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Galvis V, Prada AM, Tello A, Parra MM, Camacho PA, Polit MP. Safety of intracameral application of moxifloxacin and dexamethasone (Vigadexa®) after phacoemulsification surgery. Graefes Arch Clin Exp Ophthalmol 2023; 261:3215-3221. [PMID: 37227478 PMCID: PMC10587335 DOI: 10.1007/s00417-023-06095-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Intracameral antibiotics, such as moxifloxacin and cefuroxime, are safe to corneal endothelial cells and effective prophylaxis of endophthalmitis after cataract surgery. Corneal endothelial cells decrease in density after cataract surgery. Any substance used in the anterior chamber may affect corneal endothelial cells and lead to a greater decrease in density. This study wants to determine the percentage of endothelial cell loss after cataract extraction by phacoemulsification with off-label intracameral injection of moxifloxacin and dexamethasone (Vigadexa®). METHODS An observational retrospective study was performed. The clinical records of patients undergoing cataract surgery by phacoemulsification plus intracameral injection of Vigadexa® were analyzed. Endothelial cell loss (ECL) was calculated using preoperative and postoperative endothelial cell density. The relation of endothelial cell loss with cataract grade using LOCS III classification, total surgery time, total ultrasound time, total longitudinal power time, total torsional amplitude time, total aspiration time, estimated fluid usage, and cumulative dissipated energy (CDE) was studied using univariate linear regression analysis and logistic regression analysis. RESULTS The median loss of corneal endothelial cells was 4.6%, interquartile range 0 to 10.4%. Nuclear color and CDE were associated with increased ECL. ECL>10% was associated with age and total ultrasound time in seconds. CONCLUSIONS The endothelial cell loss after the intracameral use of Vigadexa® at the end of cataract surgery was similar to the reported in other studies of cataract surgery without the use of intracameral prophylaxis for postoperative endophthalmitis (POE). This study confirmed the association of CDE and nuclear opalescence grade with postoperative corneal endothelial cell loss.
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Affiliation(s)
- Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Angelica Maria Prada
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Calle 158 20-95, Consultorio 301, Torre C, Cañaveral, Floridablanca, Santander, Colombia.
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia.
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia.
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
| | - Maria Margarita Parra
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Universidad Industrial de Santander (UIS), Bucaramanga, Colombia
| | - Paul Anthony Camacho
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
| | - María Paz Polit
- Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
- Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Colombia
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Yang Y, Chai H, Ding Z, Tang C, Liang Y, Li Y, Liang H. Meta-analysis of corneal endothelial changes after phacoemulsification in diabetic and non-diabetic patients. BMC Ophthalmol 2023; 23:174. [PMID: 37095472 PMCID: PMC10124059 DOI: 10.1186/s12886-023-02924-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/14/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Currently, there is still controversy about the differential changes in corneal endothelium function and morphology after phacoemulsification between Diabetes Mellitus (DM) and non-Diabetes Mellitus (non-DM) patients. In this study, we aimed to evaluate the influence of phacoemulsification on the corneal endothelium in DM and non-DM patients. METHODS Databases of PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies published between January 1, 2011 and December 25, 2021. The weighted mean difference and 95% confidence interval were used to estimate the outcomes of statistical analyses performed. RESULTS Thirteen studies involving 1744 eyes were included in this meta-analysis. No significant difference was observed in the central corneal thickness (CCT), endothelial cell density (ECD), coefficients of variation (CV), or hexagonal cell percentage (HCP) between the DM and non-DM groups (CCT: P = 0.91; ECD: P = 0.07; CV: P = 0.06; HCP: P = 0.09) preoperatively. The CCT was significantly thicker in the DM group at 1 month (P = 0.003) and 3 months (P = 0.0009) postoperatively, and there was no significant difference at 6 months postoperatively (P = 0.26) than non-DM group. The CV was significantly higher and HCP was significantly lower in the DM group at 1 month (CV:P < 0.0001, HCP: P = 0.002), with no significant difference at 3 months (CV: P = 0.09, HCP: P = 0.36) and 6 months (CV: P = 0.32, HCP: P = 0.36) postoperatively than non-DM group. DM patients had lower ECD than non-DM patients at all postoperative time points (1 month, 3 months: P < 0.00001, 6 months: P < 0.0001). CONCLUSIONS The influence of phacoemulsification on corneal endothelial damage is greater in diabetic patients. Moreover, the recovery of corneal endothelial function and morphology is delayed in these patients. Clinicians should be more attentive to the corneal health of DM patients when considering phacoemulsification.
