicity of glaucoma medications.

Corneal Endothelial Cell Loss and Morphometric Changes 5 Years after Phacoemulsification with or without CyPass Micro-Stent

To characterize long-term changes in corneal endothelial cells after phacoemulsification with or without supraciliary Micro-Stent (Alcon) implantation in eyes with open-angle glaucoma (OAG) and visually significant cataract. Three-year safety extension of a 2-year randomized clinical trial. Patients from the multicenter Study of an Implantable Device for Lowering Intraocular Pressure in Glaucoma Patients Undergoing Cataract Surgery (COMPASS) trial who underwent Micro-Stent implantation plus phacoemulsification (n= 282) or phacoemulsification alone (n= 67) were analyzed post hoc. Specular microscopy was used to assess endothelial cell loss (ECL), including changes from baseline in endothelial cell density (ECD), coefficient of variation, and percentage of hexagonal cells. Preoperative ECDs in the microstent group (2,432.6 cells/mm2 [95% confidence interval [CI], 2,382.8-2,482.4 cells/mm2]) were similar to those in the control group (2,434.5 cells/mm2 [95% CI, 2,356.5-2,512.4 cells/mm2]) groups. ECL at months 48 and 60 was greater in the Micro-Stent group than in the control group. At month 60, the mean percent of changes in ECD was-20.4% (95% CI,-23.5% to-17.5%) in the Micro-Stent group and-10.1% (95% CI,-13.9%to-6.3%) in the control group. No statistically significant between-group changes from baseline in cellular morphology were observed. Nine adverse events were possibly related to ECL, including 3 eyes with transient focal corneal edema and 4 eyes that required Micro-Stent trimming due to protrusion. In eyes with OAG, ECL after phacoemulsification is acute and stabilizes after 3months, whereas ECL after phacoemulsification plus Micro-Stent implantation proceeds for at least 5 years. Clinical findings associated with ECL in these eyes were uncommon (3.3% of implanted eyes), suggesting that ECL is generally a subclinical phenomenon.

Effect of Obstructive Sleep Apnea on Corneal Morphological Characteristics.

To determine central corneal thickness (CCT) and the corneal parameters in patients with obstructive sleep apnea (OSA), evaluate the relationship between the severity of OSA, minimum peripheral capillary oxygen saturation (min. SpO2), and corneal morphological characteristics. Patients with OSA diagnosed by full-night polysomnography before treatment were included. Patients with OSA were divided into 3 groups according to the Apnea-Hypopnea Index (AHI). The control group (CG) was examined to exclude the possibility of OSA and ocular diseases. The following data were recorded: age, sex, body mass index, ophthalmologic evaluation, and the results of polysomnography. A total of 114 eyes were studied: 74 eyes of patients with OSA and 40 eyes of the CG. The mean age was 57 ± 6 years. The mean values of CCT and endothelial cell density (ECD) varied significantly between the patients and the CG (P < 0.001). The mean values of CCT, ECD, cell variation coefficient (CV), and hexagonal cell percentage (HEX) in the group of patients with OSA were 535.28 ± 21.32 μm, 2632 ± 333, cells/mm. 31.8 ± 3.9, and 55.6 ± 6.9%, respectively. The mean CCT and ECD values for each group were lower than those for the CG. A significant negative correlation was found between CCT and ECD for AHI values (r = -0.390, P = 0.011 and r = -0.109, P = 0.040, respectively), and a weak positive correlation between CCT and ECD was found for min. SpO2 (r = 0.282, P = 0.020 and r = 0.332, P = 0.018, respectively). CV and HEX did not significantly differ between the groups and did not correlate with the results of polysomnography. Hypoxia is associated with significant changes in CCT and ECD. In patients with OSA, these parameters varied significantly when compared with the subjects in the CG. The severity of hypoxemia and the increase in AHI values reduce CCT and ECD in patients.

