Percentage Of Endothelial Cell Loss Research Articles

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

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

Optimization of phacoemulsification technique for Morgagnian cataract

This study was conducted to develop a new optimized phacoemulsification technique for Morgagnian cataract taking into account the anatomical and topographic parameters of the lens nucleus. A working classification of Morgagnian cataract was developed based on the size of the nucleus: if the edge of the nucleus is visualized at the upper edge of the pupil or between the upper edge and the middle of the pupil, it was classified as an initial stage of Morgagnian cataract with a large nucleus; if the upper edge of the nucleus is visualized in the middle of the pupil and below, it was classified as an advanced stage of Morgagnian cataract with a small nucleus. The first group included six patients who underwent surgery using the scaffold technique with removal of the whole small nucleus into the anterior chamber. The second group included 11 patients who underwent surgery using the scaffold technique with removal of the last fragment of the nucleus into the anterior chamber. The use of the scaffold technique with removal of the nucleus into the anterior chamber helped reduce the number of intraoperative complications to 16.7% in the first group, compared to 27.3% in the second group, and the percentage of endothelial cell loss to 10.1% in the first group, compared to 10.7% in the second group. The anatomical and topographic features of the lens and the anterior segment of the eye in Morgagnian cataract with a small nucleus allow for preliminary implantation of an intraocular lens into the capsular bag to protect the posterior capsule during phacoemulsification of the nucleus with minimal mechanical, hydrodynamic and acoustic damage to the surrounding structures of the eye.

Оценка выживаемости трансплантата после ФЛ-ЗПК (FS-DSEK) у пациентов с глаукомой

Purpose. To evaluate the graft survival in the dynamics of the postoperative period of FS-DSEK in patients with concomitant glaucoma. Material and methods. In total 52 eyes were operated, 32 of them with glaucoma compensated by medication (1st group), 8 with glaucoma operated by implantation of the Ahmed valve model FP8 (2nd group) and 12 with glaucoma operated by microinvasive non-penetrating deep sclerectomy with implantation of collagen antiglaucoma drainage (3rd group). All patients have a follow-up of 12 months. Results. By 1 year, the «cornea + graft» complex retained its transparency in group 1 in 84.4% of eyes (27 out of 32 eyes), in group 2 in 87.5% of cases (7 out of 8 eyes), in group 3 in 75% of cases (9 out of 12 eyes). The highest percentage of endothelial cell loss at 12 months was observed in 2nd group (Ahmed valve) – 45,4±19,5%. In other groups, endothelial cell loss was 41,8±9,1% (group 3) and 39,6±15,2% (1st group). Conclusion. Clinical results show a lower percentage of graft survival after FS-DSEK in the operated glaucoma groups. Accumulation of clinical material and further study of patterns are required. Key words:posterior lamellar keratoplasty, glaucoma, femtosecond laser, endothelial corneal dystrophy

Morphological Changes in the Endothelium of Cornea after Cataract Surgery: A Comparison between Phacoemulsification and Manual Small Incision Cataract Surgery

Background: Endothelial cell loss and corneal decompensation after cataract surgery is well-documented. After endothelial cell loss, the adjacent cells enlarge and slide over to maintain endothelial cell continuity, which is observed as a change in the endothelial cell density and morphology of the cornea. Objective: The study aims to assess and compare morphological changes (i.e., endothelial cell loss) in cornea after phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation and manual small incision cataract surgery (MSICS) with PCIOL implantation. Methods: This observational study was conducted in the Department of Ophthalmology of Combined Military Hospital (CMH), Dhaka Cantonment, Dhaka, Bangladesh, between January and July of 2016. A total of 80 patients of age-related cataract were randomly selected based on inclusion and exclusion criteria. All patients underwent complete ophthalmic evaluation pre- and post-operatively (at day 1, after 1 week and 3 months) specifically for observation of the endothelial changes in cornea. Specular microscopy was done to assess corneal endothelial change. Results: The mean endothelial cell count was found decreased at day 1 (2585.07±355.65/mm2 vs. 2598.07±385.76/mm2), after 1 week (2564.72±347.23/mm2 vs. 2388.77±326.46/mm2) and after 3 months (2476.72±346.69/mm2 vs. 2248.77±354.47/mm2) following phacoemulsification and MSICS from their preoperative values (2745.35±395.27/mm2 vs. 2673.04±388.28/mm2) respectively. However, no significant difference was observed in mean endothelial cell count of both groups (P>0.05). The mean percentage of endothelial cell loss were observed 5.84±10.02% and 2.80±0.65% at day 1, 6.58±12.15% and 10.63±15.92% at 1 week, 9.78±12.29% and 15.87±8.71% at 3 months after phacoemulsification and MSICS. However, the difference observed in amount of endothelial cell loss between the groups was not statistically significant (P>0.05). Conclusion: To summarize, a decreased endothelial cell count was observed after cataract surgery in both phacoemulsification and MSICS procedures from their preoperative values respectively. However, the difference was not significant between two procedures. Mugda Med Coll J. 2023; 6(1): 11-15

Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery

BackgroundIntracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®).MethodsAn observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis.ResultsThe median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds.ConclusionsThe endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.

Comparison of Long-Term Outcomes of DSEK and DMEK in Fuchs Endothelial Dystrophy.

This study aimed to compare the long-term endothelial cell loss, graft survival, and clinical outcomes in patients with Fuchs endothelial dystrophy (FED) after Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK) using a standardized surgical protocol. Three hundred and six consecutive DSEK and DMEK grafts of 223 patients with FED performed by 8 surgeons between January 2006 and August 2022 were analyzed. The primary outcome measures were graft survival, endothelial cell loss, and best spectacle-corrected visual acuity. At 5 years, graft survival was 96% for both DSEK and DMEK eyes. The mean percentage of endothelial cell loss was 57.7 ± 17.1 in DSEK and 56.8 ± 15.2 in DMEK eyes ( P = 0.430). The mean best spectacle-corrected visual acuity was 0.13 ± 0.14 logMAR in DSEK and 0.01 ± 0.18 logMAR in DMEK grafts ( P <0.00001) at 5 years postoperatively. Rebubbling was performed in 7.8% DSEK and 2.1% DMEK grafts ( P = 0.441). Cox regression identified rejection episodes (HR 6.5; 95% CI: 1.70-24.8; P = 0.0062) as a significant contributing factor for graft failure. DMEK had superior visual acuity outcomes compared with DSEK in these patients up to 5 years after surgery. At 5 years, there was no significant difference in graft survival or endothelial cell loss between DSEK and DMEK eyes with FED. We propose that our standardized technique reduces the need for rebubbling.

Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review.

This meta-analysis aims to compare corneal injuries and function after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). A comprehensive literature search of PubMed, EMBASE, and the Cochrane Controlled Trials Register was conducted to identify randomized controlled trials (RCT) and high-quality prospective comparative cohort studies comparing FLACS with CPS. Endothelial cell loss percentage (ECL%), central corneal thickness (CCT), endothelial cell density (ECD), endothelial cell loss (ECL), percentage of the hexagonal cell (6A), and coefficient of variance (CoV) were used as an indicator of corneal injury and function. Totally 42 trials (23 RCTs and 19 prospective cohort studies), including 3916 eyes, underwent FLACS, and a total of 3736 eyes underwent CPS. ECL% is significantly lower in the FLACS group at 1-3 days (P = 0.005), 1 week (P = 0.004), 1 month (P<0.0001), 3 months (P = 0.001), and 6 months (P = 0.004) after surgery compared to CPS. ECD and ECL appeared no statistically significant difference between the two groups, except for the significant reduction of ECD at 3 months in the CPS group (P = 0.002). CCT was significantly lower in the FLACS group at 1 week (P = 0.05) and 1 month (P = 0.002) early postoperatively. While at 1-3 days (P = 0.50), 3 months (P = 0.18), and 6 months (P = 0.11), there was no difference between the FLACS group and the CPS group. No significant difference was found in the percentage of hexagonal cells and the coefficient of variance. FLACS, compared with CPS, reduces corneal injury in the early postoperative period. Corneal edema recovered faster in the FLACS group in the early postoperative period. In addition, FLACS may be a better option for patients with corneal dysfunction.