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Affiliation(s)
- Yingqin Yang
- Department of Ophtalmology, The First Affiliated Hospital of Guangxi Medical University, NanNing, 530000, China
| | - Hongtao Chai
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Ginlin, 541001, China
| | - Zhixiang Ding
- Department of Ophtalmology, Affiliated Hospital of Guilin Medical University, Ginlin, 541001, China
| | - Chengye Tang
- Department of Ophtalmology, The First Affiliated Hospital of Guangxi Medical University, NanNing, 530000, China
| | - Yongshun Liang
- Department of Ophtalmology, The First Affiliated Hospital of Guangxi Medical University, NanNing, 530000, China
| | - Yihong Li
- Department of Ophtalmology, The First Affiliated Hospital of Guangxi Medical University, NanNing, 530000, China
| | - Hao Liang
- Department of Ophtalmology, The First Affiliated Hospital of Guangxi Medical University, NanNing, 530000, China.
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Application of the Active-Fluidics System in Phacoemulsification: A Review. J Clin Med 2023; 12:jcm12020611. [PMID: 36675540 PMCID: PMC9863491 DOI: 10.3390/jcm12020611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
The fluidics system is an indispensable and primary component of phacoemulsification. Both the gravity-fluidics system and active-fluidics system are commonly used in practice. The irrigation pressure of the gravity-fluidics system is determined by the bottle height, which is relatively constant, while the active-fluidics system is paired with a cassette that contains pressure sensors to monitor intraocular pressure changes. The active-fluidics system allows surgeons to preset a target intraocular pressure value, and it replenishes the fluids proactively; thus, the intraocular pressure is consistently maintained near the target value. Under such circumstances, stable intraocular pressure and anterior chamber volume values could be acquired. Research on surgical safety, efficiency and results have reported several strengths of the active-fluidics system. It is also advantageous in some complicated cataract surgeries. However, the system is not widely used at present, mainly due to its low penetration rate and high equipment cost. Some of its updates such as the new Active Sentry handpiece showed potential superiority in laboratory studies recently, but there is still further research to be conducted. This article gives an overview of the mechanism and performance of the active-fluidics system, and it is expected to provide clues for future research.
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Fortenbach CR, Skeie JM, Sevcik KM, Johnson AT, Oetting TA, Haugsdal JM, Sales CS, Nishimura DY, Taylor EB, Schmidt GA, Greiner MA. Metabolic and proteomic indications of diabetes progression in human aqueous humor. PLoS One 2023; 18:e0280491. [PMID: 36652491 PMCID: PMC9847982 DOI: 10.1371/journal.pone.0280491] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Diabetes mellitus is a multiorgan systemic disease impacting numerous ocular structures that results in significant ocular morbidity and often results in more frequent corneal and glaucoma surgeries for affected individuals. We hypothesize that the systemic metabolic and proteomic derangement observed in the progression of diabetes influences the composition of the aqueous humor (AH), which ultimately impacts the anterior segment health of the eye. To identify changes associated with diabetes progression, we mapped the metabolite profile and proteome of AH samples from patients with varying severities of type II diabetes (T2DM). Patients were classified as nondiabetic (ND or control), non-insulin-dependent diabetic without advanced features of disease (NAD-ni), insulin-dependent diabetic without advanced features (NAD-i), or diabetic with advanced features (AD). AH samples collected from the anterior chamber during elective ophthalmic surgery were evaluated for metabolite and protein expression changes associated with diabetic severity via gas chromatography/mass spectrometry and ultra-high performance liquid chromatography tandem mass spectrometry, respectively. Metabolic and proteomic pathway analyses were conducted utilizing MetaboAnalyst 4.0 and Ingenuity Pathway Analysis. A total of 14 control, 12 NAD-ni, 4 NAD-I, and 14 AD samples were included for analysis. Elevated levels of several branched amino acids (e.g., valine, leucine, isoleucine), and lipid metabolites (e.g., palmitate) were found only with increasing diabetic severity (i.e., the AD group). Similar proteomic trends were noted in amino acid and fatty acid metabolism and the unfolded protein/stress response. These results represent the first report of both metabolomic and proteomic evaluation of aqueous humor. Diabetes results in metabolic and proteomic perturbations detectable in the AH, and unique changes become manifest as T2DM severity worsens. Changes in AH composition may serve as an indicator of disease severity, risk assessment of anterior segment cells and structures, and potential future therapies.
