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Tello A, Galvis V. Determination of progressive endothelial cell loss after posterior chamber phakic intraocular lens implantation. Int Ophthalmol 2024; 44:195. [PMID: 38658386 DOI: 10.1007/s10792-024-03124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Comments about endothelial cell loss after posterior chamber phakic intraocular lens are provided, with a particular emphasis on the importance of determining progressive postoperative cell density reduction, excluding that related to surgical trauma.
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Affiliation(s)
- Alejandro Tello
- Centro Oftalmológico Virgilio Galvis, Centro Medico Carlos Ardila Lulle, Floor 3, Module 7. Urbanización El Bosque, Floridablanca, Santander, Colombia.
- Ophthalmology Department, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia.
- Ophthalmology Department, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia.
- Surgery Department, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
| | - Virgilio Galvis
- Centro Oftalmológico Virgilio Galvis, Centro Medico Carlos Ardila Lulle, Floor 3, Module 7. Urbanización El Bosque, Floridablanca, Santander, Colombia
- Ophthalmology Department, Fundación Oftalmológica de Santander FOSCAL, Floridablanca, Colombia
- Ophthalmology Department, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia
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Perone JM, Luc MS, Zevering Y, Vermion JC, Gan G, Goetz C. Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research. PLoS One 2024; 19:e0298795. [PMID: 38512953 PMCID: PMC10956851 DOI: 10.1371/journal.pone.0298795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Identifying pre/perioperative factors that predict corneal endothelial-cell loss (ECL) after phacoemulsification may reveal ways to reduce ECL. Our literature analysis showed that 37 studies have investigated one or several such factors but all have significant limitations. Therefore, the data of a large randomized controlled trial (PERCEPOLIS) were subjected to post-hoc multivariate analysis determining the ability of nine pre/perioperative variables to predict ECL. METHODS PERCEPOLIS was conducted in 2015-2016 to compare two phacoemulsification techniques (subluxation and divide-and-conquer) in terms of 3-month ECL. Non-inferiority between the techniques was found. In the present study, post-hoc univariate and multivariate analyses were conducted to determine associations between ECL and age, sex, cataract density, preoperative endothelial-cell density, phacoemulsification technique, effective phaco time (EPT), and 2-hour central-corneal thickness. The data are presented in the context of a narrative review of the literature. RESULTS Three-month data were available for 275 patients (94% of the randomized cohort; mean age, 74 years; 58% women). Mean LOCSIII cataract grade was 3.2. Mean EPT was 6 seconds. Mean ECL was 13%. Only an older age (beta = 0.2%, p = 0.049) and higher EPT (beta = 1.2%, p = 0.0002) predicted 3-month ECL. Cataract density was significant on univariate (p = 0.04) but not multivariate analysis. The other variables did not associate with ECL. CONCLUSIONS Older age may amplify ECL due to increased endothelial cell fragility. EPT may promote ECL via cataract density-dependent and -independent mechanisms that should be considered in future phacoemulsification research aiming to reduce ECL. Our literature analysis showed that the average ECL for relatively unselected consecutively-sampled cohorts is 12%.
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Affiliation(s)
- Jean-Marc Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Marie-Soline Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Yinka Zevering
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Grace Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Christophe Goetz
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
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Wood K, Pessach Y, Kovalyuk N, Lifshitz M, Winter H, Pikkel J. Corneal endothelial cell loss and intraocular pressure following phacoemulsification using a new viscous-cohesive ophthalmic viscosurgical device. Int Ophthalmol 2024; 44:10. [PMID: 38319386 DOI: 10.1007/s10792-024-02997-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/19/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To compare results of two ophthalmic viscosurgical devices (OVDs)-Viscoat (a dispersive OVD, Alcon) and FR-Pro (a viscous-cohesive OVD, Rayner), in phacoemulsification surgery. METHODS A prospective randomized controlled study. Patients undergoing phacoemulsification were randomly assigned to receive one of the two OVDs. Exclusion criteria were age under 40, preoperative endothelial cell count (ECC) below 1,500 cells/mm2 and an eventful surgery. The primary outcome was change in ECC from baseline to postoperative month one and month three. Secondary outcomes were the difference between ECC at postoperative month one and month three, changes in IOP and occurrence of an IOP spike ≥ 30 mmHg after surgery. RESULTS The study included 84 eyes-43 in the Viscoat group and 41 in the FR-Pro group. Mean cell density loss at month one and month three was 17.0 and 19.2%, respectively, for the Viscoat group and 18.4 and 18.8%, respectively, for the FR-Pro group, with no statistically significant difference between the groups (p = 0.772 and p = 0.671, respectively). The mean ECC difference between the month one and month three visits was 50.5 cells/mm2 and was not statistically significant (p = 0.285). One eye in each group had an IOP spike ≥ 30 mmHg, both normalized by postoperative week one. CONCLUSIONS Viscoat and FR-Pro have comparable results following phacoemulsification surgery, suggesting that while FR-Pro is not a dispersive OVD, its endothelial cell protection may be comparable to one, perhaps due to the addition of sorbitol. Furthermore, a one-month follow-up of ECC seems sufficient in such trials.
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Affiliation(s)
- Keren Wood
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel.
| | - Yuval Pessach
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Natalya Kovalyuk
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Michal Lifshitz
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Halit Winter
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Samson Assuta Ashdod University Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
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Otsuka M, Tojo N, Hayashi A. Corneal endothelial cell loss after EX-PRESS surgery depends on site of insertion, cornea or trabecular meshwork. Int Ophthalmol 2023; 43:3471-3477. [PMID: 37273152 DOI: 10.1007/s10792-023-02752-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Previously, we reported that the Ex-press® shunt (EXP) was associated with more rapid reduction in corneal endothelial cells when inserted into the cornea rather than the trabecular meshwork (TM). We compared the reduction rate of corneal endothelial cells between the corneal insertion group and TM insertion group. METHODS This was a retrospective study. We included patients who had undergone EXP surgery and were followed for > 5 years. We analyzed the corneal endothelial cell density (ECD) before and after EXP implantation. RESULTS We included 25 patients in the corneal insertion group and 53 patients in the TM insertion group. One patient in the corneal insertion group developed bullous keratopathy. The ECD decreased significantly more rapidly in the corneal insertion group (p < 0.0001), in whom the mean ECD decreased from 2227 ± 443 to 1415 ± 573 cells/mm2 at 5 years with a mean 5-year survival rate of 64.9 ± 21.9%. By contrast, in the TM insertion group, the mean ECD decreased from 2356 ± 364 to 2124 ± 579 cells/mm2 at 5 years, and the mean 5-year survival rate was 89.3 ± 18.0%. The decrease rate of ECD was calculated as 8.3%/year in the corneal insertion group and 2.2%/year in the TM insertion group. CONCLUSIONS Insertion into cornea is a risk factor for rapid ECD loss. The EXP should be inserted into the TM to preserve the corneal endothelial cells.