Corneal endothelial cell changes after phacoemulsification cataract surgery in eyes with different anterior chamber depth: A specular microscopy study

Background: Phacoemulsification surgery is performed in a limited space, therefore, anatomy and procedural parameters, such as sufficient anterior chamber depth (ACD), are essential for protecting endothelial cells during surgery from mechanical and heat damage. Specular microscope is a useful non-contact investigational technique that photographs the human corneal endothelium. Methods: This a prospective comparative cohort non-randomized study included sixty eyes of phacoemulsification cataract surgery were collected from the outpatient clinics of Tanta University Hospitals and were admitted to Ophthalmology Department. Cases were divided into three groups according to ACD. All cases were subjected to: history taking, examination [visual acuity (VA), slit lamp examination, ACD measurement using IOL master, and Specular microscopy.Results: The percentage of endothelial cell loss was much increased in the group A than in the group There was statistically significant increase in the mean CCT in the three groups post-operatively at 1week and 1month compared to pre-operative mean CCT. However, there was no notable differences in CCT among the three groups. There was no notable differences in Coefficient of variation (CV) among the three ACD groups over the entire study period.Conclusions: taking in consideration the ACD as a very important prognostic factor to be considered before phacoemulsification cataract surgery. Eyes with shallow ACs can be vulnerable to more corneal endothelial cell loss during phacoemulsification surgery.

Correlation between recipient age and visual acuity after Descemet’s membrane endothelial keratoplasty in Fuchs endothelial dystrophy

Abstract Objectives: To analyze the correlation between the recipient’s age and best corrected distance visual acuity (BCDVA) after Descemet’s membrane endothelial keratoplasty (DMEK). Materials and Methods: Design: Retrospective study. Setting: Institutional, tertiary care eye hospital. Study Population: All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuchs Endothelial Dystrophy, using a standardized protocol between August 2016 and July 2021, were included. Previous glaucoma surgery, aphakia, or complicated pseudophakia were excluded. Main Outcome Measures: Primary outcomes: Recipient’s age versus BCDVA. Secondary outcomes: Age versus uncorrected distance visual acuity (UCDVA), graft detachment (GD) versus rebubbling rates, and versus percentage endothelial cell loss (ECL) at 6 months. Data were analyzed using Pearson’s correlation analysis. Results: 104 eyes of 72 patients were included. The average age in this study was 71.13 ± 10.41 years (44–88 years). There was a significant and positive correlation between age versus BCDVA and UCDVA. However, there was no correlation between age and GD, rebubbling, and percentage of ECL at 6 months. Conclusions: Uncorrected and best-corrected distance visual acuities are better at younger ages after DMEK in Fuchs endothelial keratoplasty. Age was positively correlated with the best-corrected distance visual acuity after DMEK for Fuchs endothelial dystrophy when performed with the same technique.

Comparison of Graft Outcomes Reusing Original Intermediate-Term Cold Storage Solution for Entire Corneal Donor Storage Period With Exchanged Fresh Storage Solution After Donor Preparation in the Cornea Preservation Time Study.

The purpose of this study was to evaluate outcomes of Descemet stripping automated endothelial keratoplasty comparing exchange with fresh intermediate-term cold storage solution after lenticule preparation versus reuse of the original solution in the Cornea Preservation Time Study. In the Cornea Preservation Time Study, 508 donor corneas had lenticules prepared by the eye bank with fresh solution exchange (Fresh group) and 283 with reuse of the original solution (Original group). Storage time for all donors was ≤11 days. Graft success rates, central endothelial cell loss at 3 years, and frequency of positive donor rim cultures were compared between the 2 groups. The 3-year graft success rate (95% confidence interval) was 93.4% (90.7%-95.3%) in the Fresh group and 95.2% (91.8%-97.2%) in the Original group (adjusted hazard ratio for graft failure = 0.64, 95% confidence interval, 0.33-1.24, P = 0.19). The mean percentage endothelial cell loss was significantly greater in the Fresh group versus Original group (45% ± 22% vs. 38% ± 20%, respectively, P = 0.004). Cultures were positive in 4 (1.5%) of 267 donor rims (3 fungal and 1 bacterial) in the Fresh group and in 4 (2.5%) of 158 in the Original group ( P = 0.57). There were 2 postoperative infections in the Original group and none in the Fresh group. The use of the original intermediate-term cold storage solution did not reduce the 3-year graft success rate compared with exchanging with fresh solution after lenticule preparation for Descemet stripping automated endothelial keratoplasty, while the frequency of positive donor rim cultures did not significantly differ between groups.