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Affiliation(s)
- Christopher R. Fortenbach
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
| | - Jessica M. Skeie
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
- Iowa Lions Eye Bank, Coralville, IA, United States of America
| | - Kristina M. Sevcik
- Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
| | - A. Tim Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
| | - Thomas A. Oetting
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
| | - Jaclyn M. Haugsdal
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
| | - Christopher S. Sales
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
- Iowa Lions Eye Bank, Coralville, IA, United States of America
| | - Darryl Y. Nishimura
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
- Iowa Lions Eye Bank, Coralville, IA, United States of America
| | - Eric B. Taylor
- Department of Biochemistry, Fraternal Order of the Eagles Diabetes Research Center, Abboud Cardiovascular Research Center, Holden Comprehensive Cancer Center, and Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
| | | | - Mark A. Greiner
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, United States of America
- Iowa Lions Eye Bank, Coralville, IA, United States of America
- * E-mail:
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Chen TM, Lasarev MR, Eaton JS. Retrospective investigation of perioperative risk factors for immediate postoperative corneal erosions in dogs undergoing phacoemulsification. Vet Ophthalmol 2022; 26:191-204. [DOI: 10.1111/vop.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/15/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Tiffany Mei Chen
- Department of Surgical Sciences, School of Veterinary Medicine University of Wisconsin Madison USA
| | - Michael R. Lasarev
- Biostatistics and Medical Informatics, School of Medicine and Public Health University of Wisconsin Madison USA
| | - Joshua Seth Eaton
- Department of Surgical Sciences, School of Veterinary Medicine University of Wisconsin Madison USA
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Kang KH, Song MY, Kim KY, Hwang KY, Kwon YA, Koh K. Corneal Endothelial Cell Changes After Femtosecond Laser-Assisted Cataract Surgery in Diabetic and Nondiabetic Patients. Eye Contact Lens 2021; 47:664-669. [PMID: 34294644 DOI: 10.1097/icl.0000000000000823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare corneal endothelial cell changes after femtosecond laser-assisted cataract surgery (FLACS) in diabetic and nondiabetic patients. METHODS This retrospective study included patients with cataract who underwent FLACS performed by a single surgeon between August 2018 and November 2020. Changes in corneal endothelial cell density (ECD), hexagonality, coefficient of variation in cell size (CV), and central corneal thickness (CCT) at baseline and at the 1-month and 3-month postoperative follow-ups were investigated by dividing the patients into diabetic and nondiabetic groups. RESULTS We included 75 patients (60% men, mean age: 57.7±11.4 years, range: 27-80 years) in the analysis: 31 diabetic patients (64% men, mean age: 58.7±11.9 years, range: 27-79 years) and 44 nondiabetic patients (56% men, mean age: 57.1±11.3 years, range: 34-80 years). No differences were observed between the two groups as regards preoperative and intraoperative parameters, the mean postoperative ECD, hexagonality, and CV. At 1 month postoperatively, the CCT was significantly greater in the diabetic group (P=0.034); however, at 3 months, there was no significant difference between the two groups (P=0.927). CONCLUSIONS Changes in postoperative corneal endothelial cells were comparable between patients with and without diabetes after FLACS. Femtosecond laser-assisted cataract surgery seems to cause less damage to the corneal endothelium in diabetic patients because it uses less phacoemulsification energy.
