Reduction In Endothelial Cell Density Research Articles

Corneal Endothelial Cell Changes in Type 2 Diabetic Patients

Background: Diabetic eye disease is an end-organ response to the effects of the condition on the human system. The cornea is a transparent structure protecting the anterior one-sixth of the eye. Chronic hyperglycemia can affect the corneal layers shape and functions that responsible for corneal transparency. Objectives: Comparison of the changes in corneal endothelium namely, cell density (CD), percentage polymegathism, cell volume (CV) and pleomorphism (6A) along with central corneal thickness (CCT) in patients of type 2 diabetes mellitus with normal age and sex- matched subjects. Patients and methods: A case-control study in Sayed Galal University Hospital. 20 eyes of type 2 diabetic patients and 20 eyes of age and sex matched controls were included in the study. Age, gender, other demographic data, and relevant diabetic history were obtained. Full evaluation of both cases and controls including both anterior and posterior segment complete evaluation was done. Non- contact specular microscopy was used to study the corneal endothelial cells. Results: The mean endothelial cell density (ECD) was non-significantly lower in type 2 diabetics compared to controls (p value = 0.751.). There was a highly significant reduction in hexagonally in the cases compared to controls and highly significant increase in coefficient of variation in the cases compared to controls Conclusion: This study acknowledged that type 2 diabetes causes a significant decrease of hexagonality and increase CV (polymegathism). However, non-significant reduction of ECD was documented

Association of Iris Damage With Reduction in Corneal Endothelial Cell Density After Penetrating Keratoplasty.

To evaluate the effect of iris damage on endothelial cell loss in the early phase after penetrating keratoplasty (PKP). This prospective consecutive study included 74 patients who underwent PKP without graft rejection during the follow-up period. Endothelial cell density (ECD) was measured using specular microscopy at 1, 3, 6, and 12 months after PKP. Iris damage scores (IDSs) were determined on the basis of slit-lamp microscopy or anterior segment optical coherence tomography imaging. Graft survival rates were compared among the different IDSs. Using multivariate analysis, the factors influencing postoperative ECD were assessed, taking into consideration the presence of glaucoma, history of graft failure, donor age, and graft ECD as independent variables. Graft ECD decreased from 2674 ± 329 cells/mm to 2114 ± 570 at 1 month, 1907 ± 629 at 3 months, 1669 ± 738 at 6 months, and 1404 ± 792 at 12 months (all, P < 0.0001). ECD at 12 months was associated with the IDS (β = -0.444, P < 0.0001), graft ECD (β = 0.309, P = 0.003), and history of graft failure (β = -0.251, P = 0.016). The IDS was significantly correlated with %ECD loss at 1 month (r = 0.427, P = 0.003), at 3 months (r = 0.376, P = 0.002), at 6 months (r = 0.301, P = 0.013), and at 12 months (r = 0.517, P < 0.0001). The graft survival rates in eyes with severe iris damage were significantly lower than those in eyes with either no or mild iris damage (P < 0.0001). Severe iris damage is associated with rapid reduction in ECD and graft endothelial failure after PKP.

Randomised Clinical Trial for Postoperative Complications after Ex-PRESS Implantation versus Trabeculectomy with 2-Year Follow-Up

We compared complications between Ex-PRESS implantation and trabeculectomy for 2 years after surgery. Sixty-four open-angle glaucoma eyes were randomly assigned to treatment with trabeculectomy (n = 32) or Ex-PRESS implantation (n = 32). The primary outcomes were postoperative complications, including reduction of the endothelial cell density (ECD) of the cornea, cataract progression and the frequency of other late postoperative complications. The Ex-PRESS group had significantly greater reduction of postoperative corneal ECD than the trabeculectomy group did at 2 years after surgery (P = 0.026). Among the corneal areas measured using specular microscopy, the superior area, where the Ex-PRESS tube was inserted, had significantly more severe corneal ECD reduction than the inferior area after 2 years (−17.6% in superior area and −11.7% in inferior area, P = 0.04). More cataract progression occurred in the trabeculectomy group than in the Ex-PRESS group (P = 0.04). Twelve eyes (37.5%) in the trabeculectomy group and 4 eyes (12.5%) in the Ex-PRESS group underwent cataract surgery (P = 0.019). The total number of other postoperative complications between 3 months and 2 years was significantly higher in the trabeculectomy group than in the Ex-PRESS group (P = 0.02). Although Ex-PRESS implantation might be associated with an increased rate of corneal endothelial cell loss compared with trabeculectomy, it is beneficial for preventing cataract progression after filtering surgery.

