Functional evaluation of corneal endothelium by combined measurement of corneal volume alteration and cell density after phacoemulsification

Impacts and Correlations on Corneal Biomechanics, Corneal Optical Density and Intraocular Pressure after Cataract Surgery

The study aimed to investigate the extended effects and interrelations of corneal biomechanics, corneal optical density (COD), corneal thickness (CT), and intraocular pressure (IOP) following cataract surgery. Sixteen eyes were analyzed prospectively. The Corneal Visualization Scheimpflug Technology (Corvis ST) device assessed corneal biomechanics, while the Pentacam AxL® (Pentacam) measured COD and CT. Postoperative data were collected around six months after surgery, with a subgroup analysis of data at nine months. The Pearson correlation was used to examine the relationship between surgical-induced changes in corneal biomechanics and COD. At six months, significant postoperative differences were observed in various biomechanical indices, including uncorrected IOP (IOPuct) and biomechanics-corrected IOP (bIOP). However, many indices lost statistical significance by the nine-month mark, suggesting the reversibility of postoperative corneal changes. Postoperative COD increased at the anterior layer of the 2-6 mm annulus and incision site. The changes in COD correlated with certain biomechanical indices, including maximal (Max) deformative amplitude (DA) and stiffness parameter (SP). In conclusion, despite significant immediate postoperative changes, corneal biomechanics, COD, and IOP experienced a gradual recovery process following cataract surgery. Clinicians should maintain vigilance for any unusual changes during the short-term observation period to detect abnormalities early.

Changes in corneal thickness, corneal volume, and densitometry after long-term orthokeratology wear

PURPOSE

To investigate changes in the corneal volume, corneal densitometry and pachymetry of young myopes wearing over-night orthokeratology (OK) contact lenses.

METHODS

The medical records of 28 right eyes of young myopes wearing OK between 2013 and 2018 were reviewed retrospectively. The baseline refractive error, best corrected visual acuities at baseline and uncorrected visual acuity at the most recent visit were recorded. Corneal volume of the central 10 mm cornea; densitometry at central, nasal and temporal cornea; and pachymetry along the horizontal and vertical meridians were collected from the Pentacam® HR at baseline, after one night of lens wear, and at the latest visit.

RESULTS

The mean age of subjects was 12.03 ± 3.80 years at the time of OK lens fitting and wore OK overnight for a mean duration of 666 days (range 206-1736 days). The baseline spherical equivalent refractive error was -3.03 ± 1.56 D (range -1.00 to -6.00 D). The corneal volume increased significantly after OK wear (p = 0.001). Corneal densitometry increased after OK wear, but the change did not reach statistical significance (p = 0.113). Pachymetry in the central cornea did not change significantly across all visits (p > 0.05) but increased significantly in the mid-peripheral regions of the cornea. Baseline refractive error was not found to be correlated with the changes in corneal volume, corneal densitometry, or pachymetry.

CONCLUSION

The increase in corneal volume and densitometry and no significant change in the central corneal thickness may indicate the presence of corneal oedema from long-term OK wear. The baseline refraction was not correlated with the changes in corneal volume, densitometry or pachymetry.

Distribution of Corneal Volume and Its Associated Factors in an Elderly Population: Tehran Geriatric Eye Study

PURPOSE

The aim of this study was to determine the distribution of corneal volume (CV) using Pentacam and its relationship with demographic and ocular factors in an elderly population older than 60 years.

METHODS

The present report is a part of the Tehran Geriatric Eye Study. The sampling was performed using the multistage stratified random cluster sampling method. The preliminary ocular examinations were performed for all individuals including visual acuity measurement, objective and subjective refraction, and slit-lamp biomicroscopy. Finally, study participants underwent anterior segment imaging and ocular biometry using Pentacam AXL.

RESULTS

The mean CV was 57.92 mm3 [95% confidence interval (CI): 57.76-58.08] in the whole sample. The mean CV was 57.69 mm3 (95% CI: 57.52-57.87) after excluding diabetic patients. The mean CV was 57.79 mm3 (95% CI: 57.57-58.01) and 58.04 mm3 (95% CI: 57.83-58.26) in men and women, respectively. The mean CV was 57.96 mm3 (95% CI: 57.71-58.21), 57.84 mm3 (95% CI: 57.49-58.19), and 57.92 mm3 (95% CI: 57.7-58.13) in individuals with emmetropia, myopia, and hyperopia, respectively. The CV decreased significantly with advancing age. Moreover, the anterior chamber depth, central corneal thickness, mean keratometry, anterior corneal asphericity (Q value), and posterior corneal astigmatism were significantly directly related to CV, whereas axial length and white-to-white distance had a statistically significant inverse association with the CV.