The effects of inflammation and anti-inflammatory treatment on corneal endothelium in acute anterior uveitis

Objective: To establish the magnitude of endothelial cells alterations in acute anterior uveitis (AAU) and the clinical impact of local anti-inflammatory treatment. Methods: 27 patients at first episode of unilateral AAU were included. According to the moment of presentation in our departments, two different groups were created, early treatment uveitis group (ETUG) and delayed treatment uveitis group (DTUG). Each patient underwent a corneal endothelial specular microscopy, in both eyes, two weeks after we begun the topical treatment. Results: A statistically significant endothelial cells loss in the uveitis eye was identified in both groups, more important in DTUG. Also, in this group, the pleomorfism, polimegathism and central corneal thickness (CCT) were statistically significant increased. Conclusions: The patients with unilateral AAU and delayed presentation showed more important alterations, first structural and then functional, due to a prolonged inflammatory response. This, in association with other favorable ocular conditions can progress to a permanent corneal endothelial decompensation. The sooner the anti-inflammatory treatment was initiated, the more limited were the destructive processes. Abbreviations: AAU = Acute Anterior Uveitis, ETUG = Early Treatment Uveitis Group, DTUG = Delayed Treatment Uveitis Group, CCT = Central Corneal Thickness, CV = Coefficient of Variation, ECD = Endothelial Cells Density, HEX = Percentage of Hexagonal Cells.

Assessment of corneal endothelial status post phacoemulsification with 1% ultrasound power in hard cataracts

Purpose: This study was conducted to discover that whether Co-axial micro incision cataract surgery using 1% ultrasound is superior to phacoemulsification using higher powers in terms of corneal endothelial safety over a period of one year. Materials and Methods: This comparative randomized study was conducted from 11-01-2014 to 03-31-2016. Patients with hard cataracts [5.0-6.9 of lens opacities classification system-III] were randomized into four groups and underwent cataract surgery using ultrasound powers of 1%, 5%, 10% and 20% respectively. Post-operatively they were assessed in terms of- corneal endothelial cell loss, co-efficient of variation of cell size, percentage of hexagonal cells and corneal thickness. The other parameters that were investigated were - frequency of significant posterior capsular opacification, best corrected visual acuity and Intraocular pressure variations. Results: This study found that application of 1% ultrasound power is superior to 5%, 10% or 20% power in phacoemulsification cataract surgery in terms of quantitative endothelial cell analysis (endothelial cell density, percentage of loss of endothelial cells, coefficient of variation, central corneal thickness and percentage of hexagonal cells) over one year follow up post-operatively. On comparison all parameters were found to be statistically significant when compared to the application of 20% power. Conclusion: Negative effects of ultrasound power (used in phacoemulsification) on corneal endothelial health have been well documented in the literature. We found that minimizing this power to 1% is effective in maintaining corneal endothelial viability without compromising the surgical experience and post-operative visual outcome. Keywords: 1% Ultrasound power, Coefficient of variation, Endothelial cell density, Percentage hexagonal cells, Phacoemulsification.

Corneal thickness and endothelial changes in long-term hydroxychloroquine use

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

How does occupational radiation exposure affect corneal endothelial cell density?

Objectives: To evalute the corneal endothelium ofradiology technicians. Methods: The study included 35 radiology technicians (study group), and 34 healthy individuals as the control group. Central corneal thickness (CCT), Endothelial cell density (ECD), the coefficient of variation (CoV), and the percentage of hexagonal cells (Hexa) were measured using specular microscopy (Konan Medical Inc., Nishinomiya, Japan). Results: The mean age of the study participants was 35.82 ± 9.34 years in the study group, and 37.82 ± 8.40 years in the control group (p = 0.332). The mean ECD was 2740.63 ± 249.92 cells/mm2 in the study group, and 2828.70 ± 287.40 in the control group (p &amp;gt; 0.05). The mean CoV was 44.34 ± 6.78 % in the study group, and 44.24 ± 4.99 % in the control group (p &amp;gt; 0.05). Hexa was determined as 44.97 ± 7.98% in the study group, and 45.97 ± 7.06% in the control group (p &amp;gt; 0.05). The mean CCT was 511.50 ± 42.52 in the study group, and 514.18 ± 43.55 in the control group (p &amp;gt; 0.05). The mean ECD, CoV, Hexa, and CCTvalues were not statistically significant (p &amp;gt; 0.05). Conclusion: This study revealed that endothelial cell density, the coefficient of variation, and percentage of hexagonal cells (Hexa) were not statistically different between the radiology technicians and control group. Nevertheless, there is a need for more comprehensive, controlled studies with larger samples.