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Wenzel DA, Schultheiss C, Druchkiv V, Hellwinkel OJC, Spitzer MS, Schultheiss M, Casagrande M, Steinhorst NA. Effect of elevated irrigation bottle height during cataract surgery on corneal endothelial cells in porcine eyes. BMC Ophthalmol 2023; 23:211. [PMID: 37170242 PMCID: PMC10173645 DOI: 10.1186/s12886-023-02954-w] [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: 06/02/2022] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Cataract surgery induces corneal endothelial cell loss (ECL). This study investigates the relationship between bottle height (BH) and ECL induced due to irrigation and aspiration (I/A) in cataract surgery and quantifies protective effects of intraoperatively used ophthalmic viscoelastic substances. METHODS Intermittent I/A without phacoemulsification was performed in porcine eyes for 10 min with varying BHs of 100 cm (BH100), 125 cm (BH125), 150 cm (BH150) or no treatment (control, no I/A). Additionally, in one group a dispersive ophthalmic viscoelastic substance was injected into the anterior eye chamber before treatment with I/A at a BH of 150 cm (BH150 + V). After exposure of the corneal endothelium to I/A, the corneas were prepared to split corneal buttons on day 0 and cultivated for 15 days. Endothelial cell density (ECD) was analyzed blinded on days 1, 8 and 15. RESULTS Relative ECL significantly correlated with irrigation BH (control (n = 13): -9.69 ± 6.03% (average ± standard deviation); BH100 (n = 12): -9.69 ± 4.81%-p = 1.000; BH125 (n = 14): -19.44 ± 7.30% - p < 0.001; BH150 (n = 13): -21.99 ± 6.70%-p < 0.001). I/A-induced ECL was significantly decreased by the injection of ophthalmic viscoelastic, as BH150 + V (n = 14; -10.92 ± 4.09%-p = 1.000) showed a cell loss comparable to the control group. CONCLUSIONS ECL is altered by I/A BH and reduced when viscoelastic substances are used.
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Affiliation(s)
- Daniel A Wenzel
- University Eye Hospital, Centre for Ophthalmology, University Hospital Tübingen, Tübingen, Germany.
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Constanze Schultheiss
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasyl Druchkiv
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf J C Hellwinkel
- Department of Forensic Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Corneal Endothelial Cell Loss in Glaucoma and Glaucoma Surgery and the Utility of Management with Descemet Membrane Endothelial Keratoplasty (DMEK). J Ophthalmol 2022; 2022:1315299. [PMID: 35637682 PMCID: PMC9148223 DOI: 10.1155/2022/1315299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/10/2022] [Indexed: 01/15/2023] Open
Abstract
The corneal endothelium has a crucial role in maintaining a clear and healthy cornea. Corneal endothelial cell loss occurs naturally with age; however, a diagnosis of glaucoma and surgical intervention for glaucoma can exacerbate a decline in cell number and impairment in morphology. In glaucoma, the mechanisms for this are not well understood and this accelerated cell loss can result in corneal decompensation. Given the high prevalence of glaucoma worldwide, this review aims to explore the abnormalities observed in the corneal endothelium in differing glaucoma phenotypes and glaucoma therapies (medical or surgical including with new generation microinvasive glaucoma surgeries). Descemet membrane endothelial keratoplasty (DMEK) is increasingly being used to manage corneal endothelial failure for glaucoma patients and we aim to review the recent literature evaluating the use of this technique in this clinical scenario.
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Wang W, Yang X, Yao Q, Xu Q, Liu W, Liu J. Corneal confocal microscopic characteristics of acute angle-closure crisis. BMC Ophthalmol 2022; 22:21. [PMID: 35016625 PMCID: PMC8753899 DOI: 10.1186/s12886-022-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To investigate characteristics of the acute angle-closure crisis (AACC) and fellow eyes using confocal microscopy.
Methods
Unilateral AACC patients hospitalized at the Xi’an People’s Hospital from October 2017 to October 2020 were recruited in this cross-sectional study. Age-matched participants scheduled for cataract surgery were enrolled as a healthy control group. Corneal epithelial cells, subepithelial nerve fiber plexus, stromal cells, and endothelial cells were examined by confocal and specular microscopy.