Tuck-in deep anterior lamellar keratoplasty for the management of post-radial keratotomy keratectasia.

To evaluate the outcomes of tuck-in deep anterior lamellar keratoplasty (DALK) for the management of post-radial keratotomy (RK) keratectasia. Institution. Retrospective. Medical records of all cases presenting with post-RK keratectasia from January 2012 to December 2019 were included. Data on corrected distance visual acuity (CDVA), refraction, keratometry, ultrasonic pachymetry, corneal topography, endothelial cell count, applanation tonometry, and dilated fundus examination recorded at all follow-up visits were included. Details of surgical steps, including intraoperative and postoperative complications and any secondary procedures performed subsequently, were also recorded. 7 eyes of 5 patients that developed corneal ectasia after a previous RK procedure underwent DALK with peripheral tuck-in. All eyes had CDVA ≤6/24, preoperatively. The surgical procedure was successfully performed in all eyes without any intraoperative complications. CDVA at the final follow-up ranged between 6/9 and 6/60, with 6 eyes achieving CDVA of 6/18 or better. The median keratometric cylinder reduced from a preoperative value of 7.2 ± 9.27 diopters (D) to 2 ± 1.83 D at the final follow-up. The median central corneal thickness at the final follow-up was 598 ± 40.01 μm, and spherical equivalent ranged between -1.75 D and -3.5 D (median -2 ± 0.57). The percentage of endothelial cell loss ranged between 2.1% and 8.4%. All eyes retained graft clarity, and none showed any evidence of significant interface haze or corneal vascularization. Tuck-in DALK could successfully address corneal ectasia developing after RK, achieving visual gains. Moreover, it was able to restore the peripheral corneal thickness with a minimal risk for dehiscence of RK incisions.

OP-2 Long-term outcomes of rebubbling and graft detachment in Descemet membrane endothelial keratoplasty using a standardised protocol.

176 consecutive DMEK grafts of 125 patients performed by 8 surgeons with a standardised technique between January 2015 and January 2022 were analysed. Main outcome measures were graft detachments, rebubbling rate, postoperative outcomes, and risk factors for graft failure and rebubbling. 6 (3.4%) grafts required rebubbling (<1/3 detached). 41 (23%) grafts developed self-resolving partial detachments (<1/3detached). 5-year graft survival were 96%, 87%, and 83% in fully attached, partially detached and rebubbled eyes. Mean best spectacle corrected visual acuity (BSCVA) at last follow-up were 0.00±0.34, 0.14±0.25, and 0.18±0.19 logMAR (p=0.266) in fully attached, partially detached and rebubbled eyes. Percentage endothelial cell loss (ECL) was 57.5±14.1, 57.9±14.2, and 68.8±8.8 (p=0.035) in fully attached, partially detached and rebubbled eyes. Graft failure occurred in 9 (5.1%) eyes: 3 grafts had primary failure, 2 had early failure (<3 months), 2 had late failure (<12 months), and 2 grafts did not fully unfold intraoperatively. Intraoperative trauma (score) was a risk factor for graft failure (HR 1.81; 95% CI: 1.33 - 2.50 (p=0.0229)). Indication for surgery was a risk factor for rebubbling (HR 5.28; 95% CI: 5.11 - 72.4 (p=0.00703)). DMEK grafts had better graft survival if there was no partial detachment or rebubbling up to 5 years postop. There was significant ECL associated with rebubbling. A standardised technique reduces rebubbling and graft failure risk.