CONCLUSIONS

Aging is one of the important factors in reducing CV that should be considered. Some other topographic and biometric indices also have a significant relationship with CV.

Development of an anti-oxidative intraocular irrigating solution based on reactive persulfides

Anti-oxidative intraocular irrigating solutions (IISs) based on reactive persulfides, such as oxidized glutathione disulfide (GSSG), are commonly used worldwide. However, even with GSSG-based IISs, it has been shown that oxidative stress can occur during surgery, posing a risk to intraocular tissues. This study compared two IISs: one containing GSSG and one containing an oxidized glutathione trisulfide (GSSSG). Experimental in vivo irrigation with the IISs in rabbits showed that there was less leakage into the anterior chamber of rabbit serum albumin during perfusion with a 300-μM GSSSG IIS than with a 300-μM GSSG IIS. Experimental in vivo cataract surgery in rabbits showed that aqueous flare was suppressed 3 days after surgery with a 600-μM GSSSG IIS, but not with a 300-μM GSSSG or 300-μM GSSG IIS. Furthermore, an in vitro experiment, without any live tissue, showed that reactive oxygen species were suppressed more strongly with a 600-μM GSSSG IIS than with a 300-μM GSSG IIS. Thus, this study found that novel IISs based on GSSSG had anti-inflammatory and anti-oxidative effects during and after intraocular surgery and may decrease the rate of complications after surgery.

Effect of 532 nm argon laser pan retinal photocoagulation on corneal thickness and corneal endothelial cell parameters among proliferative diabetic retinopathy patients

Background

Laser photocoagulation has been the mainstay treatment for diabetic retinopathy (DR). However, the applied laser light must pass through multiple ocular structures such as the cornea to reach the retina, potentially causing thermal injury to non-target tissues. The purpose of this study was to examine the effects of 532 nm Argon laser pan-retinal photocoagulation (PRP) on corneal thickness and corneal endothelial cell parameters by comparing central corneal thickness (CCT), endothelial cell density (ECD), and endothelial cell area coefficient of variation (CoV) before and after PRP for proliferative diabetic retinopathy (PDR). The effect of laser PRP on these corneal parameters may help in adapting treatment protocols to reduce corneal damage and thereby improve patient outcome.

Methods

This was a prospective cohort study involving newly diagnosed PDR patients. All patients underwent specular microscopy examination (CCT, ECD and endothelial cell area CoV) both pre-PRP and at 1-week and 6-weeks after the final PRP session (post-PRP). A Carl Zeiss Visulas Argon laser (532 nm) was used to perform PRP.

Results

A total of 33 newly diagnosed PDR patients were included in this study. There were no significant differences in mean CCT, ECD, and endothelial cell area CoV at 1-week and 6-weeks following PRP compared to pre-treatment baseline (p > 0.05). Further, there were no significant correlations between laser energy delivered and CCT, ECD and endothelial cell area CoV at either post-PRP examination time.

Conclusion

Argon laser (523 nm) energy delivered within recommended ranges for PRP had no adverse effects on corneal structure.

Thermal capsulotomy: Initial clinical experience, intraoperative performance, safety, and early postoperative outcomes of precision pulse capsulotomy technology

PURPOSE

To assess the clinical safety and performance of a new thermal capsulotomy device in patients having cataract surgery.

SETTING

Launceston Eye Institute, Launceston, Tasmania, Australia.

DESIGN

Prospective case series.

METHODS

This single-surgeon consecutive series comprised eyes having capsulotomy with a precision pulse capsulotomy (PPC) device (Zepto). Baseline demographic information and preoperative, intraoperative, and early postoperative outcomes, including complications, intraocular pressure (IOP), flare photometry, corneal and retinal thickness, and specular microscopy were collected and analyzed. Outcomes included PPC performance, intraoperative complications, effective phacoemulsification time, IOP, postoperative inflammation, corneal edema, endothelial cell density, functional evaluation of the corneal endothelium, retinal thickness, cost-effectiveness, and early postoperative visual acuity.