CORNEAL CHANGES IN A SAMPLE OF PSEUDOEXFOLIATION IRAQI PATIENTS

Background: Pseudoexfoliation syndrome is a common eye disorder that can affect different parts of the eye causing significant morbidity. Objective: To compare corneal endothelial changes between patients with pseudoexfoliation syndrome and normal age matched patients. Methods: Specular microscopy was used to measure central corneal thickness, average size of endothelial cells and coefficient of variation in cell area, endothelial cell density, as well as hexagonality of 238 eyes from 238 patients (120 eyes from patients with pseudo exfoliation syndrome and 118 eyes from normal age-matched patients). Results: Patients with pseudoexfoliation syndrome had lower central corneal thickness (p value 0.049) compared to the control (491.6±28.86 vs 502.5±35.77 µm), lower endothelial cell density (p value 0.02) compared to control (2458.9±430.8 vs 2585.3±378.8 cell/mm2), lower hexagonality (P value 0.006) compared to control (48.25±18.76 vs 55.06±12,44), also a significantly higher coefficient of variation (p value 0.046) compared to control (36.15±7.381 vs 33.4±6.22). Conclusion: Pseudoexfoliation syndrome is associated with a significant change in the corneal endothelium, including reduction of endothelial cell density, increased variation of cells shape (pleomorphism) and increased variation of cells area (polymegathism). There was a significant change of central corneal thickness. Keywords: Corneal endothelium, specular microscopy, pseudoexfoliation syndrome, central corneal thickness Citation: Rasheed AM, Kadum DJ. Corneal changes in a sample of pseudoexfoliation Iraqi patients. Iraqi JMS. 2018; 16(3): 232-238. doi: 10.22578/IJMS.16.3.2

Effect of dexamethasone intravitreal implant (Ozurdex\xae) on corneal endothelium in retinal vein occlusion patients

BackgroundTo assess corneal endothelial cell changes after intravitreal dexamethasone (DEX) implant (Ozurdex®) injection in patients with macular edema secondary to retinal vein occlusion (RVO).MethodsTwenty-two eyes of 22 patients were assessed prospectively after intravitreal 0.7 mg DEX implant injection. Twenty-two eyes of 22 healthy volunteers served as control group. Corneal endothelial cell parameters including endothelial cell density (ECD), coefficient of variation of cell size (CV), percentage of hexagonality (Hex) and central corneal thickness (CCT) were analyzed before and 1 and 3 months after injection by specular microscopy. The results of the study were compared statistically.ResultsThere were 17 (77.3%) patients with branch RVO and 5 (22.7%) patients with central RVO. Mean intraocular pressure (IOP) was 14.73 mmHg before injection, 17.05 mmHg at 1 month and 17.15 mmHg at 3 months after injection. Mean IOP at 1 and 3 months were significantly higher than pre-injection value (p = 0.002 and p = 0.003, respectively). There was a statistically significant reduction in mean ECD at 3 months after injection compared to pre-injection and 1 month (p = 0.013, p = 0.009, respectively) in the injected eyes. Mean ECD showed no significant difference in the uninjected fellow eyes during the follow up (p>0.05). Mean CV and Hex did not reveal a statistically significant difference in injected and uninjected fellow eyes (p > 0.05). No significant change was observed in mean CCT values during the follow up (p = 0.8).ConclusionIntravitreal dexamethasone implant may cause a transient reduction in corneal endothelial cell density in short term without changing cell morphology.

Comparison of Standard Versus Accelerated Corneal Collagen Cross-Linking for Keratoconus: A Meta-Analysis.