Long-term results of artisan phakic intraocular lens in Egyptians

Purpose The aim of this study was to assess the long-term results of a sample of myopic Egyptian patients implanted with Artisan phakic intraocular lenses (PIOL).Patients and methods This is a retrospective longitudinal study that used data from 52 eyes of 28 patients implanted with anterior chamber iris-fixated Artisan PIOL. The postoperative assessment included refractive status, uncorrected visual acuity and best-corrected visual acuity, endothelial cell count, and the occurrence of complications for up to 15 years postoperatively.Results Higher postoperative uncorrected visual acuity (mean=0.519±0.195) and best-corrected visual acuity (mean=0.706±0.199), with improved spherical equivalent (from −12.06±2.004 to −0.74±0.9 D) and decreased endothelial cell count were all found to show statistically significant differences (P=0.007, 0.000, 0.000, and 0.007, respectively) when compared with the preoperative values. Males had a tendency for higher endothelial cell loss. The preoperative anterior chamber depth was correlated negatively with the endothelial cell loss percentage (P=0.019). An average yearly loss of 2.58% of endothelial cells was recorded following surgery. Few complications were recorded including cataract, glaucoma, and corneal decompensation.Conclusion Long-term results of Artisan PIOL implantation in Egypt showed a statistically significant visual improvement and good refractive correction with few complications but with significant endothelial cell loss.

Qualitative Alterations on Corneal Endothelial Cell Morphometry and Hexagonality After Cataract Surgery.

AimTo deeply analyze quantitative and qualitative changes of corneal endothelium after longitudinal phacoemulsification.MethodsIn this prospective interventional case series study, 50 eyes with age-related cataract have been evaluated preoperatively, intraoperatively and postoperatively. The measured parameters were surgically induced endothelial cell loss (ECL), average endothelial cell area (AVG) and hexagonality (HEX).ResultsThe relationship among the measured parameters and the energy dissipated during the two phases of phacoemulsification, sculpting and quadrant removal, has been analyzed with regard to the 5-score harm scale, a new method suggested to categorize cataracts. Two phases of phacoemulsification are linearly related (r = 1.5, P < 0.001, r2 = 79%). Plus, a quadratic model described the correlation between the percentages of ECL and AVG (P < 0.0001), while there was no specific model for the correlation between ECL and HEX.ConclusionThe 5-score harm scale allows to predict the mean changes in percentages of ECL, AVG and HEX of endothelial cells after longitudinal phacoemulsification. Also, this study confirms that the main damage on corneal endothelium is due to the energy delivered in the second phase of phacoemulsification.

Severe Corneal Edema Increases ECL From Grafts After DSAEK-Corneal Edema and ECL After DSAEK.

Objectives:To determine the relationship between the preoperative degree of corneal edema in the recipient and the endothelial cell density in grafts after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods:This retrospective case series enrolled 111 eyes of 107 patients who underwent DSAEK. The preoperative and postoperative central corneal thickness (CCT) was measured by anterior-segment optical coherence tomography. Eyes were divided into three groups according to the preoperative recipient CCT: group A (mild edema): 550 μm<CCT≤750 μm, n=38; group B (moderate edema): 750 μm<CCT≤900 μm, n=51; and group C (severe edema): 900 μm<CCT≤1,500 μm, n=22. The endothelial cell loss (ECL) was calculated by in vivo confocal microscopy and compared at 1, 6, 12, and 24 months after surgery.Results:The recipient CCT (all groups combined) was 805.99±132.70 μm preoperatively and decreased to 656.31±105.02 μm at 1 month, decreased to 626.08±81.40 μm at 6 months, and remained stable between 12 (P=0.144) and 24 months (P=0.485) postoperatively. The mean ECL was 27.34±15.43%, 33.56±17.13%, 39.18±16.71%, and 45.87±14.27% at 1, 6, 12, and 24 months, respectively. The percentage of ECL in group C was higher than that in the other 2 groups through the 24-month follow-up. The difference in ECL between groups A and C was significant at 24 months (group A: 42.45±14.47%; group C: 52.49±10.65%; P=0.019).Conclusions:The degree of corneal edema in the recipient was associated with implant ECL. Compared with mild and moderate corneal edema, the severe corneal edema may cause greater ECL after DSAEK.