RESULTS

The study evaluated 100 eyes. Complete free-floating capsulotomy was achieved in 70 eyes (72%). Focal attachments were identified in 17 eyes (18%) and broad attachments in 10 eyes (10%). Intended PPC capsulotomy failed in 3 eyes due to operator or device error. Anterior capsule tears occurred in 4 eyes (4%); otherwise, there were no significant safety signals in the early postoperative period. There was no evidence of a learning curve effect; however, use of a dispersive ophthalmic viscosurgical device (OVD) is postulated as influencing capsulotomy completeness.

CONCLUSIONS

The PPC device created round, reproducible, appropriately sized capsulotomies in 72% of eyes. The incidence of incomplete capsulotomy and radial tear rate was high and was possibly associated with the use of a dispersive OVD.

Comparative Analysis of One-Handed and Two-Handed Coaxial Phacoemulsification with 2.4-mm Clear Corneal Incision

PURPOSE

To compare the efficiency and safety of one-handed and two-handed coaxial phacoemulsification Material and Methods: Patients with cataracts underwent one-handed (one-handed group) or two-handed coaxial phacoemulsification (two-handed group) with a 2.4-mm clear corneal incision. Intraoperative phaco parameters, total surgical time, postoperative visual acuity, surgically induced astigmatism (SIA), corneal volume (CV), central corneal thickness (CCT) and corneal endothelial cell counts/size were compared between the two groups.

RESULTS

Each group comprised 105 eyes. There were no significant differences in the intraoperative phaco parameters and total surgical time between the two groups (all p > 0.05). Visual outcomes were significantly better in the one-handed group than in the two-handed group 1 week postoperatively (all p< 0.05) but not 1 month postoperatively. There was no significant difference in SIA between the two groups 1 week (p = 0.695) or 1 month postoperatively (p = 0.772). CV, CCT and endothelial cell loss were significantly lower in the one-handed group than in the two-handed group 1 week postoperatively (CV: p = 0.004; CCT: p = 0.046; endothelial cell loss: p = 0.021), but the above differences were absent 1 month postoperatively except for endothelial cell loss (endothelial cell loss: p = 0.038).

CONCLUSIONS

Both one-handed and two-handed coaxial phacoemulsification were effective and safe surgical techniques. However, the one-handed technique had the advantages of less trauma to the cornea and better early clinical outcomes than the two-handed technique for cataract patients within nuclear opalescence (NO) 3 grade ≤ 3.

Comparison of variations in cornea after one-handed and two-handed coaxial phacoemulsification

Purpose

To compare corneal variations in patients undergoing one-handed and two-handed coaxial phacoemulsification.

Setting

Eye Institute, Affiliated Hospital of Nantong University, Nantong, China.

Design

Prospective consecutive nonrandomized comparative cohort study.

Methods

Patients with cataracts were subject to one-handed (one-handed group) or two-handed coaxial phacoemulsification (two-handed group). Intraoperative phaco parameters and postoperative outcomes, such as visual acuity, surgically induced astigmatism (SIA), corneal volume, central corneal thickness, and corneal endothelial cell counts/size were compared.

Results

No significant differences in the intraoperative phaco parameters were noted between the 2 groups. At postoperative week 1, visual outcomes were significantly improved in the one-handed compared with the two-handed group (all P<0.05). Corneal volume, central corneal thickness, and average cell size were significantly decreased in the one-handed group compared with two-handed group (all P<0.05), but the aforementioned differences were ameliorated at 1 month and 3 months postoperatively. Endothelial cell loss was significantly decreased in the one-handed group compared with the two-handed group at any follow-up point (all P<0.05). No significant differences in SIA on the anterior surface were noted between the 2 groups. SIA on the posterior surface was significantly decreased in the one-handed group compared with the two-handed group at 1 week postoperatively (P=0.043) but not at 1 month and 3 months postoperatively.

Conclusion

One-handed phacoemulsification has the advantages of less trauma to the cornea and better early visual outcomes compared with the two-handed technique.

Central corneal thickness and corneal volume changes in eyes with and without pseudoexfoliation after uneventful phacoemulsification

AIM

To investigate the effects of uneventful phacoemulsification on central corneal thickness (CCT) and corneal volume (CV) in pseudoexfoliative eyes during a 3 months postoperative period and compare these changes to eyes without pseudoexfoliation (PEX) syndrome. Another purpose of this study was to compare the CCT measurements done by ultrasound pachymetry (UP) with those done by the Oculus Pentacam.