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Affiliation(s)
- Kyoung Hae Kang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
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Joo JH, Kim TG. Comparison of corneal endothelial cell changes after phacoemulsification between type 2 diabetic and nondiabetic patients. Medicine (Baltimore) 2021; 100:e27141. [PMID: 34477167 PMCID: PMC8415947 DOI: 10.1097/md.0000000000027141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study is to compare the endothelial cell density (ECD) and morphology between diabetic mellitus (DM) and nondiabetic patients at 1 year after phacoemulsification in operated eyes and nonoperated eyes.Evaluation was performed in 28 patients (56 eyes) with type 2 diabetes and 37 patients (74 eyes) without diabetes who underwent 1-year interval cataract surgery. Using a noncontact specular microscope and Scheimpflug rotating camera, corneal parameters were analyzed before and 1 year after surgery. Subgroups analysis was performed based on a disease duration 10 years and HbA1c concentration 7% and Pearson correlation analysis was performed.The mean change in ECD at 1 year after surgery was 13.28% in the DM group and 11.40% in the control group. In the fellow nonoperated eyes, the mean change was 4.47% and 3.63% in the DM and control groups, respectively. There was no significant difference in postoperative ECD, coefficient of variance, hexagonality, and central corneal thickness between 2 groups. In the subgroup analysis, the long disease duration DM group (≥10 years) had a significantly greater ECD loss than the control and short disease duration DM groups (<10 years). Blood urea nitrogen (BUN) showed a significant correlation with postoperative ECD change (r = -0.474, P = .011).The diabetic group with a longer disease duration showed significantly greater ECD decrease compared to the nondiabetic group and BUN correlated with ECD changes after phacoemulsification. Postoperative ECD loss may be high if the disease duration is long or if the BUN level is high.
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8
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Shah R, Amador C, Tormanen K, Ghiam S, Saghizadeh M, Arumugaswami V, Kumar A, Kramerov AA, Ljubimov AV. Systemic diseases and the cornea. Exp Eye Res 2021; 204:108455. [PMID: 33485845 PMCID: PMC7946758 DOI: 10.1016/j.exer.2021.108455] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
There is a number of systemic diseases affecting the cornea. These include endocrine disorders (diabetes, Graves' disease, Addison's disease, hyperparathyroidism), infections with viruses (SARS-CoV-2, herpes simplex, varicella zoster, HTLV-1, Epstein-Barr virus) and bacteria (tuberculosis, syphilis and Pseudomonas aeruginosa), autoimmune and inflammatory diseases (rheumatoid arthritis, Sjögren's syndrome, lupus erythematosus, gout, atopic and vernal keratoconjunctivitis, multiple sclerosis, granulomatosis with polyangiitis, sarcoidosis, Cogan's syndrome, immunobullous diseases), corneal deposit disorders (Wilson's disease, cystinosis, Fabry disease, Meretoja's syndrome, mucopolysaccharidosis, hyperlipoproteinemia), and genetic disorders (aniridia, Ehlers-Danlos syndromes, Marfan syndrome). Corneal manifestations often provide an insight to underlying systemic diseases and can act as the first indicator of an undiagnosed systemic condition. Routine eye exams can bring attention to potentially life-threatening illnesses. In this review, we provide a fairly detailed overview of the pathologic changes in the cornea described in various systemic diseases and also discuss underlying molecular mechanisms, as well as current and emerging treatments.