To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen cross-linking (ACXL) for the treatment of keratoconus. PubMed, Embase, the Cochrane Library, and the US trial registry were searched for trials comparing SCXL and ACXL for keratoconus up to October 2017. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Primary outcomes were changes in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness (CCT), and endothelial cell density (ECD). Eleven trials were included. For primary outcomes, SCXL showed a greater reduction in Kmax (SMD 0.32; 95% CI 0.16, 0.48) than ACXL. For secondary outcomes, the decrease in CCT (SMD 0.32; 95% CI 0.03, 0.61) and ECD (SMD 0.26; 95% CI 0.06, 0.46) was less with ACXL than with SCXL. For the other outcomes, there were no statistically significant differences. SCXL has a greater effect in terms of reduction in Kmax than ACXL, while ACXL induces less reduction in CCT and ECD than SCXL. Further well-designed randomized controlled trials comparing ACXL and SCXL are indicated.

Effectiveness and safety of sulcus fixation of Baerveldt glaucoma implants in glaucomatous eyes in patients who underwent multiple intraocular surgeries.

The purpose of this study was to evaluate the surgical success of sulcus fixation of Baerveldt glaucoma implant (BGIs) in special reference to corneal damage. This observational prospective cohort study included 24 patients who underwent a median of 3.0 previous intraocular surgeries and sulcus fixation of BGIs for the first time. The intraocular pressure (IOP), the number of ocular hypotensives used, corneal endothelial cell density (ECD), and logMAR-converted best-corrected visual acuity (VA) of each patient were measured preoperatively and postoperatively until 12months after surgery. Surgical success was evaluated after 12months based on the reduction of IOP (5-21mmHg and > 20% reduction), corneal damage (postoperative development of decompensation, unmeasurable ECD, or ECD reduction of > 20%), loss of light perception, and need for additional surgeries. Surgical success was noted in 16 (66.7%) patients when corneal damage was included as a failure criterion, whereas surgery was successful in 21 (87.5%) patients when solely judged using IOP control similarly as previous clinical trials. The median IOP decreased from 27.5mmHg preoperatively to 14.5mmHg postoperatively (P < 0.0001). The number of ocular hypotensives was significantly reduced postoperatively (P < 0.0001). The median postoperative ECD reduction was only 0.15%, although ECD could not be measured during follow-up or it was significantly reduced by > 20% in six patients. VA was not significantly reduced after surgery. Adverse effects were observed in 15 patients (62.5 cumulative %). Sulcus fixation of BGIs may be effective and safe in patients with glaucomatous eyes who underwent multiple prior intraocular surgeries.

The feasibility and efficacy of preparing porcine Descemet's membrane endothelial keratoplasty (DMEK) grafts by two techniques: An ex-vivo investigation for future xeno-DMEK.

Descemet's membrane endothelial keratoplasty (DMEK) might be a promising technique for future xeno-corneal transplantation due to its ultrathin graft, extremely low rejection occurrence, suture-free graft fixation, and minimal immunosuppressive regime usage. The aim of this study is to explore the feasibility and efficacy of preparing porcine DMEK grafts by 2 techniques and investigate the graft ultrastructure. Two mainstream techniques, mechanical stripping technique and liquid bubble technique, were modified to prepare the porcine DMEK grafts. In all, 40 corneas harvested from WZS-pigs (aged 10-12months) were subjected to the techniques (20 corneas for each technique). The success rate, time consumption, and endothelial cell density (ECD) before and after preparation were recorded and compared between the 2 techniques. And the ultrastructure of the porcine DEMK graft was investigated by transmission electron microscope. In addition, 9 WZS-pigs with different ages were sacrificed to explore the correlation between the thickness of Descemet's membrane and porcine age. After modifying several technical details, the porcine DMEK grafts were successfully prepared by either mechanical stripping technique or liquid bubble technique, and the mark technique to distinguish the 2 sides of the graft was also explored. In all, 13 DMEK grafts (65%) were prepared successfully by the mechanical stripping technique, whereas 14 successful cases (70%) were prepared by the liquid bubble technique. The success rates between the 2 techniques showed no significant difference (P=.847). However, the mechanical stripping technique was significantly time-consuming when compared with the liquid bubble technique (P<.0001). The ECDs reduced significantly after preparation no matter what techniques were used (P<.0001), but the ECD after the liquid bubble preparation was significantly higher than the ECD after mechanical stripping (P=.032). The ECD reduction positively correlated to the time consumption for both mechanical stripping technique (P=.0014, R2 =0.621) and liquid bubble technique (P=.013, R2 =0.412). The ultrastructure showed the graft was comprised of stromal residuals, non-banded layer, and endothelial layer. Unlike human Descemet's membrane (DM), anterior banded layer was not observed. The thickness of porcine DM increased with the age, and a significant positive correlation between them was found (P<.0001, R2 =0.949), and the predict equation was Y=0.3764*X+7.378 (Y indicates the thickness, whereas X indicates the age). Porcine DMEK grafts could be prepared either by mechanical stripping technique or liquid bubble technique, and the liquid bubble technique seems superior over the mechanical stripping technique regarding time consumption and ECD preservation. Although there are several technical barriers to overcome, xeno-DMEK might be a promising direction for future xeno-corneal transplantation.

