Non-invasive assessment of corneal endothelial permeability by means of electrical impedance measurements

In Vivo Measurement of Human Corneal Impedance Value

PURPOSE

To examine the validity of in vivo electrical corneal resistance (CR) measurements taken by a corneal resistance device (CRD).

METHODS

Eighty-two eyes (mean age ± SD, 50.1 ± 23.3; range, 22-87 years: 50 eyes of 33 males and 32 eyes of 17 females) of patients who had undergone cataract surgery and volunteers at the Kanazawa Medical University Hospital were enrolled. The CR was compared among gender; age; side, that is, left versus right eye; healthy (fluorescein-negative) versus epithelium-injured eyes (fluorescein-positive), corneal radius of curvature; corneal endothelial cell count; and corneal thickness.

RESULTS

The mean ± SD of the CR in the 82 eyes was 273.2 ± 78.2 Ω. By age group, the mean ± SD CR was 283.3 ± 87.4 Ω (30 eyes) in the 20s, 275.0 ± 50.0 Ω (4 eyes) in the 30s, 266.7 ± 70.7 Ω (9 eyes) in the 40s, 257.1 ± 53.5 Ω (7 eyes) in the 50s, 242.9 ± 78.7 Ω (7 eyes) in the 60s, 266.7 ± 84.0 Ω (18 eyes) in the 70s, and 300.0 ± 81.6 Ω (7 eyes) in the 80s, with no significant difference among the groups. By gender, the mean ± SD CR was 270.0 ± 83.0 Ω (50 eyes) in males and 278.0 ± 71.0 Ω (32 eyes) in females. By side, the CR values were 282.9 ± 83.4 Ω (44 eyes) in the right eye, 265.9 ± 71.3 Ω (41 eyes) in the left eye, with no significant difference among the groups. By status, the values were 280.0 ± 70.0 Ω (44 eyes) in healthy eyes and 200.0 ± 144.2 Ω (13 eyes) in injured eyes, with a significant between-group difference (P = 0.009). The mean ± SD corneal thickness (0.56 ± 0.03 mm) in 46 healthy eyes was slightly correlated with the CR.

CONCLUSIONS

The CRD quantitatively measured the CR in healthy eyes. The CR did not differ significantly by age, gender, or left versus right eye. The significant difference in CR between the healthy and injured eyes showed that the measurements have validity.

Mechanics and spiral formation in the rat cornea

During the maturation of some mammals such as mice and rats, corneal epithelial cells tend to develop into patterns such as spirals over time. A better understanding of these patterns can help to understand how the organ develops and may give insight into some of the diseases affecting corneal development. In this paper, a framework for explaining the development of the epithelial cells forming spiral patterns due to the effect of tensile and shear strains is proposed. Using chimeric animals, made by combining embryonic cells from genetically distinguishable strains, we can observe the development of patterns in the cornea. Aggregates of cell progeny from one strain or the other called patches form as organs and tissue develop. The boundaries of these patches are fitted with logarithmic spirals on confocal images of adult rat corneas. To compare with observed patterns, we develop a three-dimensional large strain finite element model for the rat cornea under intraocular pressure to examine the strain distribution on the cornea surface. The model includes the effects of oriented and dispersed fibrils families throughout the cornea and a nearly incompressible matrix. Tracing the directions of critical strain vectors on the cornea surface leads to spiral-like curves that are compared to the observed logarithmic spirals. Good agreement between the observed and numerical curves supports the proposed assumption that shear and tensile strains facilitate sliding of epithelial cells to develop spiral patterns.

New trends in quantitative assessment of the corneal barrier function

The cornea is a very particular tissue due to its transparency and its barrier function as it has to resist against the daily insults of the external environment. In addition, maintenance of this barrier function is of crucial importance to ensure a correct corneal homeostasis. Here, the corneal epithelial permeability has been assessed in vivo by means of non-invasive tetrapolar impedance measurements, taking advantage of the huge impact of the ion fluxes in the passive electrical properties of living tissues. This has been possible by using a flexible sensor based in SU-8 photoresist. In this work, a further analysis focused on the validation of the presented sensor is performed by monitoring the healing process of corneas that were previously wounded. The obtained impedance measurements have been compared with the damaged area observed in corneal fluorescein staining images. The successful results confirm the feasibility of this novel method, as it represents a more sensitive in vivo and non-invasive test to assess low alterations of the epithelial permeability. Then, it could be used as an excellent complement to the fluorescein staining image evaluation.

Implications of the alpha dispersion for studies on interaction of tobacco smoke--corneal tissue

In this work, we have carried out a dielectric study to determine the effect of tobacco smoke on the rat corneal function. Measurements were performed over the frequency range of 500 Hz-100 kHz in air and at the temperature of 35°C. The frequency dependencies of the loss tangent for both healthy and smoky cornea exhibit two peaks with different width occurring as a narrow at 2 kHz and a broad at around 16 kHz. The distribution parameter α at 2 kHz has a value of about 0.3, which increases to 0.6 at 16 kHz. The magnitude of the permittivity decrement at 2 and 16 kHz is about two and four times higher, respectively, for the smoky cornea than that for the healthy one. These dielectric studies indicate that the present method is useful in detection of the effect of tobacco smoke exposure on the corneal behavior.

Electrical signaling in control of ocular cell behaviors

Epithelia of the cornea, lens and retina contain a vast array of ion channels and pumps. Together they produce a polarized flow of ions in and out of cells, as well as across the epithelia. These naturally occurring ion fluxes are essential to the hydration and metabolism of the ocular tissues, especially for the avascular cornea and lens. The directional transport of ions generates electric fields and currents in those tissues. Applied electric fields affect migration, division and proliferation of ocular cells which are important in homeostasis and healing of the ocular tissues. Abnormalities in any of those aspects may underlie many ocular diseases, for example chronic corneal ulcers, posterior capsule opacity after cataract surgery, and retinopathies. Electric field-inducing cellular responses, termed electrical signaling here, therefore may be an unexpected yet powerful mechanism in regulating ocular cell behavior. Both endogenous electric fields and applied electric fields could be exploited to regulate ocular cells. We aim to briefly describe the physiology of the naturally occurring electrical activities in the corneal, lens, and retinal epithelia, to provide experimental evidence of the effects of electric fields on ocular cell behaviors, and to suggest possible clinical implications.

Measurement of corneal endothelial impedance with non-invasive external electrodes--a theoretical study

The corneal endothelial cell layer function is critical for the maintenance of hydration and transparency of the cornea. Recent advances in corneal lamellar transplantation point to the need for reliable, non-invasive and rapid endothelial function assessment. Findings using an invasive electrode in an experimental animal model have suggested an association between bioimpedance parameters and endothelial cell function. Currently, however there is no clinical device that allows for non-invasive measurements of endothelial layer electrical impedance. This report is a finite element simulation study that models the human eye. It evaluates the feasibility of using external non-invasive electrodes to detect changes in endothelial layer electrical properties as a function of electrode location and measurement frequencies. The findings show that the ratio between the potential recorded at low and high frequencies is sensitive to changes in endothelial resistivity as well as endothelial capacitance. Moreover, the optimal electrode configuration yielding the highest sensitivity is one where the current injecting electrodes are oppose to each other and the voltage recording electrodes are adjacent to the current injecting electrodes. This first-order theoretical study suggests that a non-invasive device which measures electrical properties of the endothelial layer from the exterior of the eye could be developed. Clearly further animal and human studies are required to develop a reliable clinical tool.