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Musa M, Zeppieri M, Enaholo ES, Chukwuyem E, Salati C. An Overview of Corneal Transplantation in the Past Decade. Clin Pract 2023; 13:264-279. [PMID: 36826166 PMCID: PMC9955122 DOI: 10.3390/clinpract13010024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The cornea is a transparent avascular structure located in the front of the eye that refracts light entering the eyes and also serves as a barrier between the outside world and the internal contents of the eye. Like every other body part, the cornea may suffer insult from trauma, infection, and inflammation. In the case of trauma, a prior infection that left a scar, or conditions such as keratoconus that warrant the removal of all or part of the cornea (keratoplasty), it is important to use healthy donor corneal tissues and cells that can replace the damaged cornea. The types of cornea transplant techniques employed currently include: penetrating keratoplasty, endothelial keratoplasty (EK), and artificial cornea transplant. Postoperative failure acutely or after years can result after a cornea transplant and may require a repeat transplant. This minireview briefly examines the various types of corneal transplant methodologies, indications, contraindications, presurgical protocols, sources of cornea transplant material, wound healing after surgery complications, co-morbidities, and the effect of COVID-19 in corneal transplant surgery.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Nigeria
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
- Correspondence:
| | - Ehimare S. Enaholo
- Centre for Sight Africa, Nkpor, Onitsha 434112, Nigeria
- Africa Eye Laser Centre, Benin 300001, Nigeria
| | - Ekele Chukwuyem
- Centre for Sight Africa, Nkpor, Onitsha 434112, Nigeria
- Africa Eye Laser Centre, Benin 300001, Nigeria
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Doughty MJ. A prospective analysis of corneal endothelial polymegethism and cell density in young adult Asians. Clin Exp Optom 2021; 97:256-63. [DOI: 10.1111/cxo.12127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/30/2013] [Accepted: 09/29/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- Michael J Doughty
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom,
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Ong Tone S, Bruha MJ, Böhm M, Prescott C, Jurkunas U. Regional variability in corneal endothelial cell density between guttae and non-guttae areas in Fuchs endothelial corneal dystrophy. Can J Ophthalmol 2019; 54:570-576. [PMID: 31564347 DOI: 10.1016/j.jcjo.2018.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/31/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the regional variability of corneal endothelial cell density (ECD) between guttae and non-guttae areas in subjects with Fuchs endothelial corneal dystrophy (FECD) using non-contact specular microscopy and confocal microscopy. DESIGN Retrospective chart review from 2009 to 2014 at the Massachusetts Eye and Ear Infirmary. PARTICIPANTS One hundred fifteen eyes of 73 subjects with FECD. METHODS Subjects with FECD underwent same-day specular and confocal microscopy in the same eye. Clinical stage of disease was documented on the day of image acquisition. Regional variability of ECD associated with guttae and non-guttae areas was assessed. Manual endothelial cell counts were performed. RESULTS Thirty-two percent of subjects had high quality endothelial images by both specular and confocal microscopy. Of these subjects, 83% were classified clinically as early-stage FECD. There was a significant association between stage of disease and the ability to obtain high quality specular images (χ2; p = 0.0012). There was no difference in mean ECD derived from specular (1363 ± 594 cells/mm2) or confocal (1391 ± 493 cells/mm2; p = 0.75) images. There was a statistically significant decrease of 31.8 ± 21.7% in mean ECD in areas surrounding guttae (1296 ± 560 cells/mm2) compared to non-guttae areas (1926 ± 674 cells/mm2; p < 0.0001) as determined by confocal microscopy. CONCLUSION These findings support confocal microscopy as an alternative to specular microscopy for evaluating the corneal endothelium of patients with FECD, especially those with advanced disease. Confocal microscopy also revealed regional differences in ECD in guttae and non-guttae areas in patients with FECD.
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Affiliation(s)
- Stephan Ong Tone
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Mass
| | | | - Myriam Böhm
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Mass
| | | | - Ula Jurkunas
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Mass.