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Affiliation(s)
- Mitusya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Chihara E, Tanito M, Kono M, Matsuda A, Honda R, Ishida K, Funaki T, Hamanaka T. Different patterns in the corneal endothelial cell loss after pars plana and pars limbal insertion of the Baerveldt glaucoma implant. Am J Ophthalmol 2023; 253:12-21. [PMID: 37119996 DOI: 10.1016/j.ajo.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE To assess corneal endothelial cell (CE) loss after pars plana (PP) and pars limbal (PL) insertion of a Baerveldt glaucoma implant (BGI). DESIGN Retrospective multicenter interventional comparative study. METHODS We studied central CE loss for 5 years after BGI surgery in 192 eyes. RESULTS The prevalence of bullous keratopathy (BK) was greater in the PL cohort than in the PP cohort (P = .003). The CE loss after simultaneous PP vitrectomy and tube insertion into the vitreous cavity was 11.9% in the first year, which was greater than that of 2.9% in eyes where the tube was inserted simply into the vitreous cavity after a prior vitrectomy (P = .046). The annual percentage CE loss after the first year decreased unidirectionally in both of those groups and was 1.3% and 1.0% in the fifth year, respectively (P < .001). For limbal insertion, the CE loss in the simple PL cohort was biphasic, decreasing from 10.5% in the first year to 7.0% in the fifth year. Simultaneous cataract and BGI surgery enhanced the CE loss slightly in the first year in the PP and PL cohorts to 13.0% and 14.0%, respectively. However, these increases were not significant (P = .816 and .358, respectively). Low preoperative CE density (P < .001) and insertion site (P = .020) were significant risk factors for the development of BK. CONCLUSIONS CE loss in the PL and PP cohorts was biphasic and unidirectional, respectively. The difference in annual CE loss became evident over time. PP tube implantation may be advantageous when the preoperative CE density is low.
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Affiliation(s)
- Etsuo Chihara
- From the Sensho-kai Eye Institute (E.C.), Kyoto; Department of Ophthalmology, Shimane University Faculty of Medicine (E.C., M.T., M.K.), Shimane.
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine (E.C., M.T., M.K.), Shimane
| | - Michihiro Kono
- Department of Ophthalmology, Shimane University Faculty of Medicine (E.C., M.T., M.K.), Shimane
| | - Akira Matsuda
- Department of Ophthalmology, Juntendo University (A.M., R.H.), Tokyo
| | - Rio Honda
- Department of Ophthalmology, Juntendo University (A.M., R.H.), Tokyo
| | - Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center (K.I.), Tokyo
| | - Toshinari Funaki
- Department of Ophthalmology, Japanese Red Cross Medical Center (T.F., T.H.), Tokyo, Japan
| | - Teruhiko Hamanaka
- Department of Ophthalmology, Japanese Red Cross Medical Center (T.F., T.H.), Tokyo, Japan
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Fu L, Hollick EJ. OP-2 Long-term outcomes of rebubbling and graft detachment in Descemet membrane endothelial keratoplasty using a standardised protocol. BMJ Open Ophthalmol 2022; 7:A1. [PMID: 36161821 DOI: 10.1136/bmjophth-2022-bcm.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
UNLABELLED *Correspondence, Lana Fu: L.Fu@nhs.net OBJECTIVE: To analyse risk factors and long-term outcomes after rebubbling and graft detachment in Descemet membrane endothelial keratoplasty (DMEK). METHODS AND ANALYSIS 176 consecutive DMEK grafts of 125 patients performed by 8 surgeons with a standardised technique between January 2015 and January 2022 were analysed. Main outcome measures were graft detachments, rebubbling rate, postoperative outcomes, and risk factors for graft failure and rebubbling. RESULTS 6 (3.4%) grafts required rebubbling (<1/3 detached). 41 (23%) grafts developed self-resolving partial detachments (<1/3detached). 5-year graft survival were 96%, 87%, and 83% in fully attached, partially detached and rebubbled eyes. Mean best spectacle corrected visual acuity (BSCVA) at last follow-up were 0.00±0.34, 0.14±0.25, and 0.18±0.19 logMAR (p=0.266) in fully attached, partially detached and rebubbled eyes. Percentage endothelial cell loss (ECL) was 57.5±14.1, 57.9±14.2, and 68.8±8.8 (p=0.035) in fully attached, partially detached and rebubbled eyes. Graft failure occurred in 9 (5.1%) eyes: 3 grafts had primary failure, 2 had early failure (<3 months), 2 had late failure (<12 months), and 2 grafts did not fully unfold intraoperatively. Intraoperative trauma (score) was a risk factor for graft failure (HR 1.81; 95% CI: 1.33 - 2.50 (p=0.0229)). Indication for surgery was a risk factor for rebubbling (HR 5.28; 95% CI: 5.11 - 72.4 (p=0.00703)). CONCLUSION DMEK grafts had better graft survival if there was no partial detachment or rebubbling up to 5 years postop. There was significant ECL associated with rebubbling. A standardised technique reduces rebubbling and graft failure risk.
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Affiliation(s)
- Lana Fu
- King's College Hospital, London, UK
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Lee KE, Sung KR, Shin JW. Effect of Postoperative Trimming of the Tube Portion of Ahmed Glaucoma Valve on Corneal Endothelial Cell Loss. J Glaucoma 2022; 31:102-108. [PMID: 34628423 DOI: 10.1097/ijg.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/18/2021] [Indexed: 11/25/2022]
Abstract
PRCIS We reduced the tube length through a small limbal incision in eyes that underwent Ahmed glaucoma valve (AGV) implantation and found that the rate of corneal endothelial cell (CEC) density was markedly reduced from -12.2% per year to -3.5% per year after this simple procedure. PURPOSE The aim was to evaluate the effect of postoperative tube tip trimming (TT) after AGV implantation on CEC loss. METHODS In this retrospective cohort study, a total of 75 eyes from 67 patients (41 eyes in the AGV implantation only group (AGVG: mean follow-up, 42.2±13.8 mo) and 34 eyes in the TT after AGV implantation group (TAGVG: mean follow-up, 64.9±18.5 mo) were analyzed. TT was performed through a small limbal incision at a mean of 41 months after AGV implantation. Both groups were followed up for at least 1 year and underwent at least 2 specular microscopic examinations after AGV implantation and/or TT. RESULTS In the AGVG, CEC density was reduced from 2247.0±527.3 to 1665.7±643.3 cells/mm2 (P<0.001). In the TAGVG, it was reduced from 2383.1±619.4 to 1552.9±700.9 cells/mm2 before TT (mean 41 mo of follow-up) and after TT, to 1394.6±654.7 cells/mm2 (mean 26 mo of the follow-up). The reduction rate of CEC density before TT was -12.2±6.5% per year, and this rate was significantly reduced to -3.5±6.9% per year after TT in the TAGVG (P=0.002). The probability of corneal failure defined as a 15% reduction in CEC density was significantly reduced after TT in TAGVG (P=0.038). CONCLUSIONS Tube TT after AGV implantation markedly reduced the rate of CEC loss without serious complications in eyes with AGV implantation.