CORNEAL ENDOTHELIOPATHY IN PSEUDOEXFOLIATION SYNDROME

Background: Pseudoexfoliation syndrome is a common disorder with a wide range of ophthalmic presentation and risks. Corneal endotheliopathy is one of these presentations. Objective: To evaluate corneal endothelial cell morphology, density and function in eyes with pseudoexfoliation syndrome. Methods: 120 eyes of sixty patients with clinically evident unilateral pseudoexfoliation were examined with non-contact specular microscopy (SP-3000P) Topcon Corporation. Central corneal thickness (T), cell density (CD), and percentage of cell hexagonality (HEX%) were measured and the values of the affected eyes were compared to those of the fellow normal eyes. Corneas with CD less than 2000/mm2 or HEX% &lt;50% were considered as at-risk corneas for decompensation. The pseudoexfoliated eyes were subdivided into three groups according to the density of the pseudoexfoliated material (those with deposits on the lens capsule alone, on the pupil margin alone or on both) and the morphometric values of endothelial cells in each group were studied. Statistical analysis was performed using a 2-tailed Student t-test and the Chi square test, P value &lt;0.05 was considered significant. Results: Significant increase in central corneal thickness (500.25±28.95 micron vs 493.18±28.59 micron) and reduction in endothelial cell density (2307.5±272.3 vs 2480.2±289.9 cell/mm2) with a non- significant decrease in cell hexagonality (51.78±8.9 vs 53.48±6.2 %) was noticed in eyes affected by pseudoexfoliation syndrome as compared to the contralateral normal eyes. The changes were noticed more when the severity of the condition increases as reflected by the density of the pseudoexfoliated material. At risk corneas were found more frequently in eyes with pseudoexfoliation based on both endothelial cell density and cell hexagonality. Conclusion: Pseudoexfoliation syndrome is a cause of corneal endotheliopathy and a risk for corneal decompensation. More endothelial cell changes are found in eyes with advanced pseudoexfoliation. Extra care and more meticulous handling is required while operating upon eyes with pseudoexfoliation to reduce the risk for corneal decompensation. Keywords: Pseudoexfoliation, corneal endothelium, endotheliopathy, decompensation. Citation: Kareem AA, Neamah GAT. Corneal endotheliopathy in pseudoexfoliation syndrome. Iraqi JMS. 2018; Vol. 16(1): 57-65. doi: 10.22578/IJMS.16.1.9

Effect of laser peripheral iridotomy using argon and neodymium-YAG lasers on corneal endothelial cell density: 7-year longitudinal evaluation.