MATERIAL AND METHOD

A total of 42 eyes of 42 consecutive patients with cataracts and PEX syndrome that underwent uneventful phacoemulsification were enrolled in this prospective study. A control group of 42 eyes of 42 patients with cataracts/without PEX was employed for comparison. CV and CCT measurements were obtained preoperatively and at 1 and 3 months postoperatively with the Pentacam. CCT values were also measured with UP. T test and Wilcoxon sign test were used to compare the variables.

RESULTS

The mean age of the patients was 72.1 ± 8.3 and 66.6 ± 9.6 years in PEX and non-PEX group, respectively. In both groups, there were no significant differences between preoperative and postoperative CV (Fig. 1), CCT by the Pentacam (Fig. 2) and CCT by UP (Fig. 3) values (p > 0.05). CCT measurements obtained by two devices were also similar, and there were no statistically significant differences (p > 0.05). Changes in CV and CCT remained stabile at 3 months postoperatively.

CONCLUSION

Eyes with and without PEX syndrome exhibit similar corneal features before and after phacoemulsification. A surgery in early stages of cataracts in PEX syndrome, not only provides a non-complicated surgery, but also leads to a less damaged cornea similar to eyes without PEX.

The use of femtosecond lasers in cataract surgery: review of the published results with the LenSx system

PURPOSE

To review the published literature describing the use of the LenSx femtosecond laser technology (Alcon Laboratories, Inc., Fort Worth, TX) in cataract surgery.

METHODS

Literature review.

RESULTS

The LenSx system has been used in more than 200,000 cataract surgery procedures to date. Pre-clinical evaluations have shown that this system produces accurate and reproducible capsulorhexes, and that both the energy required for phacoemulsification and total phacoemulsification time are less than with conventional phacoemulsification. In comparative studies, femtosecond lasers have been shown to produce more precise and reproducible capsulorhexes than manual procedures, and better intraocular lens placement; capsule overlap, circularity of capsulotomy, and centration of the intraocular lens are consistently better with femtosecond lasers than with manual procedures. The improved quality of capsulorhexis and intraocular lens positioning are reflected in favorable visual and refractive outcomes. As with any new technology, there is a significant learning curve: prospective cohort studies have shown that the incidence of intraoperative complications such as suction breaks or anterior capsular tears or tags decreases with experience. In general, the incidence of such complications is within the range (< 2%) considered in recent evidence-based guidelines to be feasible and desirable.

CONCLUSIONS

Although femtosecond laser cataract surgery is in its infancy, the technology is evolving rapidly and offers the potential for more consistent and predictable results after cataract surgery.

Assessment of anterior chamber parameters after cataract surgery by Galilei dual Scheimpflug analyzer

OBJECTIVE

To quantify the difference between anterior chamber parameters determined by the Galilei dual Scheimpflug analyzer after uneventful cataract surgery in normotensive eyes.

METHODS

In this study, 39 eyes of 30 patients (11 men and 19 women) who had uneventful cataract surgery with phacoemulsification were evaluated preoperatively, and at 1 month postoperatively with the Galilei. We investigated the measurements including anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), and the 3-, 5-, and 7-mm corneal thickness (CT) preoperatively and postoperatively.

RESULTS

The differences between ACD (P=0.01), ACA (P=0.07), ACV (P=0.01), and 7-mm CT (P=0.01), and intraocular pressure (P=0.03) were statistically significant after the first month of phacoemulsification. However, the differences between CCT (P=0.60), 3-mm CT (P=0.75), and 5-mm (P=0.17) CT were not statistically significant.

CONCLUSIONS

After the first month of cataract surgery, a significant increase was observed in ACD, ACV, ACA, and 7-mm CT parameters, which were practically determined by a new noncontact Scheimpflug imagining system.

Toward zero effective phacoemulsification time using femtosecond laser pretreatment

OBJECTIVE

To compare effective phacoemulsification time after femtosecond laser pretreatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss.

DESIGN

Prospective, consecutive, single-surgeon case-control study.

CONTROLS

Controls underwent phacoemulsification cataract extraction plus insertion of an intraocular lens (IOL). Cases underwent pretreatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion.