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Affiliation(s)
- Ko Eun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, Seoul, Korea
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Abstract
BACKGROUND Glaucoma is the leading cause of global irreversible blindness, often associated with raised intraocular pressure (IOP). Where medical or laser treatment has failed or is not tolerated, surgery is often required. Minimally-invasive surgical approaches have been developed in recent years to reduce IOP with lower surgical risks. Supraciliary microstent surgery for the treatment of open-angle glaucoma (OAG) is one such approach. OBJECTIVES To evaluate the efficacy and safety of supraciliary microstent surgery for the treatment of OAG, and to compare with standard medical, laser or surgical treatments. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2020, Issue 8); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 27 August 2020. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of supraciliary microstent surgery, alone or with cataract surgery, compared to other surgical treatments (cataract surgery alone, other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts from the database search to identify studies that met the selection criteria. Data extraction, analysis, and evaluation of risk of bias from selected studies was performed independently and according to standard Cochrane methodology. MAIN RESULTS One study met the inclusion criteria of this review, evaluating the efficacy and safety of the Cypass supraciliary microstent surgery for the treatment of OAG, comparing phacoemulsification + supraciliary microstent surgery with phacoemulsification alone over 24 months. This study comprised 505 eyes of 505 participants with both OAG and cataract, 374 randomised to the phacoemulsification + microstent group. In this study, the perceived risk of bias from random sequence generation, allocation concealment and selective reporting was low. However, we considered the study to be at high risk of performance bias as surgeons/investigators were unmasked. Attrition bias was unclear, with 448/505 participants contributing to per protocol analysis. Insertion of a Cypass supraciliary microstent combined with phacoemulsification probably increases the proportion of participants who are medication-free (not using eye-drops) at 24 months compared with phacoemulsification alone (85% versus 59%, risk ratio (RR) 1.27, 95% confidence interval (CI) 1.09 to 1.49, moderate-certainty evidence). There is high-certainty evidence that a greater improvement in mean IOP occurs in the phacoemulsification + microstent group - mean (SD) change in IOP from baseline of -5.4 (3.9) mmHg in the phacoemulsification group, compared to -7.4 (4.4) mmHg in the phacoemulsification + microstent group at 24 months (mean difference -2.0 mmHg, 95% CI -2.85 to -1.15). There is moderate-certainty evidence that insertion of a microstent is probably associated with a greater reduction in use of IOP-lowering drops (mean reduction of 0.7 medications in the phacoemulsification group, compared to a mean reduction of 1.2 medications in the phacoemulsification + microstent group). Insertion of a microstent during phacoemulsification may reduce the requirement for further glaucoma intervention to control IOP at a later stage compared to phacoemulsification alone (RR 0.26, 95% CI 0.07 to 1.04, low-certainty evidence). There is no evidence relating to the rate of visual field progression, or proportion of participants whose visual field loss progressed in this study. There is moderate-certainty evidence showing little or no difference in the proportion of participants experiencing postoperative complications over 24 months between participants in the microstent group compared to those who received phacoemulsification alone (RR 1.1, 95% CI 0.8 to 1.4). Five year post-approval data regarding the safety of the Cypass supraciliary microstent showed increased endothelial cell loss, associated with the position of the microstent in the anterior chamber. There were no reported health-related quality of life (HRQoL) outcomes in the included study. AUTHORS' CONCLUSIONS Data from this single RCT show superiority of supraciliary microstent surgery when combined with phacoemulsification compared to phacoemulsification alone in achieving medication-free control of OAG. However, there are long-term safety concerns with the device used in this trial, relating to the observed significant loss of corneal endothelial cells at five years following device implantation. At the time of this review, this device has been withdrawn from the market. This review has found that few high-quality studies exist comparing supraciliary microstent surgery to standard medical, laser or surgical glaucoma treatments. This should be addressed by further appropriately designed RCTs with sufficient long-term follow-up to ensure robust safety data are obtained. Consideration of health-related quality of life outcomes should also feature in trial design.
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Affiliation(s)
- Amanjeet Sandhu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, UK
| | - Kuang Hu
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology UCL & NIHR Biomedical Research Centre, London, UK
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Fei X, Cai Y, Lin F, Huang Y, Liu T, Liu Y. Amniotic fluid mesenchymal stem cells repair mouse corneal cold injury by promoting mRNA N4-acetylcytidine modification and ETV4/JUN/CCND2 signal axis activation. Hum Cell 2021; 34:86-98. [PMID: 33010000 PMCID: PMC7788028 DOI: 10.1007/s13577-020-00442-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
Severe corneal injury is one of the main causes of loss of visual function. Mesenchymal stem cells (MSCs) have the ability to repair damaged cells in vivo. The present study aimed to explore whether MSCs could function as a cell therapy tool to replace traditional methods to treat corneal injury. CD44 + /CD105 + mesenchymal stem cells isolated from mouse amniotic fluid (mAF-MSCs) were injected into mice after cryoinjury to induce corneal endothelial cell injury. Histopathological assays indicated that mAF-MSCs could promote the growth of corneal epithelial cells, reduce keratitis, and repair the corneal damage caused by low temperature. cDNA microarray analysis revealed that the mAF-MSCs affected the expression patterns of mRNAs related to cell proliferation and differentiation pathways in the mice after transplantation. The results of quantitative real-time PCR and western blotting revealed that NAT12, NAT10, and the ETV4/JUN/CCND2 signaling axis were elevated significantly in the mAF-MSC-transplantation group, compared with those in the phosphate-buffered saline-treated groups. High performance liquid chromatography-mass spectroscopy results revealed that mAF-MSCs could promote mRNA N4-acetylcytidine (ac4C) modification and high expression of N-acetyltransferase in the eyeballs. RNA immunoprecipitation-PCR results showed that a specific product comprising Vegfa, Klf4, Ccnd2, Jun, and Etv4 mRNA specific coding region sites could be amplified using PCR from complexes formed in mAF-MSC-transplanted samples cross-linked with anti-ac4C antibodies. Thus, mouse amniotic fluid MSCs could repair the mouse corneal cold injury by promoting the ETV4/JUN/CCND2 signal axis activation and improving its stability by stimulating N4-acetylcytidine modification of their mRNAs.
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Affiliation(s)
- Xinfeng Fei
- Department of Ophthalmology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, 100 Haining Road, Shanghai, 200080, China
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200080, China
| | - Yuying Cai
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai, 200080, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, 200080, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai General Hospital, Shanghai, 200080, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai General Hospital, Shanghai, 200080, China
| | - Feng Lin
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200080, China
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai, 200080, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, 200080, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai General Hospital, Shanghai, 200080, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai General Hospital, Shanghai, 200080, China
| | - Yongyi Huang
- School of Environmental and Chemical Engineering, Shanghai University, Shanghai, 200444, China
| | - Te Liu
- Shanghai Geriatric Institute of Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Building C, 365 Xiangyang Road, Shanghai, 200031, China.
| | - Yan Liu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, 200080, China.
- National Clinical Research Center for Eye Diseases, Shanghai General Hospital, Shanghai, 200080, China.
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai General Hospital, Shanghai, 200080, China.