To evaluate the changes in corneal endothelial cell density (ECD) over a 7-year period after laser peripheral iridotomy (LPI) using argon and neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers. Retrospective case series. Eyes that underwent prophylactic LPI using argon and Nd:YAG lasers were followed up for 7 years. Central corneal endothelial cells were observed by use of noncontact specular microscopy preoperatively and at 1 and 7 years postoperatively. Changes in ECD and the associations between preoperative ECD and the total energy of the Nd:YAG laser were evaluated. Fifty-one eyes of 51 patients were followed up for 7 years. The ECD significantly decreased after LPI (P < 0.049), and the reduction rate at 1 year after the surgery (1.69 ± 4.80%, 95% CI: 0.34%-3.04%) was significantly higher than the annual reduction rates after 1 year (0.17 ± 0.85%/y, P = 0.036, 95% CI: -0.07% to 0.41%). No association was found between the preoperative ECD and the total laser energy. Long-term evaluation indicated that the reduction in ECD after argon-Nd:YAG laser LPI was present but small during the initial year and was negligible after 1 year.

Iris reconstruction using autologous iris preserved in cold balanced salt solution for 8 hours in iatrogenic total iridodialysis during cataract surgery: a case report

BackgroundA large iris defect or extensive iridodialysis can be an intractable cause of visual disturbance, photophobia, glare, monocular diplopia, or cosmetic deformity. The implantation of an artificial iris substitute could be an effective option, but this can cause a reduction in endothelial cell density. We succeeded in the anatomical restoration of iris tissue that was totally dialyzed out of the eye, and was preserved in cold balanced salt solution for 8 h. Engrafted iris tissue was maintained within the aqueous humor.Case presentationA 71-year-old man was referred to our clinic for management of an iatrogenic total iridodialysis. The totally dialyzed iris tissue was immediately preserved in sterile cold balanced salt solution and packed in a sterile biopsy bottle that was surrounded with ice cubes. Under general anesthesia, a pars plana vitrectomy was performed to remove the remaining lens cortex and vitreous fiber anterior to the equator. A sulcus-positioned intraocular lens (IOL) was repositioned and fixed by ab externo scleral sutures. Preserved iris tissue was inserted and ironed using both iris spatula and ocular viscoelastic devices. Five-point ab interno scleral sutures were made 1.0 mm posterior to the limbus.ConclusionsThe engrafted iris was successfully maintained for 6 months and did not undergo any atrophic change or depigmentation, which may be caused by primary implantation failure due to a blocked blood supply.

SUTURELESS CLEAR CORNEAL ULTRASONIC FRAGMENTATION FOR RETAINED LENS FRAGMENTS

To describe the safety and efficacy of removing posteriorly dislocated lens fragments with the use of intravitreal ultrasonic fragmentation through a limbal, clear cornea self-sealing incision. Patients presenting with posteriorly luxated nuclei were enrolled in this prospective case series. Preoperative examination included evaluation of the corneal endothelium by means of specular microscopy. A 3-port 25+ pars plana vitrectomy was initially performed. Following vitrectomy, sclerotomies were sealed using scleral plugs and a limbal/clear corneal incision was performed for the insertion of the fragmatome probe. The incision was slightly larger (1 mm) than the diameter of the fragmatome probe (20 gauge = 0.81 mm) to avoid wound overheating. At the end of the procedure, an appropriate intraocular lens either sulcus-fixated or angle-supported was implanted. Primary outcome measures were mean postoperative best-corrected visual acuity, intraoperative or postoperative complications, and intraoperative challenging features. In all eyes, fragmentation was completed successfully with a mean total ultrasound time of 113.4 seconds. Nucleus density was ≥3 in all cases (mean ± SD = 3.8 ± 0.4). Intraoperative challenges included viewing difficulties because of corneal distortion, fragment turbulence, and leakage through the limbal incision potentially compromising fundus visualization. There was statistically nonsignificant reduction in endothelial cell density ranging between 1932 ± 187 cells per square millimeter preoperatively to 1789 ± 213 cells per square millimeter at the first month postoperatively (P = 0.79). Clear corneal, sutureless ultrasonic fragmentation seems to be a novel, safe, and efficient method for the removal of hard posteriorly dislocated lens fragments, sparing the need for a 20-gauge scleral port.

Corneal endothelium and central corneal thickness changes in type 2 diabetes mellitus.