Long-term Outcomes of Descemet Stripping Endothelial Keratoplasty: Ten-Year Graft Survival and Endothelial Cell Loss

To determine 10-year outcomes for graft and endothelial cell survival after Descemet stripping endothelial keratoplasty (DSEK), including risk factors for graft failure. Retrospective clinical cohort study. Three hundred fifty-six consecutive DSEK grafts performed by 10 surgeons using a standardized protocol were analyzed. Primary outcomes were cumulative graft survival and percentage endothelial cell loss (ECL) from 6 months to 10 years; secondary outcomes included risk factors for graft failure, postoperative complications, visual outcomes, and central corneal thickness. Indications include Fuchs endothelial dystrophy (n=209), bullous keratopathy (n=88), and previous graft failure (n=39). One hundred and four eyes (29%) had preoperative glaucoma. Cumulative graft survival rates of all eyes at 1, 3, 5, and 10 years were 97%, 90%, 85%, and 79%, respectively. Ten-year graft survival for Fuchs endothelial dystrophy was 92%. Mean ± SD percentage ECL of all grafts was 46.6% ± 17.3% at year 1, 54.9% ± 18.7% at year 3, 59.6% ± 17.4% at year 5, and 73.1% ± 9.7% at year 10. Cox regression identified preoperative glaucoma (hazard ratio [HR]: 8.41; 95% CI, 1.30-54.5; P=.026), including previous glaucoma surgery (HR: 3.63; 95% CI: 1.03-12.74; P=.04) and regrafts (HR: 5.29; 95% CI: 2.02-13.89; P=.001) as significant risk factors for graft failure. At 10 years, DSEK survival rate was 79% for all eyes, including complex grafts, and ECL was 73%. For Fuchs endothelial dystrophy, 10-year graft survival rate was 92%. Despite a mean 10-year endothelial cell count of only 692 cells/mm2, graft survival remained high with good vision. DSEK continues to be a viable treatment option, especially in complex eyes with comorbidity.

Corneal endothelial cell loss after trabeculectomy and phacoemulsification in one or two steps: a prospective study

ObjectiveThe objective of this study was to analyse the results of the surgical treatment of coexisting cataract and glaucoma and its effects on corneal endothelial cell density (CECD).MethodsWe include two longitudinal prospective studies: one randomised that included 40 eyes with open angle glaucoma that received one- (n = 20) or two-step (n = 20) phacotrabeculectomy and another that included 20 eyes that received phacoemulsification. We assess the impact of surgery on different clinical variables and in particular in CECD using Confoscan 4™ confocal microscopy and semiautomatic counting methods.ResultsPhacoemulsification and phacotrabeculectomy, but not trabeculectomy, increase significantly best-corrected visual acuity and anterior chamber depth and trabeculectomy and one- or two-step phacotrabeculectomy decreased similarly the intraocular pressure. We document percentages of endothelial cell loss of 3.1%, 17.9%, 31.6% and 42.6% after trabeculectomy, phacoemulsification and one- or two-step phacotrabeculectomy, respectively. The coefficient of variation did not increase significantly after surgery but the percentage of hexagonality decreased significantly after phacoemulsification and after two-step phacotrabeculectomy.ConclusionsTrabeculectomy, phacoemulsification and phacotrabeculectomy are surgical techniques that cause morphological changes and decrease the densities of the corneal endothelial cells. Trabeculectomy produces lesser endothelial cell loss than phacoemulsification, and phacoemulsification lesser cell loss than phacotrabeculectomy. Two-step phacotrabeculectomy (trabeculectomy followed 3 months later by phacoemulsification) causes more cell loss than one-step phacotrabeculectomy, and this could be due to the cumulative effects of two separate surgical traumas or to a negative conditioning lesion effect of the first surgery. For the treatment of coexisting glaucoma and cataract, one-step phacotrabeculectomy is the treatment of choice.