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Miyagi H, Stanley AA, Chokshi TJ, Pasqualino CY, Hoehn AL, Murphy CJ, Thomasy SM. Comparison of automated vs manual analysis of corneal endothelial cell density and morphology in normal and corneal endothelial dystrophy-affected dogs. Vet Ophthalmol 2019; 23:44-51. [PMID: 31179615 DOI: 10.1111/vop.12682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/02/2019] [Accepted: 05/14/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the efficacy of automated imaging software of the Nidek ConfoScan 4 confocal biomicroscope at analyzing canine corneal endothelial cell density and morphology in health and disease, by comparing to a manual analysis method. ANIMAL STUDIED Nineteen eyes of 10 dogs were evaluated and include three Beagles, three Jack Russell Terriers, and four miscellaneous breeds. Twelve clinically normal and seven eyes affected with corneal endothelial dystrophy (CED) were scanned and analyzed. PROCEDURES Endothelial cell density (ECD), mean and standard deviation (SD) of cell area, percent polymegathism, mean and SD of the number of cell sides, and percent pleomorphism were calculated using automated and manual methods for each scan. RESULTS The automated analysis showed significantly greater ECD in comparison with the manual frame method due to misidentification of cell domains in CED-affected dogs. No significant differences in ECD were observed between normal and CED-affected dogs in automated analysis, while CED-affected dogs showed significantly lower ECD in manual frame method and planimetry. Using both automated and manual methods, CED-affected dogs showed greater variability of cell area or the number of cell sides than normal dogs. CONCLUSION The automated imaging software is unable to accurately identify cell borders in CED-affected dogs resulting in inaccurate estimates of ECD. Thus, manual analysis is recommended for use in clinical trials assessing adverse events associated with novel medical treatments and/or surgical procedures.
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Affiliation(s)
- Hidetaka Miyagi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California.,Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Amelia A Stanley
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Tanvi J Chokshi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Carina Y Pasqualino
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Alyssa L Hoehn
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California.,Department of Ophthalmology & Vision Science, School of Medicine, University of California, Davis, Davis, California
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California.,Department of Ophthalmology & Vision Science, School of Medicine, University of California, Davis, Davis, California
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Patients With Dry Eye Disease and Low Subbasal Nerve Density Are at High Risk for Accelerated Corneal Endothelial Cell Loss. Cornea 2017; 36:196-201. [PMID: 28060067 DOI: 10.1097/ico.0000000000001057] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate changes in corneal endothelial cell density over time in patients with dry eye disease (DED) and to correlate endothelial cell loss with corneal subbasal nerve density. METHODS This retrospective study included 40 eyes of 20 patients with DED. Laser in vivo confocal microscopy had been performed in the central cornea of both eyes at an initial visit and repeated after a mean follow-up of 33.2 ± 10.2 months. The densities of corneal endothelial cells and subbasal nerves were measured in both visits and compared with 13 eyes of 13 normal age-matched controls. RESULTS At the initial visit, the DED group had lower densities of corneal endothelial cells (2620 ± 386 cells/mm) and subbasal nerves (17.8 ± 7.5 mm/mm) compared with the control group (2861 ± 292 cells/mm and 22.8 ± 3.0 mm/mm, with P = 0.08 and P = 0.01, respectively). At the end of follow-up, although there was no significant change in subbasal nerve density (16.7 ± 7.2 mm/mm, P = 0.43), the mean corneal endothelial cell density significantly decreased to 2465 ± 391 cells/mm (P = 0.01), with a mean corneal endothelial cell loss of 2.1 ± 3.6% per year. The endothelial cell loss showed a statistically significant negative correlation with the initial subbasal nerve density (Rs = -0.55, P = 0.02). CONCLUSIONS Patients with DED have an accelerated corneal endothelial cell loss compared with that reported in the literature for normal aging. Those with lower subbasal nerve density, in particular, are at a higher risk for endothelial cell loss over time.
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Morphometry of organ cultured corneal endothelium using Voronoi segmentation. Cell Tissue Bank 2017; 18:167-183. [DOI: 10.1007/s10561-017-9622-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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Duman R, Tok Çevik M, Görkem Çevik S, Duman R, Perente İ. Corneal endothelial cell density in healthy Caucasian population. Saudi J Ophthalmol 2016; 30:236-239. [PMID: 28003782 PMCID: PMC5161821 DOI: 10.1016/j.sjopt.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/25/2016] [Indexed: 11/17/2022] Open
Abstract
AIM To reveal the changes of corneal endothelial characteristics with aging among Caucasian population. METHODS Non-contact specular microscopy was performed in 564 eyes of 282 healthy Caucasian Turkish patients. Endothelial cell density (MCD), mean cell area (MCA), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness (CCT) were measured. RESULTS The mean age was 42 ± 17.1 (6-85) years. The MCD of the population was 2732 ± 305 cell/mm2 (range, 1904-3802 cell/mm2). The MCA was 368 ± 41 m2 (range, 263-522 m2). The mean CV in cell size was 34 ± 7 (range, 25-68), the mean percentage of hexagonal cells was 46 ± 8% (range, 25-76%), and CCT was 513 ± 39 (range, 407-623). There was statistically significantly negative correlation (p < 0.05) between age and cell density, hexagonality, and pachymetry. There was statistically significant correlation (p < 0.05) between age and MCA. CONCLUSION We report the normal values of corneal endothelial characteristics in Caucasian Turkish eyes. Over the age of 20, the MCD of Caucasian eyes is more than the Indian and Iranian eyes and less than the Chinese eyes. Caucasian population's cell density in under the age of 20 is 3101 ± 268 cell/mm2.