PurposeThis study was conducted to compare the corneal endothelial cell density (ECD), morphological features, and central corneal thickness (CCT) in type 2 diabetes mellitus (DM) with age-matched, nondiabetic control subjects using EM-3000 Specular Microscope.Study designThis was a prospective, hospital-based, nonrandomized, case–control, observational, and quantitative study.Subjects and methodsThe study included 57 patients (57 eyes) with type 2 DM and 45 control (nondiabetic) subjects (45 eyes). The corneal endothelial structure and CCT were examined in all eyes by noncontact specular microscopy using EM-3000 Specular Microscope. The endothelial structure was studied for ECD, coefficient of variation of cell area (CV), and percentage of hexagonal cells.ResultsThe study included 36 eyes without diabetic retinopathy (DR), 14 eyes with nonproliferative DR, and 7 eyes with proliferative DR. There were 26 eyes with a duration of ≤10 years and 31 eyes with a duration of >10 years. Also, there were 24 eyes with HbA1c ≤7.5% and 33 eyes with HbA1c >7.5%. ECD was significantly lower in the diabetic cornea than in control group (P=0.014). CV was higher in diabetic cornea (P=0.008). The diabetic cornea group had lower percentage of hexagonal cells than the control group, but the difference was not statistically significant (P=0.603). Also, diabetic cornea was thicker than control group, but not statistically significant (P=0.301).ConclusionThis study documented that type 2 DM causes a significant reduction of ECD and increased CV (polymegathism). Also, diabetic cornea has increased CCT and lower percentage of hexagonal cells than normal subjects, but without statistical significance.

Effects of Cataract Surgery on Endothelium in Transplanted Corneal Grafts: Comparison of Extracapsular Cataract Extraction and Phacoemulsification for Complicated Cataract after Penetrating Keratoplasty.

Background:The endothelium should be carefully evaluated when choosing a surgical technique for cataract removal. Therefore, we aimed to study the effects of different cataract surgery techniques on endothelial cell loss in transplanted corneal grafts.Methods:A total of 54 patients who received complicated cataract surgery in post-penetrating keratoplasty (PKP) eyes at the Shandong Eye Institute between February 2001 and June 2014 were included, and clinical records were reviewed. Baseline demographic details, clinical characteristics, endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were recorded. Wilcoxon rank-sum test and Wilcoxon signed-rank test were used to test the equality of medians. A regression model was constructed to compare the reduced rate of ECD.Results:Of the 54 eyes included in this study, extracapsular cataract extraction (ECCE) was performed in 34 eyes of 33 patients (ECCE group) whereas phacoemulsification was performed in 20 eyes of 20 patients (phacoemulsification group). There was no significant difference in the median age (P = 0.081) or preoperative ECD (P = 0.585) between the two groups. At 6 months after cataract surgery, ECD in ECCE group was significantly higher than that in phacoemulsification group (P = 0.043). In addition, the endothelial cell loss rate in ECCE group was significantly lower than that in phacoemulsification group at 2 months (P = 0.018), 4 months (P < 0.001), and 6 months (P < 0.001) after cataract surgery. Endothelial cell loss rate after cataract surgery increased over the 6-month study duration in both ECCE group (P < 0.001) and phacoemulsification group (P < 0.001), but phacoemulsification resulted in a greater reduction in ECD than that of ECCE in transplanted corneal grafts (P < 0.001). There was no significant difference in postoperative BCVA between the two groups (P = 0.065).Conclusion:ECCE is more suitable than phacoemulsification in cataract surgery in complicated cataract after PKP.

Apoptosis regulates endothelial cell number and capillary vessel diameter but not vessel regression during retinal angiogenesis.

The growth of hierarchical blood vessel networks occurs by angiogenesis. During this process, new vessel growth is accompanied by the removal of redundant vessel segments by selective vessel regression ('pruning') and a reduction in endothelial cell (EC) density in order to establish an efficient, hierarchical network. EC apoptosis has long been recognised for its association with angiogenesis, but its contribution to this process has remained unclear. We generated mice in which EC apoptosis was blocked by tissue-specific deletion of the apoptosis effector proteins BAK and BAX. Using the retina as a model, we found that apoptosis made a minor contribution to the efficiency of capillary regression around arteries where apoptosis was most concentrated, but was otherwise dispensable for vessel pruning. Instead, apoptosis was necessary for the removal of non-perfused vessel segments and the reduction in EC density that occurs during vessel maturation. In the absence of apoptosis, increased EC density resulted in an increase in the diameter of capillaries, but not arteries or veins. Our findings show that apoptosis does not influence the number of vessels generated during angiogenesis. Rather it removes non-perfused vessel segments and regulates EC number during vessel maturation, which has vessel-specific consequences for vessel diameter.