Results
This study enrolled 41 unilateral AACC patients (82 eyes) and 20 healthy controls (40 eyes). Confocal microscopy revealed that the corneal nerve fiber density, corneal nerve branch density and corneal nerve fiber length were reduced significantly in AACC eyes. The stromal cells were swollen and the size of the endothelial cells was uneven with the deposition of punctate high-reflective keratic precipitate on the surface. In severe cases, the cell volume was enlarged, deformed, and fused. The corneal subepithelial nerve fiber, stromal layer, and endothelial layer were unremarkable in the fellow eyes, and the density of the endothelial cells was 2601 ± 529 cells/mm2, which was higher than 1654 ± 999 cells/mm2 in AACC eyes (P < 0.001). Corneal edema prevented the examination of 17 eyes using specular microscopy and in only four eyes using confocal microscopy. There were no significant differences in endothelial cell density between confocal and specular microscopy in the AACC eyes (P = 0.674) and fellow eyes (P = 0.247). The hexagonal cell ratio reduced significantly (P < 0.001), and average cell size and coefficient of variation of the endothelial cells increased significantly compared with fellow eyes (P < 0.001, P = 0.008).
Conclusions
AACC eye showed decreased density and length of corneal subepithelial nerve fiber plexus, activation of stromal cells, increased endothelial cell polymorphism, and decreased density.
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Cong L, Pan X, Xia Y, Zhang Y, Cheng J, Dong Y. The effects of acute angle closure crisis on corneal endothelial cells in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2022; 13:956780. [PMID: 36111300 PMCID: PMC9468933 DOI: 10.3389/fendo.2022.956780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study investigated the effects of acute angle closure crisis (AACC) on the corneal endothelial cells in patients with type 2 diabetes mellitus (DM) to identify the factors that cause corneal endothelial cell injury. METHODS We examined 154 patients who visited Qingdao Eye Hospital for AACC in one eye (154 eyes; 28 men and 126 women; mean age of 68 ± 8 years). We divided the participants into non-DM, DM well-control, and DM poor-control groups, with the unaffected eyes used as controls. Each participant was evaluated at the hospital while under AACC. We measured the relevant index and corneal parameters of the participants for statistical analysis. RESULTS There were significant statistical differences in corneal parameters among the three groups. The decreased levels of central endothelial cell density (CD) and the percentage of hexagonal cells (6A) were statistically relevant among the groups (P<0.05). The AACC duration was correlated with CD loss rate among the groups (P<0.05). The DM duration was correlated with CD loss rate in the DM well-control group. Compared with the non-DM group, the level of 6A decreased more significantly in the DM group after AACC (P<0.05). The AACC duration in the DM well-control group was significantly shorter than in the non-DM and DM poor-control groups (P<0.001). The DM poor-control group showed significantly worse visual acuity when compared with the other groups (P<0.05). CONCLUSIONS DM may impact the functional status of corneal endothelial cells. AACC can worsen the corneal endothelium damage in patients with DM. Blood glucose levels and the duration of intraocular hypertension are closely related to the severity of corneal endothelial injury.
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Affiliation(s)
- Lin Cong
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Xiaojing Pan
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
- *Correspondence: Xiaojing Pan,
| | - Yiping Xia
- Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital), Qingdao, China
| | - Yangyang Zhang
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Jun Cheng
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Yanling Dong
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
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Soebijantoro I, Gondhowiardjo TD, Soesatyo M. Association Between Anterior Chamber Angle and Corneal Endothelial Cell Density in Chronic Angle Closure. Clin Ophthalmol 2021; 15:1957-1964. [PMID: 34007148 PMCID: PMC8121679 DOI: 10.2147/opth.s309005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the association between corneal endothelial cell density (ECD) and degree of anterior chamber angle (ACA) opening in eyes with chronic angle closure glaucoma. Methods The study was conducted at JEC Eye Hospitals in Indonesia. Treatment-naïve patients aged ≥40 years with IOP >21 mmHg and peripheral anterior chamber depth (ACD) grade 2 or less by Van Herick's technique were recruited. Trabecular iris angle (TIA; degree) was measured using anterior segment optical coherence tomography (AS-OCT) and classified as: grade 1 ≤10°, grade 2 11-20°, and grade 3 >20°. Noncontact specular microscopy was performed, and the following corneal parameters were obtained:ECD (cells/mm2), coefficient of variation (CV; μm2/cell), percentage of hexagonal cells, and central corneal thickness (CCT; μm). Results A total of 52 eyes from 52 subjects were recruited (16 grade 1 TIA, 24 grade 2 TIA, and 12 grade 3 TIA). Presenting IOP was not significantly different between groups. The median central corneal ECD was 2684.5 (1433-2934), 2587.0 (1902-3103), and 2441.0 (1659-3005) cells/mm2 in grade 1, 2, and 3 TIA, respectively, with no significant differences across the groups (P = 0.67). The CV was lowest in grade 3 TIA (36.4 ± 7.2 μm2/cell), and highest in grade 1 TIA (38.3 ± 9.6 μm2/cell), but the differences were not significant (P = 0.74). Likewise, the percentage of hexagonality and CCT was not significantly different. TIA was not correlated with IOP but was modestly correlated with age. Conclusion The corneal ECD and morphological characteristics such as CV and hexagonality were not significantly different across various TIA grading in chronic angle closure. This may reflect the lack of chronic and gradual IOP insult on corneal endothelial parameters as TIA did not show direct effect towards IOP.