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Affiliation(s)
- Rahmi Duman
- Department of Ophthalmology, Afyon Kocatepe University, 03200 Afyon, Turkey
- Corresponding author.
| | - Mediha Tok Çevik
- Department of Ophthalmology, Düziçi State Hospital, 80600 Adana, Turkey
| | - Sadık Görkem Çevik
- Department of Ophthalmology, Bursa Yuksek Ihtisas Training and Research Hospital, 16330 Bursa, Turkey
| | - Reşat Duman
- Department of Ophthalmology, Afyon Kocatepe University, 03200 Afyon, Turkey
| | - İrfan Perente
- Department of Ophthalmology, Beyoğlu Eye Hospital, 34220 Istanbul, Turkey
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Overestimation of Corneal Endothelial Cell Density in Smaller Frame Sizes in In Vivo Confocal Microscopy. Cornea 2016; 35:363-9. [DOI: 10.1097/ico.0000000000000698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fully automatic evaluation of the corneal endothelium from in vivo confocal microscopy. BMC Med Imaging 2015; 15:13. [PMID: 25928199 PMCID: PMC4451752 DOI: 10.1186/s12880-015-0054-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/07/2015] [Indexed: 11/11/2022] Open
Abstract
Background Manual and semi-automatic analyses of images, acquired in vivo by confocal microscopy, are often used to determine the quality of corneal endothelium in the human eye. These procedures are highly time consuming. Here, we present two fully automatic methods to analyze and quantify corneal endothelium imaged by in vivo white light slit-scanning confocal microscopy. Methods In the first approach, endothelial cell density is estimated with the help of spatial frequency analysis. We evaluate published methods, and propose a new, parameter-free method. In the second approach, based on the stochastic watershed, cells are automatically segmented and the result is used to estimate cell density, polymegathism (cell size variability) and pleomorphism (cell shape variation). We show how to determine optimal values for the three parameters of this algorithm, and compare its results to a semi-automatic delineation by a trained observer. Results The frequency analysis method proposed here is more precise than any published method. The segmentation method outperforms the fully automatic method in the NAVIS software (Nidek Technologies Srl, Padova, Italy), which significantly overestimates the number of cells for cell densities below approximately 1200 mm−2, as well as previously published methods. Conclusions The methods presented here provide a significant improvement over the state of the art, and make in vivo, automated assessment of corneal endothelium more accessible. The segmentation method proposed paves the way to many possible new morphometric parameters, which can quickly and precisely be determined from the segmented image. Electronic supplementary material The online version of this article (doi:10.1186/s12880-015-0054-3) contains supplementary material, which is available to authorized users.
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McLaren JW, Bachman LA, Kane KM, Patel SV. Objective assessment of the corneal endothelium in Fuchs' endothelial dystrophy. Invest Ophthalmol Vis Sci 2014; 55:1184-90. [PMID: 24508788 DOI: 10.1167/iovs.13-13041] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To develop a standardized method of endothelial cell density (ECD) assessment in Fuchs' endothelial dystrophy that maximizes the sample area and uses the clearest endothelial cells in confocal images. METHODS The corneal endothelium of 51 eyes from 30 patients, with varying degrees of Fuchs' endothelial dystrophy, was examined using confocal microscopy. In two or three distinct images of the central endothelium, local contiguous cell density was determined using a variable frame method. The effective ECD was the product of the local cell density and the fraction of the image that was free of guttae. Two examiners assessed the severity of disease in each eye during slit-lamp examination and assigned a severity grade of 1 to 6. In a second group of 55 eyes with Fuchs' dystrophy from 30 patients, the clinical grade was predicted from the effective ECD and the regression coefficients of the first group and compared to the subjective clinical grade assigned by one examiner. RESULTS The effective ECD decreased linearly with subjective grade (r = -0.93, P < 0.001). The grade predicted from the effective ECD differed from the subjective clinical grade by -0.1 ± 0.8 (mean difference ± standard deviation). CONCLUSIONS The effective ECD in confocal images provides an objective means of assessing the corneal endothelium in Fuchs' dystrophy and might be a useful tool in clinical studies.
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Affiliation(s)
- Jay W McLaren
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Inherent errors of the fixed-frame counting method for corneal endothelial cell density in eye banks. Cell Tissue Bank 2013; 15:451-9. [DOI: 10.1007/s10561-013-9411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/21/2013] [Indexed: 10/26/2022]
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