The efficacy and complications of black diaphragm intra-ocular lens implantation in patients with congenital aniridia.

To evaluate the efficacy and complications of black diaphragm intra-ocular (BDI) lens implantation in patients with congenital aniridia. Twenty patients underwent BDI lens implantation for the treatment of congenital aniridia from January 1999 to December 2012. Fifteen patients (23 eyes) were enrolled in our study, and the mean follow-up period was 26months. Patient demographics, clinical evaluations [visual acuity (VA), best-corrected visual acuity (BCVA), intra-ocular pressure measurement (IOP), corneal endothelial cell density (ECD) and ultrasound biomicroscopy (UBM)], complications and treatments were analysed for each patient. Sixteen eyes (70.1%) had a BCVA better than 20/200 after BDI lens implantation, and photophobia obviously decreased in all patients. Six eyes (26.09%) developed secondary glaucoma after BDI lens implantation, and one eye underwent glaucoma surgery. Corneal decompensation occurred in two eyes (8.70%), one of which was complicated by glaucoma. Two eyes (8.70%) developed visual axis opacity (VAO) after surgery. One patient (4.35%) had limbal stem cell failure, and another patient (4.35%) had an eccentric BDI lens. Intra-ocular pressure measurement elevation and ECD reduction were found after BDI lens implantation. Black diaphragm intra-ocular lens implantation can effectively improve VA, decrease photophobia and resolve cosmetic issues in most congenital aniridia eyes. Glaucoma, corneal decompensation and VAO were the major long-term complications of BDI lens implantation in patients with congenital aniridia. All patients should be managed attentively because of high risk of complications and followed long term to achieve favourable outcomes.

Visual Outcomes and Graft Thickness in Microthin DSAEK--One-Year Results.

To evaluate visual outcomes, endothelial graft thickness, and complications in microthin Descemet stripping automated endothelial keratoplasty (DSAEK). A prospective interventional cohort of 130 eyes of 114 consecutive patients underwent microthin DSAEK. Endothelial graft preparation included pachymetry-controlled stromal dehydration to reduce donor thickness between 550 and 530 μm by a custom airflow device, before a single-pass microkeratome dissection with a uniform cutting head of 350 μm to achieve microthin endothelial grafts (<130 μm). Data on visual acuity, graft thickness, endothelial cell loss, and complication rates were analyzed. Pachymetry-controlled donor preconditioning reduced donor thickness on average by 67 μm (range 0-186, SD 44.7) from 590 μm (range 485-806, SD 53) to 528 μm (range 480-620, SD 23), P < 0.01, and allowed graft preparation without any case of intraoperative graft loss or perforation. The resultant mean graft thickness was 94 μm (SD 25) intraoperatively, 94 μm (SD 26) at 1 month, and 90 μm (SD 19) at 12 months. Of note, 98.2% of eyes without significant visual comorbidity achieved best-corrected Snellen acuity of 6/9 or more at 12 months. There was a 35.8% and 41% reduction in endothelial cell density at 3 and 12 months, respectively. Postoperative graft detachment occurred in 5% of cases (1.7% in uncomplicated eyes). There was no graft loss during preparation, and none developed immune rejection during the study period. The microthin DSAEK procedure offers a simple and safe technique to prepare thin endothelial grafts with a low risk of graft wastage, low risk of postoperative detachment, and visual results that are comparable to those of other thin endothelial keratoplasty procedures.