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai General Hospital, Shanghai, 200080, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai General Hospital, Shanghai, 200080, China.
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Hsiao FC, Chen HT, Chen KJ, Hsueh YJ, Meir YJJ, Lu TT, Cheng CM, Wu WC, Chen HC. Accelerated corneal endothelial cell loss in two patients with granulomatosis with polyangiitis following phacoemulsification. BMC Ophthalmol 2020; 20:480. [PMID: 33287743 PMCID: PMC7720459 DOI: 10.1186/s12886-020-01752-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generally, the loss rate of human endothelial cells (HCEC) in routine cataract surgery is 8.5%. When the corneal endothelial cells density (ECD) drops, the HCEC may decompensate to keep cornea dehydration which leads to corneal edema. Granulomatosis with polyangiitis (GPA) is an uncommon autoimmune disease involving multiple organs including eyes such as conjunctivitis, scleritis, uveitis, and corneal ulcer. In this study, we report two cases of GPA whose corneal ECD decreased significantly after phacoemulsification cataract surgery. CASE PRESENTATION In the first case of 69-year-old male with GPA, the ECD dropped 39.6% (OD) four months after phacoemulsification and 38.1% (OS) six months postoperatively respectively. At the final follow-up, the residual ECD was only 55% in the right eye in the 49th month, and 56% remained in the left eye in the 39th month. In the second case of 54-year old female, left ECD dropped 63.9% at the 4th month after surgery and 69.6% ECD remained at the 15th month postoperatively while similar ECD of right eye before and after left eye surgery. CONCLUSION Extensive preoperative ophthalmic evaluation and meticulous postoperative inflammation control should be applied to prevent severe loss of HCEC in GPA patients.
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Affiliation(s)
- Fang-Chi Hsiao
- Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Linkou, Taoyuan, 33305 Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Ta Chen
- Department of Internal Medicine, Taipei City Hospital- Heping Branch, Taipei, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Linkou, Taoyuan, 33305 Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Jen Hsueh
- Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Linkou, Taoyuan, 33305 Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yaa-Jyuhn James Meir
- Department of Biomedical Sciences, Chang Gung University College of Medicine, Taiyuan, Taiwan
| | - Tsai-Te Lu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Linkou, Taoyuan, 33305 Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Linkou, Taoyuan, 33305 Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
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11
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Asgari S, Aghamirsalim M, Mehravaran S, Hashemi H. Effect of Down syndrome and keratoconus on corneal density and volume: a triple comparative study. Sci Rep 2020; 10:9098. [PMID: 32499561 PMCID: PMC7272627 DOI: 10.1038/s41598-020-66108-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
Keratoconus (KCN) and Down syndrome affect the corneal density and volume. In this study included Down syndrome patients with and without KCN (24 Down-KCN and 204 Down-nonKCN eyes) and normal age- and gender-matched individuals (184 eyes). Studied parameters were the corneal density measured with Pentacam HR in 5 concentric zones and annuli (0-2 mm, 2-6 mm, 6-10 mm, 10-12 mm, and 0-12 mm) in 4 different depth layers (anterior 120 µm, posterior 60 µm, middle layer, and the full thickness of the cornea), and the 10 mm zone corneal volume. In Down-KCN, Down-nonKCN, and control groups, respectively, mean full thickness density in the 0-12 mm zone was 19.35 ± 2.92, 17.85 ± 2.55, and 15.78 ± 2.67 GSU, and mean corneal volume was 57.45 ± 4.37, 56.99 ± 3.46, and 61.43 ± 3.42mm3. All density readings were significantly different between the three studied groups (all P < 0.01) except full thickness density in 0-2 mm and 2-6 mm (P > 0.05) and corneal volume (P = 0.519) between Down-KCN and Down-nonKCN groups; these inter-group densitometry differences within the 6 mm zone were only in the middle layer, and not the anterior or posterior thickness layers (all P > 0.05). Corneal density increased with age and corneal thickness, but there was no significant relationship with gender. Overall, Down syndrome is associated with increased density and light scatter in all corneal layers up to the 12 mm diameter. In Down patients with KCN, the increased light scatter and density in the 6 mm zone is only in the middle thickness layer. Corneal volume is reduced in Down syndrome irrespective of the presence or absence of KCN.
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Affiliation(s)
- Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | | | - Shiva Mehravaran
- ASCEND Center for Biomedical Research, Morgan State University, Baltimore, MD, USA
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran.
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12
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Abstract
PURPOSE We report a case of localized endothelial decompensation due to airbag deployment during a motor vehicle accident. CASE REPORT A middle-aged woman involved in a motor vehicle accident presented with diminution of vision in left eye. Initial ocular examination revealed corneal abrasion, localized central corneal edema and mild anterior chamber reaction. An anterior-segment ocular coherence tomography (AS-OCT) revealed focal paracentral corneal edema. Patient was managed with lubricating eye drops and antibiotic steroid combination. Significant endothelial cell loss compared to right eye was noted on specular examination. At one- month follow-up, visual acuity recovered to 6/6 but the pleomorphism and polymegathism persisted. CONCLUSION Airbag-related localized corneal endothelial decompensation is a less known occurrence. This case emphasizes on the fact that serial monitoring of endothelial counts and conservative management can prove beneficial in such scenarios.
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Affiliation(s)
| | - Harshika Chawla
- Department of Ophthalmology, All India Institute of Medical Sciences, Rishikesh, 249204, India.
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13
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Li X, Ni S, Li S, Zheng Q, Wu J, Liang G, Xu W. Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis. Am J Ophthalmol 2018; 192:10-19. [PMID: 29750951 DOI: 10.1016/j.ajo.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). DESIGN Systematic review and network meta-analysis. METHODS The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. RESULTS A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. CONCLUSIONS Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.
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Affiliation(s)
- Xi Li
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Shuang Ni
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Shuyi Li
- Department of Ophthalmology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Qianyin Zheng
- Department of Ophthalmology, Taizhou Hospital, Taizhou, Zhejiang, China
| | - Jing Wu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Guanlu Liang
- Department of Ophthalmology, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Wen Xu
- Eye Center, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China.