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Park HM, Choi J, Lee WJ, Uhm KB. Rate of central corneal thickness changes in primary angle closure eyes: long-term follow-up results. BMC Ophthalmol 2021; 21:145. [PMID: 33752630 PMCID: PMC7986557 DOI: 10.1186/s12886-021-01908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background Central corneal thickness (CCT) and its association with intraocular pressure, which is a pivotal parameter in glaucoma management, has previously been reported. In this study, we intended to investigate the long-term change of CCT in terms of rate in eyes with primary angle-closure (PAC). Additionally, we aimed to analyze events that could affect CCT. Methods In this retrospective study, 26 patients with PAC who had a follow-up period of more than 5 years were analyzed. The rate of CCT changes from baseline was evaluated from the serial CCT measurements over the average follow-up period. The pattern of CCT change rate according to modes of treatment and history of angle-closure attack was analyzed using the repeated linear mixed model analysis. Results A total of 52 eyes were enrolled. The CCT reduction rate of the entire study population was − 0.72 ± 0.22 μm/yr (P = 0.001) with statistical significance. The CCT thinning rate of the laser peripheral iridotomy (PI) group was − 0.53 ± 0.25 μm/yr (P = 0.034) and that of the surgical trabeculectomy group was − 1.32 ± 0.43 μm/yr (P = 0.002), and it was not statistically significant (P = 0.112). The rate of CCT thinning in patients with a history of acute angle-closure attack was − 0.81 ± 0.31 μm/yr (P = 0.009) and that in patients without an attack was − 0.63 ± 0.30 μm/yr (P = 0.001), and it was not statistically significant (P = 0.680). Baseline CCT appeared to be the only significant factor affecting the rate of CCT changes (P < 0.001). Conclusions We found a significant reduction in CCT over a long observation period in PAC eyes. We also found that the rates of CCT reduction were not affected by different treatment modalities or acute angle-closure attacks. The analysis of long-term CCT changes in conjunction with baseline CCT would also be helpful in the clinical evaluation of the PAC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01908-4.
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Affiliation(s)
- Hae Min Park
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, South Korea.,Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, South Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, South Korea. .,Department of Ophthalmology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, South Korea.
| | - Ki Bang Uhm
- Department of Ophthalmology, Hanyang University College of Medicine, 222-1, Wangsimni-ro Seongdong-gu, Seoul, 04763, South Korea
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Yu ZY, Wu L, Qu B. Changes in corneal endothelial cell density in patients with primary open-angle glaucoma. World J Clin Cases 2019; 7:1978-1985. [PMID: 31423429 PMCID: PMC6695540 DOI: 10.12998/wjcc.v7.i15.1978] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Glaucoma is a group of diseases characterized by a specific pattern of optic nerve neuropathy and retinopathy. Increasing evidence demonstrates glaucoma associated corneal endothelium loss. Direct-compression mechanism due to elevated intraocular pressure (IOP), cell toxicity after long term exposure to preservatives and glaucoma surgery have been reported to be the possible mechanism. Herein, we compare the specular endothelial microscopy in primary open-angle glaucoma (POAG) patients and healthy controls of the same age group to observe the corneal endothelium changes and the correlations to the mean IOP in a Chinese case control study.