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Affiliation(s)
- Ruchi Shah
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Cynthia Amador
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kati Tormanen
- Center for Neurobiology and Vaccine Development, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sean Ghiam
- Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Mehrnoosh Saghizadeh
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vaithi Arumugaswami
- Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI, USA
| | - Andrei A Kramerov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander V Ljubimov
- Eye Program, Board of Governors Regenerative Medicine Institute, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Departments of Molecular and Medical Pharmacology, Medicine, and Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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Beato JN, Esteves-Leandro J, Reis D, Falcão M, Rosas V, Carneiro Â, Falcão Reis F. Evaluation of Corneal Structure and Endothelial Morphological Characteristics in Type 2 Diabetic and Non-Diabetic Patients. Clin Ophthalmol 2020; 14:1993-1999. [PMID: 32764865 PMCID: PMC7369306 DOI: 10.2147/opth.s256244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare corneal structure and endothelial morphological features between patients with type 2 diabetes mellitus (DM) and non-diabetic patients; and determine if the DM duration, glycated hemoglobin (HbA1c) levels, and diabetic retinopathy (DR) stage affect corneal morphological properties. Patients and Methods Sixty diabetic patients and 47 age- and sex-matched controls were enrolled in this cross-sectional study. DM group was analyzed according disease duration, HbA1c levels, and presence of retinopathy. Endothelial cell density (ECD) and morphology (average and coefficient of variation [CV] of cell size, percentage of hexagonal cells) were recorded using non-contact specular microscopy. Central corneal thickness (CCT) and corneal volume were measured by scheimpflug tomography. Univariate and multivariate linear regression analyses were performed to evaluate the relationship between demographical, clinical, and ocular variables with CCT and ECD. Results There were no statistically significant differences in the endothelium cell density or morphology between DM and non-DM groups (p>0.05). Also, there was no statistical difference between groups for CCT or corneal volume (p>0.05). Multivariate linear regression analysis showed that older age (p=0.028) was significantly associated with lower ECD; CCT was found to be significantly greater in males (p<0.001) and positively associated with corneal volume (p<0.001). Conclusion The present study did not find any statistically significant differences between the corneal structural and endothelial characteristics of diabetic and non-diabetic subjects; other demographical parameters, such as age and gender, seem to be more determinant for the corneal properties.
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Affiliation(s)
- João N Beato
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - David Reis
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vítor Rosas
- Department of Ophthalmology, São João Hospital, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão Reis
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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10
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Investigation of the Effects of Phacoemulsification Surgery on Corneal Endothelium. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.739876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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Budiman B. Comparison of Endothelial Cell Density, Morphological Changes and Central Corneal Thickness after Phacoemulsification between Diabetic and Non-Diabetic Patients. Open Ophthalmol J 2020. [DOI: 10.2174/1874364102014010015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Corneal endothelial tissues are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients.
Purpose:
To compare endothelial density, hexagonality, Coefficient of Variance (CV) and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at four weeks after phacoemulsification.
Methods:
Specular microscopy examinations prior to phacoemulsification and at four-weeks after phacoemulsification were performed on diabetic and non-diabetic groups with cataract. Later, patients in the diabetic group were divided based on their HbA1c level. The changes in endothelial density, the percentage of hexagonality, CV and CCT were evaluated.
Results:
At a four-weeks follow up, there were no statistical differences in endothelial cells density, CV and CCT changes between diabetic and non-diabetic groups. Mean (SD) of hexagonality percentage at four weeks of follow-up was lower (p-value=0.001) in diabetic group [(14.6) 41.7%] compared to non-diabetic group [(14.5) 50.1%]. There were no differences in endothelial cells density, hexagonality, CV and CCT values between the diabetic group with HbA1c level <7.5% and HbA1c level ≥7.5% at 4-weeks after phacoemulsification.
Conclusion:
There were no statistically significant differences in the endothelial loss, reduction of CV and CCT changes between the diabetic and non-diabetic group at four-weeks follow up after phacoemulsification. Diabetic group showed greater hexagonality decrease compared to non-diabetic group at four weeks after phacoemulsification. Different HbA1c levels did not affect the changes in endothelial density, the percentage of hexagonality, CV and CCT after phacoemulsification.