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14
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Iwasaki K, Arimura S, Takihara Y, Takamura Y, Inatani M. Prospective cohort study of corneal endothelial cell loss after Baerveldt glaucoma implantation. PLoS One 2018; 13:e0201342. [PMID: 30048529 PMCID: PMC6062117 DOI: 10.1371/journal.pone.0201342] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 07/13/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate corneal endothelial cell loss after Baerveldt glaucoma implantation. Methods We prospectively evaluated changes in endothelial cell density (ECD) in the cornea of 59 patients (59 eyes) who underwent Baerveldt glaucoma implantation. Tubes were inserted into the anterior chamber in 45 eyes and pars plana in 14 eyes. The primary outcome measure was the change in corneal ECD after Baerveldt glaucoma implantation. Secondary outcome measures included relationships between corneal ECD and optical coherence tomography images of tube parameters (tube–cornea distance and tube–cornea angle) and prognostic factors for corneal ECD loss. Results Corneal ECD decreased significantly by 9.2% at 12 months after surgery (P = 0.001). In the anterior chamber Baerveldt glaucoma implantation group, corneal ECD at the tube insertion quadrant decreased significantly by 9.6% at 3 months (P = <0.001), 10.7% at 6 months (P = <0.001), and 13.1% at 12 months (P = <0.001). Corneal ECD at the center decreased significantly at 6 months after surgery (7.2% loss; P = 0.012) and at 12 months after surgery (12.1% loss; P = 0.001). Corneal ECD at the contralateral quadrant decreased significantly at 12 months after surgery only (10.3% loss; P = 0.004). In the pars plana Baerveldt glaucoma implantation group, no significant loss of corneal ECD was found in any corneal areas at any post-surgery follow-up visits. Tube-cornea angle was negatively correlated with the rate of corneal ECD loss at the tube insertion quadrant; r = −0.55 (P = 0.0013). In multivariable analyses, exfoliation glaucoma and narrower tube–cornea angle were significant prognostic factors for severe corneal ECD loss (P = 0.0068 and P = 0.046, respectively). Conclusions Anterior chamber Baerveldt glaucoma implantation causes corneal endothelial cell loss. Corneal endothelial cell loss starts at the tube insertion quadrant. Exfoliation glaucoma and narrower tube-corneal angle are associated with severe loss of corneal endothelial cells.
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Affiliation(s)
- Kentaro Iwasaki
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shogo Arimura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuji Takihara
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- * E-mail:
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15
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Hayashi T, Oyakawa I, Matsuzawa A, Yuda K, Shimizu T, Tsuchiya A, Mizuki N, Kato N. Descemet membrane endothelial keratoplasty using ophthalmic viscoelastic devices for eyes with laser iridotomy-induced corneal endothelial decompensation: Analysis of 11 eyes. Medicine (Baltimore) 2018; 97:e11245. [PMID: 29952990 PMCID: PMC6039634 DOI: 10.1097/md.0000000000011245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Graft insertion into the anterior chamber is one of the most important procedures for successful Descemet membrane endothelial keratoplasty (DMEK). Especially in eyes with fragile zonular fibers and a shallow anterior chamber, smooth graft insertion tends to become more difficult. Ophthalmic viscoelastic devices (OVDs) can usually help to retain the space in the anterior chamber and to improve the safety of manipulations during various ophthalmic surgeries. Therefore, we postulated that graft insertion into the anterior chamber could be improved by their use. The purpose of this study is to investigate the availability and efficacy of OVDs during graft insertion in DMEK surgery.A total of 11 eyes of 9 patients with bullous keratopathy who underwent DMEK were retrospectively analyzed. The cause of bullous keratopathy was corneal endothelial decompensation following laser iridotomy in all eyes. We used low viscous dispersive OVD (Opegan) to maintain the anterior chamber depth during graft insertion in all of the eyes.The graft insertion was uneventful in all of the eyes. The inserted graft was attached to the back surface of the cornea. However, 2 eyes needed rebubbling, and after rebubbling, all of the 2 grafts completely attached to the back surface of the cornea. The best spectacle-corrected visual acuity significantly improved 6 months after surgery (P < .001) and the central corneal thickness significantly decreased (P < .001).The use of OVD facilitates safer graft insertion during DMEK, and subsequently prevents endothelial cell loss, which leads to a successful procedure.
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Affiliation(s)
- Takahiko Hayashi
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa
| | - Itaru Oyakawa
- Department of Ophthalmology, Heart Life Hospital
- Department of Ophthalmology, Ryukyu University, Okinawa
| | - Akiko Matsuzawa
- Department of Ophthalmology, St. Marianna University School of Medicine
- Department of Ophthalmology, Kawasaki Municipal Tama Hospital, Kanagawa
| | - Kentaro Yuda
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa
| | - Toshiki Shimizu
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa
| | - Ayako Tsuchiya
- Department of Ophthalmology, Yokohama Minami Kyosai Hospital
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa
| | - Nobuhisa Mizuki
- Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa
| | - Naoko Kato
- Department of Ophthalmology, Saitama Medical University, Saitama, Japan
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16
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Bhogal M, Lwin CN, Seah XY, Murugan E, Adnan K, Lin SJ, Peh G, Mehta JS. Real-time assessment of corneal endothelial cell damage following graft preparation and donor insertion for DMEK. PLoS One 2017; 12:e0184824. [PMID: 28977017 PMCID: PMC5627903 DOI: 10.1371/journal.pone.0184824] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To establish a method for assessing graft viability, in-vivo, following corneal transplantation. METHODS Optimization of calcein AM fluorescence and toxicity assessment was performed in cultured human corneal endothelial cells and ex-vivo corneal tissue. Descemet membrane endothelial keratoplasty grafts were incubated with calcein AM and imaged pre and post preparation, and in-situ after insertion and unfolding in a pig eye model. Global, macroscopic images of the entire graft and individual cell resolution could be attained by altering the magnification of a clinical confocal scanning laser microscope. Patterns of cell loss observed in situ were compared to those seen using standard ex-vivo techniques. RESULTS Calcein AM showed a positive dose-fluorescence relationship. A dose of 2.67μmol was sufficient to allow clear discrimination between viable and non-viable areas (sensitivity of 96.6% with a specificity of 96.1%) and was not toxic to cultured endothelial cells or ex-vivo corneal tissue. Patterns of cell loss seen in-situ closely matched those seen on ex-vivo assessment with fluorescence viability imaging, trypan blue/alizarin red staining or scanning electron microscopy. Iatrogenic graft damage from preparation and insertion varied between 7-35% and incarceration of the graft tissue within surgical wounds was identified as a significant cause of endothelial damage. CONCLUSIONS In-situ graft viability assessment using clinical imaging devices provides comparable information to ex-vivo methods. This method shows high sensitivity and specificity, is non-toxic and can be used to evaluate immediate cell viability in new grafting techniques in-vivo.
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Affiliation(s)
- Maninder Bhogal
- Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Institute of Ophthalmology, University College London, London, United Kingdom
- * E-mail: (M.B.); (J.S.M.)
| | - Chan N. Lwin
- Singapore Eye Research Institute, Singapore, Singapore
| | - Xin-Yi Seah
- Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Shu-Jun Lin
- Singapore Eye Research Institute, Singapore, Singapore
| | - Gary Peh
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore, Singapore
- * E-mail: (M.B.); (J.S.M.)