METHODS

Two hundred one eyes underwent cataract surgery between April 2012 and July 2012. Data collected included patient demographics, preoperative characteristics, femtosecond lens fragmentation method, effective phacoemulsification time (EPT), intraoperative complications, and postoperative outcomes.

MAIN OUTCOME MEASURES

Effective phacoemulsification time, intraoperative complications, corneal endothelial cell loss, as well as postoperative best-corrected visual acuity, intraocular pressure, and refractive outcomes.

RESULTS

Patient demographics were similar between groups. There was no difference between baseline cataract grades (2.59 ± 0.71 vs. 2.52 ± 0.72, not significant). One hundred percent of cases pretreated with the femtosecond laser had complete capsulotomy. Mean EPT was reduced by 83.6% in the femtosecond pretreatment group (P<0.0001) when compared with controls, with 30% having 0 EPT (P<0.0001). Effective phacoemulsification time was reduced 28.6% within the femtosecond group using improved lens fragmentation algorithms, and a further 72.8% reduction was achieved with a 20-gauge phacoemulsification tip. Overall, there was a 96.2% reduction in EPT between controls and the optimized femtosecond pretreatment group. This was associated with a 36.1% reduction in endothelial cell loss in the femtosecond group. Visual and refractive outcomes were similar to those of conventional cataract surgery.

CONCLUSIONS

Femtosecond laser pretreatment results in a significant reduction in effective phacoemulsification time, including the possibility of 0 EPT. Further reductions may be achieved using optimization of lens fragmentation patterns and surgical technique.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification

PURPOSE

To compare the effect of conventional phacoemulsification and femtosecond laser-assisted cataract surgery on the cornea using Scheimpflug imaging and noncontact specular microscopy.

METHODS

In each group, 38 eyes (38 patients) underwent cataract surgery using either femtosecond laser-assisted (Alcon LenSx laser) (femtolaser group) or conventional phacoemulsification (phaco group). Central corneal thickness, 3-mm corneal volume, and Pentacam Nucleus Staging (PNS) were determined by a rotating Scheimpflug camera (Pentacam HR, Oculus Optikgeräte GmbH), and the volume stress index was calculated at 1 day and 1 month postoperatively. Endothelial cell count was measured by noncontact specular microscopy preoperatively, 1 day, 1 week, and 1 month postoperatively.

RESULTS

Central corneal thickness was significantly higher in the phaco group (607±91 μm) than in the femtolaser group (580±42 μm) on day 1, but did not differ significantly preoperatively and at 1 week and 1 month. Volume stress index at day 1 was significantly lower in the femtolaser group than in the phaco group (P<.05) but did not differ significantly at 1 month. Multivariate regression analysis showed that the type of surgery had a significant effect on central corneal thickness.

CONCLUSIONS

Femtosecond laser-assisted cataract surgery causes less corneal swelling in the early postoperative period and may cause less trauma to corneal endothelial cells than manual phacoemulsification.

Early changes in corneal edema following torsional phacoemulsification using anterior segment optical coherence tomography and Scheimpflug photography

PURPOSE

To assess corneal edema after torsional phacoemulsification using anterior segment optical coherence tomography (AS-OCT) and Scheimpflug photography (Pentacam).

METHODS

Seventy-six eyes with cataract surgery were randomized into 2 groups: a 2.2 mm micro-coaxial incision group (n = 37) and a 2.8 mm standard incision group (n = 39). Patients were examined preoperatively and at 1 day, 1 week and 1 month postoperatively. Incision architecture and pachymetry at the wound level were measured by AS-OCT. The corneal volume within 3.0 and 10.0 mm circles of the cornea was measured using Pentacam.

RESULTS

The cumulative dissipated energy (CDE) was lower in the micro-coaxial incision (2.2 mm) group than in the standard incision (2.8 mm) group (P = 0.043). Corneal edema measurements showed less corneal thickness at the endothelial side of the incision on postoperative day 1 in the micro-incision group (1061 ± 76 vs. 1153 ± 97 μm, P = 0.041). The corneal volume within the 10.0 mm circle was less on postoperative day 1 in the micro-incision group (63.75 ± 4.83 vs. 65.97 ± 4.52 mm(3), P = 0.035). The endothelial cell count did not change significantly throughout the study.