AIM To investigate corneal endothelial cell density in Chinese patients with POAG.
METHODS A case control study was performed on 60 eyes of 60 patients with POAG. Exclusion criteria included history of corneal diseases, intraocular diseases, contact lens use, ocular trauma or surgery (including intraocular surgery and laser treatment), congenital abnormalities or systemic diseases such as diabetes. Intraocular pressure was measured using Goldmann tonometry. Indirect specular microscopy (TOPCON SP-2000P) was performed on central corneas and endothelial images were acquired. Endothelial cell density, area and cell counts were analyzed.
RESULTS Endothelial cell density was 2959 ± 236 cells/mm2 in healthy controls and 2757 ± 262 cells/mm2 in patients with POAG. The POAG eyes had significantly lower endothelial cell density compared to healthy control eyes (P < 0.001). In the POAG group, endothelial cell density was 2686 ± 233 cells/mm2 in the patients receiving medication and 2856 ± 272 cells/mm2 in the untreated subgroup. The eyes receiving medication had significantly lower endothelial cell density compared to untreated eyes. There was a negative correlation between cell density and mean IOP (r = −0.286, P = 0.004), positive correlation between the average cell area and mean IOP (r = 0.228, P = 0.022), maximum cell area and mean IOP (r = 0.218, P = 0.029) and minimum cell area and mean IOP (r = 0.290, P = 0.003). The percentage of hexagonal cells was not correlated with mean IOP.
CONCLUSION Patients with POAG have lower corneal endothelial cell density than healthy controls of the same age. This may be attributed to mechanical damage from elevated IOP and toxicity of glaucoma medications.
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Affiliation(s)
- Zi-Yan Yu
- Department of Ophthalmology, 4th Affiliated Hospital of China Medical University, Eye hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China
| | - Ling Wu
- Department of Ophthalmology, the 4th people’s Hospital of Shenyang, Shenyang 110005, Liaoning Province, China
| | - Bo Qu
- Department of Ophthalmology, 4th Affiliated Hospital of China Medical University, Eye hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China
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Efficacy and Safety of Argon Laser Peripheral Iridoplasty and Systemic Medical Therapy in Asian Patients with Acute Primary Angle Closure: A Meta-Analysis of Randomized Controlled Trials. J Ophthalmol 2019; 2019:7697416. [PMID: 31192000 PMCID: PMC6525875 DOI: 10.1155/2019/7697416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/21/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to assess the percent reduction in the intraocular pressure (IOP) after argon laser peripheral iridoplasty (ALPI) and systemic medical therapy in patients with acute primary angle closure (APAC). METHODS We searched a number of electronic databases, including MEDLINE, EMBASE, PubMed, and Cochrane Library. We searched the electronic databases from the inception of the databases to August 2018. The primary outcomes included the IOP reduction (IOPR), percent reduction in IOP (IOPR%) from baseline to the endpoint and peripheral anterior synechiae (PAS). The secondary outcomes included the cup-to-disc ratio (CDR), mean endothelial count, and percent of patients requiring topical glaucoma medication. Summary weighted mean difference (WMD), odds ratio (OR), and 95% confidence intervals (CIs) were calculated. RESULTS Four eligible studies including 183 eyes (92 in the ALPI group and 91 in the medical therapy group) were identified. When comparing ALPI to medical therapy, the WMDs of the IOPR% were 30.03 (95% CI: 21.33 to 38.72, p < 0.00001) at 15 minutes, 27.39 (95% CI: 18.89 to 35.89, p < 0.00001) at 30 minutes, 18.15 (95% CI: 10.63 to 25.68, p < 0.00001) at 1 hour, and 12.91 (95% CI: 4.50 to 21.32, p=0.003) at 2 hours. There was no statistically significant difference between the two groups at 24 hours and at more than 6 months after therapy. Meanwhile, no significant difference was observed in the degree of PAS, CDR, mean endothelial count, and percent of patients requiring topical glaucoma medication after treatment between the two groups. CONCLUSIONS Both ALPI and systemic medications were effective with regard to decreasing the IOP. ALPI was more effective in lowering the IOP within the first two hours. Therefore, ALPI may be a better choice for rapidly lowering the IOP in patients with APAC within a short period.
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