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Zhong J, Jia J, Yu J, Zhang L, Xiang Y. Preoperative photocoagulation reduces corneal endothelial cell damage after vitrectomy in patients with proliferative diabetic retinopathy. Medicine (Baltimore) 2017; 96:e7971. [PMID: 28984756 PMCID: PMC5737992 DOI: 10.1097/md.0000000000007971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes and is a leading cause of visual decline and irreversible blindness. So we designed this study to investigate retrospectively the effect of preoperative photocoagulation on corneal endothelial cells after vitrectomy in patients with PDR.The study included 52 eyes of 46 patients with PDR complicated with vitreous hemorrhage, who underwent vitrectomy. Patients were apportioned to a photocoagulation group (26 eyes/23 patients) or nonphotocoagulation group (26/23 patients), according to their history of preoperative photocoagulation. A specular microscope was used to assess the corneal endothelial cell density and percentage of hexagonal cells (PHC) before surgery, and at 1 week, 1 month, and 3 months after surgery.The cell density was lower 3 months after surgery in the photocoagulation group, but at 1 month in the nonphotocoagulation group, all cases were significantly different from the preoperative value (P < .05 or P < .01). One week after surgery, the mean cell densities between the photocoagulation and nonphotocoagulation groups were not statistically different (P > .05). However, the mean cell densities at 1 and 3 months after surgery in the photocoagulation group were significantly higher than those in the nonphotocoagulation group (P < .05). The PHC values in the photocoagulation group at 1 week and in the nonphotocoagulation group at 1 week, 1 month, and 3 months were much lower than their respective preoperative values (P < .05 or P < .01). More importantly, at 1 and 3 months, the PHC had recovered to preoperative values in the photocoagulation group, but not in the nonphotocoagulation group. As for cell density and PHC, they were both significantly higher 1 and 3 months after surgery in the photocoagulation group than in the nonphotocoagulation group (P < .05).Photocoagulation before vitrectomy reduces subsequent corneal endothelial cell damage in PDR patients.
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Yagi-Yaguchi Y, Yamaguchi T, Higa K, Suzuki T, Yazu H, Aketa N, Satake Y, Tsubota K, Shimazaki J. Preoperative Aqueous Cytokine Levels Are Associated With a Rapid Reduction in Endothelial Cells After Penetrating Keratoplasty. Am J Ophthalmol 2017; 181:166-173. [PMID: 28734818 DOI: 10.1016/j.ajo.2017.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the influence of preoperative inflammatory cytokine levels in the aqueous humor (AqH) on the endothelial cell density (ECD) after penetrating keratoplasty (PKP). DESIGN Prospective, interventional, consecutive case series. METHODS This study includes 70 consecutive patients (mean age 73.7 ± 10.6 years) who underwent PKP (37 eyes) or cataract surgery (controls, 33 eyes). A total of 70 AqH samples were collected at the beginning of each surgery. The levels of cytokines (interleukin [IL]-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, IL-17A, interferon [IFN]-α, IFN-γ, monocyte chemotactic protein [MCP]-1, E-selectin and P-selectin) in AqH were measured by multiplex bead immunoassay. The subjects who underwent PKP were classified into 2 groups: ECD ≥ 1200 cells/mm2 at 6 months (24 eyes), and ECD < 1200 cells/mm2 at 6 months (13 eyes). RESULTS The ECD at 3 months significantly correlated with the preoperative levels of IL-10 (r = -0.428, P = .02) and IFN-γ (r = -0.412, P = .029). The ECD at 6 months significantly correlated with the preoperative levels of IL-10 (r = -0.399, P = .024), MCP-1 (r = -0.444, P = .011), and IFN-γ (r = -0.474, P = .006). The preoperative levels of IL-6, IL-10, MCP-1, IFN-γ, and P-selectin in AqH were significantly higher in eyes with ECD < 1200 cells/mm2 compared with those with ECD ≥ 1200 cells/mm2 at 6 months (P < .05). CONCLUSIONS Higher preoperative levels of IL-10, MCP-1, and IFN-γ in the AqH were associated with low ECD after PKP.
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Affiliation(s)
- Yukari Yagi-Yaguchi
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Kazunari Higa
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Terumasa Suzuki
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Naohiko Aketa
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyuki Satake
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Abstract
PURPOSE The authors report a case with multiple iris burns after conductive keratoplasty to correct hyperopia. METHODS Case report. RESULTS A 52-year-old woman with hyperopia had a previous conductive keratoplasty procedure and underwent a conductive keratoplasty re-treatment 6 months later. Postoperatively, she presented with 360-degree iris burns in both eyes that were correlated with the corneal conductive keratoplasty scars. In addition, specular microscopy revealed decreased endothelial cell density for both eyes. CONCLUSIONS This is the first reported case of iris burns associated with conductive keratoplasty. [J Refract Surg. 2016;32(11):776-778.].
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20
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Teoh LS, Foo SW, Mansurali VN, Ang EL, Md Noh UK, Bastion MLC. Evaluation of Corneal Endothelial Cell Loss After Uncomplicated Phacoemulsification Cataract Surgery With Intracameral Phenylephrine. Asia Pac J Ophthalmol (Phila) 2017; 6:318-325. [PMID: 28581284 DOI: 10.22608/apo.2016206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To study the effects of intracameral phenylephrine 1.5% on corneal endothelial cell loss and morphological changes in patients who had uneventful phacoemulsification surgery. DESIGN A double-blind randomized controlled trial. METHODS This study comprised 295 patients who were randomized into the intracameral (ICM) mydriatic group or topical mydriatic group. Central corneal endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells were measured preoperatively and postoperatively at 1 week, 6 weeks, and 3 months with specular microscope. RESULTS There was no significant difference in endothelial cell density and endothelial cell loss between the topical and ICM mydriatic groups. At 3 months, the mean endothelial cell density in the ICM group was 2129.76 ± 423.53 cells/mm2 and 2100.54 ± 393.00 cells/mm2 in the topical group (P = 0.539). The endothelial cell loss was 18.60 ± 12.79% in the IC M group and 19.44 ± 11.24% in the topical group (P = 0.550). No significant difference was seen in the percentage of hexagonal cells and coefficient of variation of patients between the 2 groups. CONCLUSIONS Intracameral phenylephrine was not associated with increased risk of postoperative endothelial cell loss or morphological changes. It can be safely injected into the anterior chamber for pupil dilatation before phacoemulsification cataract surgery.
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Affiliation(s)
- Li Sar Teoh
- Department of Ophthalmology, Penang General Hospital, George Town, Malaysia
| | - Siu Wan Foo
- Department of Ophthalmology, Penang General Hospital, George Town, Malaysia
| | | | - Ee Ling Ang
- Department of Ophthalmology, Penang General Hospital, George Town, Malaysia
| | - Umi Kalthum Md Noh
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Bhargava R, Kumar P, Sharma SK, Arora Y. Phacoemulsification Versus Manual Small Incision Cataract Surgery in Patients With Fuchs Heterochromic Iridocyclitis. Asia Pac J Ophthalmol (Phila) 2016; 5:330-4. [PMID: 26939115 DOI: 10.1097/apo.0000000000000191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of phacoemulsification and manual small incision cataract surgery (SICS) to treat cataract in patients with Fuchs heterochromic iridocyclitis (FHI). DESIGN A randomized, double-masked, prospective, multicenter study. METHODS Consecutive patients with cataract after FHI were randomly assigned to have phacoemulsification or manual SICS by 1 of 2 surgeons experienced in both techniques. Complications (intraoperatively and postoperatively), operative time, visual acuities, endothelial cell counts, and surgically induced astigmatism were compared. RESULTS At 6 months, 65 (92.8%) patients in the phacoemulsification group and 70 (92.1%) in the manual SICS group had a corrected distance visual acuity of 20/63 or better (P = 0.974). Surgical time was significantly shorter in the SICS group (11.2 ± 2.4 minutes) than in the phacoemulsification group (14.2 ± 3.1 minutes) (P < 0.001). The mean surgically induced astigmatism was 0.8 ± 0.2 diopters (D) in the phacoemulsification group and 1.16 ± 0.2 D in the SICS group (P < 0.001). Endothelial cell counts at 1 week and at 6 months did not differ significantly in the phacoemulsification and SICS groups (t test; P = 0.133 and P = 0.032, respectively). Intraoperatively, 2 (3%) eyes randomized to receive phacoemulsification and 4 (5.3%) eyes randomized to receive SICS had posterior capsular rent (P = 0.465). CONCLUSIONS Both techniques achieved good visual outcomes with low rates of complications. Manual SICS may be a viable alternative for cataract management in patients with FHI in settings with limited access to phacoemulsification.