CONCLUSION

The micro-coaxial 2.2 mm incision may incur slightly less damage than the 2.8 mm standard incision in the context of torsional phacoemulsification. Observation of corneal morphology and damage using AS-OCT and Pentacam can be helpful in the evaluation and quantification of fine corneal edema.

Evaluation of anterior segment parameter changes using the Pentacam after uneventful phacoemulsification

PURPOSE

This study set out to evaluate the influences of uneventful phacoemulsification on the anterior segment parameters obtained with the Pentacam rotating Scheimpflug camera and intraocular pressure (IOP).

METHODS

A total of 42 eyes of 34 patients (26 men, eight women) were evaluated preoperatively, and at 1, 3 and 6 months postoperatively with the Pentacam. Intraocular pressure was measured with the Goldmann applanation tonometer. The non-parametric paired t-test was used to compare preoperative and 1-, 3- and 6-month postoperative measurements of anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA) width, central corneal thickness (CCT), the central 3-, 5- and 7-mm corneal volume (CV), pupil size, and IOP. Pearson's correlation test was used to evaluate the relationships between IOP and ACD, ACV and ACA width.

RESULTS

The differences between ACD, ACV, ACA and IOP values taken preoperatively and those taken postoperatively at 1, 3 and 6 months were statistically significant (p<0.05). The differences between CCT, central 3-, 5- and 7-mm CV, and pupil size measurements taken preoperatively and those taken postoperatively at 1, 3 and 6 months were not statistically significant (p>0.05). The decrease in IOP was not correlated with the changes in ACD, ACV and ACA (p>0.05).

CONCLUSIONS

Uneventful phacoemulsification significantly reduced IOP, increased ACD and ACV, and widened the ACA. However, alterations in CV, CCT and pupil size values were not statistically significant. Alterations in ACD, ACV, ACA and IOP remain stable after the first month of surgery.

Ophthalmic features of spinocerebellar ataxia type 7

BACKGROUND

Patients with spinocerebellar ataxia 7 (SCA7) are known to develop ocular abnormalities. The purpose of this study was to characterize these abnormalities in greater detail and with the aid of newer quantitative technologies.

METHODS

Seven patients with SCA7 diagnosed by genetic analysis at La Paz Hospital (Madrid, Spain), a country-wide referral center for ataxias, were included in the study. Demographic data and ocular features were recorded from a complete ophthalmologic examination, specular microscopy, corneal topography (Pentacam), and optical coherence tomography (OCT).

RESULTS

All 7 patients had decreased visual acuity associated with varying degrees of macular pigmentary changes on ophthalmoscopy. All 7 had lower corneal endothelial cell densities than expected for their age, and 5 had increased corneal volume, although none had corneal edema. Patients with mild disease showed retinal thinning at the fovea. In patients with more advanced disease, retinal thinning was present also in the outer zone of the macula. Mean peripapillary retinal nerve fiber layer thickness was decreased in all patients; however, the temporal quadrant was spared except in advanced disease.

CONCLUSIONS

This study of 7 patients with SCA7 amplifies previous reports of ophthalmic abnormalities in this condition by providing data from specular microscopy, corneal topography, and OCT. Abnormalities were present in the anterior and posterior ocular segments, as well as in eye movements and pupillary reactions. Visual dysfunction, present in all patients, was associated with retinal thinning. Decreased endothelial cell density and increased corneal thickness were common.

Advances in anterior segment imaging and analysis

PURPOSE OF REVIEW

Efforts to visualize and quantify key aspects of anterior segment ocular anatomy have fostered the development of many new imaging modalities and supportive technological advances in the last decade. This has been accompanied by an increase in the quantity and complexity of data available to the clinician. This article briefly reviews recent imaging advances and new challenges in the effective use of these complex datasets to solve clinical problems.

RECENT FINDINGS

The current revolution in corneal imaging includes two advancing fronts: new or improved imaging modalities and new methods of data representation. Areas of significant activity include increased speed and resolution, enhanced microstructural imaging, and marked increases in the amount of data available on the three-dimensional macrostructure and microstructure of the cornea. Some efforts to represent these data in clinically useful terms and to emphasize critical interpretation of the end-user data are reviewed.

SUMMARY

Recent advances in anterior segment imaging technology bring new opportunities and novel challenges to the end-user. These developments are capable of producing increasingly sophisticated three-dimensional representations of the anterior segment that will support novel applications for the diagnosis and treatment of anterior segment disease.