Reduced Corneal Endothelial Cell Density in Patients With Dry Eye Disease

To evaluate corneal endothelial cell density (ECD) in patients with dry eye disease (DED) compared to an age-matched control group. Cross-sectional, controlled study. This study included 90 eyes of 45 patients with moderate to severe DED (aged 53.7 ± 9.8 years) and 30 eyes of 15 normal controls (aged 50.7 ± 9.8 years). All subjects had a complete ophthalmic evaluation including symptom assessment using the Ocular Surface Disease Index (OSDI) and corneal fluorescein staining. In addition, laser scanning invivo confocal microscopy was performed to measure the density of the following parameters in the central cornea: endothelial cells, subbasal nerves, and subbasal immune dendritic cells. Corneal ECD was significantly lower in the DED group (2595.8 ± 356.1 cells/mm(2)) than in the control group (2812.7 ± 395.2 cells/mm(2), P= .046). The DED group showed significantly lower corneal subbasal nerve density (17.1 ± 6.9mm/mm(2)) compared to the control group (24.7 ± 4.4mm/mm(2), P < .001). Dendritic cell density was significantly higher in the DED group than in the controls (111.7 ± 137.3 vs 32.0 ± 24.4 cells/mm(2), respectively, P= .002). There were statistically significant correlations between corneal ECD and dry eye severity parameters including the OSDI score (rs=-0.26, P= .03), and corneal fluorescein staining (rs=-0.28, P= .008). There is a significant reduction in corneal ECD in DED that correlates with clinical severity of the disease.

Femtosecond laser-assisted anterior lamellar keratoplasty for the treatment of stromal corneal pathology.

BackgroundTo describe the initial outcomes and safety of anterior lamellar keratoplasty (ALK) assisted by a femtosecond laser for stromal corneal pathology.MethodsA non-comparative case series of 14 eyes (13 patients) with various stromal corneal diseases underwent ALK with a femtosecond laser. Femtosecond laser settings, technique, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and endothelial cell density (ECD) were measured.ResultsAll eyes were successfully treated without intraoperative complications. The UCVA improved in 11 eyes (78.6%) compared with preoperative UCVA. The mean difference between preoperative and postoperative UCVA was a gain of 1.7 lines (range, unchanged to 6 lines). The BCVA improved in all eyes compared with preoperative levels. The mean difference between preoperative and postoperative BCVA was a gain of 2.4 lines (range, 1–8 lines). In 3 eyes, phototherapeutic keratectomy was performed. The mean reduction in endothelial cell density was 3.7% after a mean 7.3 months of follow-up. No graft rejection, infection, or epithelial ingrowth was found.ConclusionsFemtosecond laser-assisted ALK improved UCVA and BCVA in patients with stromal corneal pathology. Our early results indicated that the femtosecond laser produced an effective and smooth dissection through opaque corneas even deeper corneal tissue.

Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty for Macular Corneal Dystrophy: A Randomized Trial

To compare outcomes of big-bubble deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. Prospective, randomized, interventional case series. setting: Single hospital. patients: Eighty-two eyes of 54 patients requiring keratoplasty for the treatment of macular corneal dystrophy without endothelial involvement were included. main outcome measures: Operative complications, uncorrected visual acuity, best-corrected visual acuity, contrast sensitivity function, higher-order aberrations, and endothelial cell density were evaluated. The DALK and PK group consisted of 35 and 41 eyes, respectively. Best-corrected visual acuity after surgery was 20/40 or better 68.5% and 70.7% of the eyes in the DALK and PK groups, respectively (P > .05). No statistically significant differences between groups were found in contrast sensitivity function with and without glare for any spatial frequency (P > .05). Significantly higher levels of higher-order aberrations were found in the DALK group (P < .01). In both groups, a progressive and statistically significant reduction in endothelial cell density was found (P < .01). At the last follow-up, the mean endothelial cell loss was 18.1% and 26.9% in DALK and PK groups, respectively (P = .03). Graft rejection episodes were seen in 5 eyes (12.1%) in the PK group, and regrafting was necessary in 3 eyes (7.3%). Recurrence of the disease was documented in 5.7% and 4.8% of the eyes in the DALK and PK groups, respectively. Deep anterior lamellar keratoplasty with the big-bubble technique provided comparable visual and optical results as PK and resulted in less endothelial damage, as well as eliminating endothelial rejection in macular corneal dystrophy. Deep anterior lamellar keratoplasty surgery is a viable option for macular corneal dystrophy without endothelial involvement.