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Richdale K, Chao C, Hamilton M. Eye care providers' emerging roles in early detection of diabetes and management of diabetic changes to the ocular surface: a review. BMJ Open Diabetes Res Care 2020; 8:8/1/e001094. [PMID: 32299899 PMCID: PMC7199150 DOI: 10.1136/bmjdrc-2019-001094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
US adults visit eye care providers more often than primary healthcare providers, placing these doctors in a prime position to help identify and manage patients with prediabetes and diabetes. Currently, diabetes is identified in eye clinics in an advanced stage, only after visible signs of diabetic retinopathy. Recent ophthalmic research has identified multiple subclinical and clinical changes that occur in the anterior segment of the eye with metabolic disease. The corneal epithelium exhibits increased defects and poor healing, including an increased risk of neurotrophic keratitis. Increased thickness and stiffness of the cornea artificially alters intraocular pressure. There is damage to the endothelial cells and changes to the bacterial species on the ocular surface, both of which can increase risk of complications with surgery. Decreased corneal sensitivity due to a loss of nerve density predispose patients with metabolic disease to further neurotrophic complications. Patients with diabetes have increased Meibomian gland dysfunction, blepharitis and reduced tear production, resulting in increased rates of dry eye disease and discomfort. Early detection of metabolic disease may allow eye care providers to be more proactive in recommending referral and intervention in order to reduce the risk of blindness and other diabetes-related morbidity. Continued research is needed to better understand the time course of changes to the anterior segment and what can be done to better detect and diagnose patients with prediabetes or undiagnosed diabetes and provide improved care for these patients.
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Affiliation(s)
- Kathryn Richdale
- College of Optometry, University of Houston, Houston, Texas, USA
| | - Cecilia Chao
- College of Optometry, University of Houston, Houston, Texas, USA
- School of Optometry and Vision Science, University of New South Wales-Kensington Campus, Sydney, New South Wales, Australia
| | - Marc Hamilton
- Health and Human Performance, University of Houston, Houston, Texas, USA
- Biology and Biochemistry, University of Houston, Houston, Texas, USA
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Labetoulle M, Behndig A, Tassignon MJ, Nuijts R, Mencucci R, Güell JL, Pleyer U, Szaflik J, Rosen P, Bérard A, Chiambaretta F, Cochener-Lamard B. Safety and efficacy of a standardized intracameral combination of mydriatics and anesthetic for cataract surgery in type-2 diabetic patients. BMC Ophthalmol 2020; 20:81. [PMID: 32126990 PMCID: PMC7055021 DOI: 10.1186/s12886-020-01343-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Cataract surgery in diabetics is more technically challenging due to a number of factors including poor intraoperative pupil dilation and a higher risk of vision threatening complications. This study evaluates the safety and efficacy of an intracameral combination of 2 mydriatics and 1 anesthetic (ICMA, Mydrane) for cataract surgery in patients with well-controlled type-2 diabetes. Methods Post-hoc subgroup analysis of a phase 3 randomized study, comparing ICMA to a conventional topical regimen. Data were collected from 68 centers in Europe and Algeria. Only well-controlled type-2 diabetics, free of pre-proliferative retinopathy, were included. The results for non-diabetics are also reported. The primary efficacy variable was successful capsulorhexis without additional mydriatic treatment. Postoperative safety included adverse events, endothelial cell density and vision. Results Among 591 randomized patients, 57 (9.6%) had controlled type 2 diabetes [24 (42.1%) in the ICMA Group and 33 (57.9%) in the Topical Group; intention-to-treat (ITT) set]. Among diabetics, capsulorhexis was successfully performed without additional mydriatics in 24 (96.0%; modified-ITT set) patients in the ICMA Group and 26 (89.7%) in the Topical Group. These proportions were similar in non-diabetics. No diabetic patient [1 (0.5%) non-diabetics] in the ICMA Group had a significant decrease in pupil size (≥3 mm) intraoperatively compared to 4 (16.0%; modified-ITT set) diabetics [16 (7.3%) non-diabetics] in the Topical group. Ocular AE among diabetics occurred in 2 (8.0%; Safety set) patients in the ICMA Group and 5 (16.7%) in the Topical Group. Endothelial cell density at 1 month postoperatively was similar between groups in diabetics (P = 0.627) and non-diabetics (P = 0.368). Conclusions ICMA is effective and can be safely used in patients with well-controlled diabetes, with potential advantages compared to a topical regimen including reduced systemic risk, better corneal integrity and reduced risk of ocular complications. Trial registration The trial was registered at (reference # NCT02101359) on April 2, 2014.