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Affiliation(s)
- Rahul Bhargava
- From the Departments of *Ophthalmology and †Pathology, School of Medical Sciences and Research, Sharda University, Greater Noida; and ‡Department of Ophthalmology, Rotary Eye Hospital, Maranda, Palampur, India
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Módis LJ, Szalai E, Flaskó Z, Németh G. Corneal endothelial morphology and function after torsional and longitudinal ultrasound mode phacoemulsification. Rom J Ophthalmol 2016; 60:109-115. [PMID: 29450332 PMCID: PMC5711360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 06/08/2023] Open
Abstract
PURPOSE To study the endothelial cell morphology and corneal thickness changes after phacoemulsification by using the OZil torsional and longitudinal ultrasound techniques (Infiniti Vision System, Alcon Laboratories). SETTING Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary. METHODS 52 patients with cataract were randomly assigned to longitudinal ultrasound and torsional mode group. All surgeries were performed through a 2.2 mm clear corneal incision, the method employed being divide and conquer. The endothelial morphometry such as cell density (ECD), mean cell area, coefficient of variation of cell area, and central corneal thickness were examined with specular microscopy (EM-1000, Tomey) preoperatively and 4, 8 weeks postoperatively. RESULTS ECD values decreased significantly in both surgical groups (P < .001, repeated- mesures ANOVA), the postoperative endothelial cell loss was higher in the longitudinal ultrasound mode group (3.5% and 6.5%, at 4 and 8 weeks after surgery) than in the torsional group (3.3% and 5.5%, at 4 and 8 weeks after surgery), the difference not being significant between the two groups (P = .164 and P = .479, at 4 and 8 weeks after surgery, Mann-Whitney test). There was no statistically significant difference in any of the assessed parameters between the two surgical groups (P > .05). No significant correlation was found between the endothelial cell loss and the nucleus density. CONCLUSIONS Both phacoemulsification techniques were safe and effective. The torsional handpiece performs oscillatory movements and delivers less energy into the eye than the longitudinal ultrasound technique, therefore providing more favorable energy and thermal safety profile.
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Affiliation(s)
- László Jr Módis
- Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Eszter Szalai
- Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Flaskó
- Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Gábor Németh
- Department of Ophthalmology, Clinical Center, University of Debrecen, Debrecen, Hungary
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Huang Z, Miao X. [Analysis of the Effect of Non-phacoemulsification Cataract Operation on Corneal Endothelial Cell Nucleus Division]. Eye Sci 2015; 30:106-109. [PMID: 26930837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To investigate the effect of non-phacoemulsification cataract operation in two different patterns of nucleus delivery on the quantity and morphology of corneal endothelial cells and postoperative visual acuity. METHODS Forty patients diagnosed with cataract underwent cataract surgery and were assigned into the direct nuclear delivery and semi-nuclear delivery groups. Lens density was measured and divided into the hard and soft lenses according to Emery-little lens nucleus grading system. Non-phacoemulsification cataract operation was performed. At 3 d after surgery, the quantity and morphology of corneal endothelium were counted and observed under corneal endothelial microscope. During 3-month postoperative follow-up, the endothelial cell loss rate, morphological changes and visual acuity were compared among four groups. RESULTS Corneal endothelial cell loss rate in the direct delivery of hard nucleus group significantly differed from those in the other three groups before and 3 months after operation (P < 0.01), whereas no statistical significance was found among the direct delivery of soft nucleus, semi-delivery of hard nucleus and semi-delivery soft nucleus groups (all P > 0.05). Preoperative and postoperative 2-d visual acuity did not differ between the semi-delivery of hard nucleus and direct delivery of soft nucleus groups (P = 0.49), significantly differed from those in the semi-delivery of soft nucleus (P = 0.03) and direct delivery of hard nucleus groups (P = 0.14). Visual acuity at postoperative four months did not differ among four groups (P = 0.067). CONCLUSION During non-phacoemulsification cataract surgery, direct delivery of hard nucleus caused severe injury to corneal endothelium and semi-delivery of soft nucleus yielded mild corneal endothelial injury. Slight corneal endothelial injury exerted no apparent effect upon visual acuity and corneal endothelial morphology at three months after surgery.
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Gogate P, Optom JJB, Deshpande S, Naidoo K. Meta-analysis to Compare the Safety and Efficacy of Manual Small Incision Cataract Surgery and Phacoemulsification. Middle East Afr J Ophthalmol 2015; 22:362-9. [PMID: 26180478 PMCID: PMC4502183 DOI: 10.4103/0974-9233.159763] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE A systematic review and meta-analysis comparing the safety, efficacy, and expenses related to phacoemulsification versus manual small incision cataract surgery (SICS). METHODS PubMed, Cochrane, and Scopus databases were searched with key words manual SICS 6/18 and 6/60; astigmatism and endothelial cell loss postoperatively, intra- and post-operative complications, phacoemulsification, and comparison of SICS and phacoemulsification. Non-English language manuscripts and manuscripts not indexed in the three databases were also search for comparison of SICS with phacoemulsification. Data were compared between techniques for postoperative uncorrected and corrected distance visual acuity (UCVA and best corrected visual acuity [BCVA], respectively) better than 6/9, surgical cost and duration of surgery. The Oxford cataract treatment and evaluation team scores were used for grading intraoperative and postoperative complications, uncorrected near vision. RESULT This review analyzed, 11 comparative studies documenting 76,838 eyes that had undergone cataract surgery considered for analysis. UCVA of 6/18 UCVA and 6/18 BCVA were comparable between techniques (P = 0.373 and P = 0.567, respectively). BCVA of 6/9 was comparable between techniques (P = 0.685). UCVA of 6/60 and 6/60 BCVA aided and unaided vision were comparable (P = 0.126 and P = 0.317, respectively). There was no statistical difference in: Endothelial cell loss during surgery (P = 0.298), intraoperative (P = 0.964) complications, and postoperative complications (P = 0.362). The phacoemulsification group had statistically significantly less astigmatism (P = 0.005) and more eyes with UCVA of 6/9 (P = 0.040). UCVA at near was statistically significantly better with SICS due to astigmatism and safer during the learning phase (P = 0.003). The average time for SICS was lower than phacoemulsification and cost <½ of phacoemulsification. CONCLUSION The outcome of this meta-analysis indicated there is no difference between phacoemulsification and SICS for BCVA and UCVA of 6/18 and 6/60. Endothelial cell loss and intraoperative and postoperative complications were similar between procedures. SICS resulted in statistically greater astigmatism and UCVA of 6/9 or worse, however, near UCVA was better.