Effect of Intracameral Injection of Preservative Free, Fixed Concentration of Combined Mydriatic plus Anaesthetic Formulation on Corneal Endothelial Cell Count in Phacoemulsification

Purpose: To evaluate the efficacy and safety of intracameral injection of a standardized combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% on corneal endothelial cell count at phacoemulsification. Methods: In this prospective randomized controlled study, 30 eyes of 30 patients undergoing phacoemulsification were assigned to 2 groups. 15 eyes (Intracameral Group A) received 0.2ml of a combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% just after the first incision. While 15 eyes (Group B) received a topical regimen of one drop of each of cyclopentolate hydrochloride 1% and tropicamide 1%, every 15min for 1hour preoperatively. The main outcome measures were safety on corneal endothelium, by comparing the preoperative and 3 weeks postoperative corneal endothelium cell count in the two groups. Efficacy was also evaluated by measuring pupil size before capsulorhexis and before intraocular lens implantation, in both groups. Results: There was no significant statistical difference in the percentage of endothelial cell loss between the Groups A (27.4%) and the reference Group B (25.7%), with P value (0.595). Regarding Pupillary dilatation, adequate dilatation (&gt;7.4mm) was achieved in both groups. Dilatation was maintained to the end of operation in the Fydrane group, while in the reference group, reduction in pupillary dilatation occurred in 20% (3 cases) reaching pupil diameter 5.5mm before IOL implantation. Conclusions: This study showed that intracameral injection of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1% is safe on corneal endothelium and effective in maintaining pupillary dilatation throughout the surgery

Evaluation of various preservation media for storage of donor corneas.

Purpose:To compare the physical and microbiological characteristics of McCarey-Kaufman (MK), Cornisol, and Optisol-GS media and evaluate the outcomes of keratoplasty performed using corneas stored in these three media.Methods:The study involved 60 donor corneas which were distributed in 3 groups: MK, Cornisol, and Optisol-GS. Corneas in these groups were further analyzed based on the type of keratoplasty performed (full thickness versus endothelial keratoplasty). At baseline, the endothelial cell density and death to preservation time of donor corneas were recorded. Following keratoplasty, patients were evaluated on day 1, at 1 month, 3 months, and 6 months follow-up. Outcomes were assessed in terms of corrected distance visual acuity (CDVA), endothelial cell density, percentage endothelial cell loss, and corneal thickness. The storage media were also assessed for their physical quality and their microbiological characteristics.Results:Physical characteristics of all three media were found to be within normal limits. Mean CDVA was comparable among the 3 groups at 6-month follow-up. The absolute endothelial cell count values were significantly lower for corneas stored in MK medium (1873.7 ± 261.1 cells/mm2) compared to the Cornisol (2085.0 ± 230.3 cells/mm2) and Optisol-GS media [(2180.3 ± 217.2 cells/mm2) (P = <0.001)]. Corneas stored in Optisol-GS medium were significantly thinner at 1-month follow-up with no significant difference at 6 months (P = 0.66).Conclusion:Optisol-GS and Cornisol media were found to preserve endothelial cell density better and stabilize corneal thickness earlier as compared to the MK medium. However, the functional outcomes were comparable among the three groups.

Descemet Stripping Automated Endothelial Keratoplasty

The purpose is to determine if the preoperative central endothelial cell density (ECD) in triple (phacoemulsification plus intraocular lens implantation plus DSAEK) and non-triple Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) procedures have a relationship with the 5-year postoperative ECD or percent Endothelial Cell Loss (ECL).Out of 986 consecutive DSAEK surgeries for Fuchs dystrophy, 241 eyes had 5-year ECD measurements available. Endothelial cell densities were then evaluated against preoperative ECDs to obtain measures of ECL. Triple and non-triple procedures were isolated and compared independently.One hundred eighty two eyes had undergone a triple procedure and 59 had not. The mean ECD at 5 years was 1560 ± 648 cells/mm2 for triples and 1483 ± 621 cells/mm2 for non-triples (P = .42). Endothelial Cell loss was 44.4% ± 21.7% and 44.4% ± 22.0%, respectively for eyes that underwent a triple or non-triple (P = .99). There was a moderate, but significant correlation between preoperative ECD and the ECD at 5 years after DSAEK for both triples (r = 0.39, P < .001), and non-triples (r = 0.32, P = .01), respectively.In Descemets stripping automated endothelial keratoplasty grafts, higher preoperative donor ECD was correlated with higher ECD at 5 years postoperatively but was unaffected by a concurrent cataract surgery in the triple procedure.