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Affiliation(s)
- Marc Labetoulle
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, 94275, Paris, France.
| | | | | | - Rudy Nuijts
- University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Rita Mencucci
- A.O.U. Careggi, Clinica Oculistica, Università degli Studi di Firenze, Florence, Italy
| | | | - Uwe Pleyer
- Universitäts-Augenklinik, Charité Campus Virchow-Klinik, Berlin, Germany
| | - Jacek Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Warszawa, Poland
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Skeie JM, Aldrich BT, Goldstein AS, Schmidt GA, Reed CR, Greiner MA. Proteomic analysis of corneal endothelial cell-descemet membrane tissues reveals influence of insulin dependence and disease severity in type 2 diabetes mellitus. PLoS One 2018. [PMID: 29529022 PMCID: PMC5846724 DOI: 10.1371/journal.pone.0192287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to characterize the proteome of the corneal endothelial cell layer and its basement membrane (Descemet membrane) in humans with various severities of type II diabetes mellitus compared to controls, and identify differentially expressed proteins across a range of diabetic disease severities that may influence corneal endothelial cell health. Endothelium-Descemet membrane complex tissues were peeled from transplant suitable donor corneas. Protein fractions were isolated from each sample and subjected to multidimensional liquid chromatography and tandem mass spectrometry. Peptide spectra were matched to the human proteome, assigned gene ontology, and grouped into protein signaling pathways unique to each of the disease states. We identified an average of 12,472 unique proteins in each of the endothelium-Descemet membrane complex tissue samples. There were 2,409 differentially expressed protein isoforms that included previously known risk factors for type II diabetes mellitus related to metabolic processes, oxidative stress, and inflammation. Gene ontology analysis demonstrated that diabetes progression has many protein footprints related to metabolic processes, binding, and catalysis. The most represented pathways involved in diabetes progression included mitochondrial dysfunction, cell-cell junction structure, and protein synthesis regulation. This proteomic dataset identifies novel corneal endothelial cell and Descemet membrane protein expression in various stages of diabetic disease. These findings give insight into the mechanisms involved in diabetes progression relevant to the corneal endothelium and its basement membrane, prioritize new pathways for therapeutic targeting, and provide insight into potential biomarkers for determining the health of this tissue.
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Affiliation(s)
- Jessica M. Skeie
- University of Iowa Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Iowa City, United States of America
- Iowa Lions Eye Bank, Coralville, United States of America
- Cornea Research Center, University of Iowa, Iowa City, United States of America
| | - Benjamin T. Aldrich
- University of Iowa Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Iowa City, United States of America
- Iowa Lions Eye Bank, Coralville, United States of America
- Cornea Research Center, University of Iowa, Iowa City, United States of America
| | - Andrew S. Goldstein
- University of Iowa Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Iowa City, United States of America
- Iowa Lions Eye Bank, Coralville, United States of America
| | - Gregory A. Schmidt
- Iowa Lions Eye Bank, Coralville, United States of America
- Cornea Research Center, University of Iowa, Iowa City, United States of America
| | - Cynthia R. Reed
- Iowa Lions Eye Bank, Coralville, United States of America
- Cornea Research Center, University of Iowa, Iowa City, United States of America
| | - Mark A. Greiner
- University of Iowa Carver College of Medicine, Department of Ophthalmology and Visual Sciences, Iowa City, United States of America
- Iowa Lions Eye Bank, Coralville, United States of America
- Cornea Research Center, University of Iowa, Iowa City, United States of America
- * E-mail:
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