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Affiliation(s)
- Parikshit Gogate
- African Vision Research Institute, Durban, South Africa
- Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
- Department of Ophthalmology, Padmashri D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India
| | - Jyoti Jaggernath B. Optom
- African Vision Research Institute, Durban, South Africa
- Brien Holden Vision Institute, Sydney, Australia
| | | | - Kovin Naidoo
- African Vision Research Institute, Durban, South Africa
- Brien Holden Vision Institute, Sydney, Australia
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Cinar E, Zengin MO, Kucukerdonmez C. Evaluation of corneal endothelial cell damage after vitreoretinal surgery: comparison of different endotamponades. Eye (Lond) 2015; 29:670-4. [PMID: 25771819 PMCID: PMC4429277 DOI: 10.1038/eye.2015.26] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/26/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We evaluated corneal endothelial cell (EC) damage after vitreoretinal surgery and compared the results using different tamponades. MATERIALS AND METHODS This prospective controlled study included 45 eyes of 45 patients (24 females, 21 males) who underwent pars plana vitrectomy with gas (sulphur hexafluoride, SF6, 20%) or silicone oil (SO) tamponade. Patients were assigned to one of the three groups: group 1 (phakic, 20% SF6 gas), group 2 (pseudophakic, 20% SF6 gas), and group 3 (phakic, SO). Mean endothelial cell density (MCD), mean cell area (MCA), coefficient of variation in cell size (CV), and percentage of hexagonal cells (HC) values were measured using a non-contact specular microscope (SP-2000P; Topcon, Japan) at baseline and at 3 months after surgery. The fellow eye of each patient was used as a control. RESULTS Group 2, which had the lowest baseline MCD and MCA values, was found to be different than groups 1 and 3 (P=0.028 and 0.022, respectively). At 3 months postoperatively, all groups showed significantly lower MCD, HC and CV values than at baseline (all P<0.05). The mean changes in MCD at 3 months after surgery were 3.8±2.8% (mean±SD), 8.0±7.5%, and 4.6±5.4% in groups 1-3, respectively. The mean MCD changes in the fellow eyes were 0.31±1.41% in group 1, -0.63±1.90% in group 2, and 0.14±0.52 in group 3 at 3 months postoperatively (P>0.05 for all). CONCLUSIONS Our findings revealed that corneal EC damage may occur after vitreoretinal surgery with gas or SO tamponade. Eyes that had undergone previous cataract surgery were more vulnerable to EC loss than phakic eyes, supporting the protective effect of an intact lens.
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Affiliation(s)
- E Cinar
- Department of Ophthalmology, Faculty of Medicine, Izmir University, Izmir, Turkey
| | - M O Zengin
- Department of Ophthalmology, Faculty of Medicine, Izmir University, Izmir, Turkey
| | - C Kucukerdonmez
- Department of Ophthalmology, Faculty of Medicine, Izmir University, Izmir, Turkey
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Labiris G, Sideroudi H, Rousopoulos K, Kozobolis VP. Cohesive versus dispersive-cohesive ophthalmic viscosurgical device in torsional intelligent phaco. J Cataract Refract Surg 2015; 41:681-2. [PMID: 25804586 DOI: 10.1016/j.jcrs.2015.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/10/2015] [Indexed: 12/01/2022]
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Busin M, Madi S, Scorcia V, Santorum P, Nahum Y. A Two-Piece Microkeratome-Assisted Mushroom Keratoplasty Improves the Outcomes and Survival of Grafts Performed in Eyes with Diseased Stroma and Healthy Endothelium (An American Ophthalmological Society Thesis). Trans Am Ophthalmol Soc 2015; 113:T1. [PMID: 26538771 PMCID: PMC4597759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE To test the hypothesis that a new microkeratome-assisted penetrating keratoplasty (PK) technique employing transplantation of a two-piece mushroom-shaped graft may result in better visual outcomes and graft survival rates than those of conventional PK. METHODS Retrospective chart review of 96 eyes at low risk and 76 eyes at high risk for immunologic rejection (all with full-thickness central corneal opacity and otherwise healthy endothelium) undergoing mushroom PK between 2004 and 2012 at our Institution. Outcome measures were best-corrected visual acuity (BCVA), refraction, corneal topography, endothelial cell density, graft rejection, and survival probability. RESULTS Five years postoperatively, BCVA of 20/40 and 20/20 was recorded in 100% and over 50% of eyes, respectively. Mean spherical equivalent of refractive error did not vary significantly over a 5-year period; astigmatism averaged always below 4 diopters, with no statistically significant change over time, and was of the regular type in over 90% of eyes. Endothelial cell density decreased to about 40% of the eye bank count 2 years after mushroom PK and did not change significantly thereafter. Five years postoperatively, probabilities of graft immunologic rejection and graft survival were below 5% and above 95%, respectively. There was no statistically significant difference in endothelial cell loss, graft rejection, and survival probability between low-risk and high-risk subgroups. CONCLUSIONS Refractive and visual outcomes of mushroom PK compare favorably with those of conventional full-thickness keratoplasty. In eyes at high risk for immunologic rejection, mushroom PK provides a considerably higher probability of graft survival than conventional PK.
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Affiliation(s)
- Massimo Busin
- Department of Ophthalmology, "Villa Igea-Villa Serena" Private Hospitals, Forlì, Italy
| | - Silvana Madi
- Department of Ophthalmology, Alexandria University, Alexandria, Egypt
| | - Vincenzo Scorcia
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
| | - Paolo Santorum
- Department of Ophthalmology, "San Maurizio" Central Regional Hospital, Bolzano, Italy
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Buschschlüter S, Koch C, von Eicken J, Höh H. Computation of the temperature rise at the corneal endothelium during cataract surgery by modeling of heat generation inside the anterior chamber. Ultrasound Med Biol 2014; 40:2431-2444. [PMID: 25130447 DOI: 10.1016/j.ultrasmedbio.2014.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 06/03/2023]
Abstract
The corneal endothelium sustaining the transparency of the cornea is a vulnerable cell layer. Thermal exposure during phacoemulsification is considered to be a potential cause of post-operative cell loss. Knowledge of the temperature rise and particularly of its dependence on region and system settings could deliver useful information about a potential correlation with cell damage. However, there exists a lack of understanding of the process and location of heat generation. Analytical calculations and experiments enabled the quantification of different mechanisms acting as heat sources during phacoemulsification. Heat generation caused by viscous friction was estimated using both an analytical approach and a numerical simulation. In contrast to absorption of sound and self-heating of the probe, this effect was ascertained to be the main heat source. Calorimetric measurement of the power input verified this modeling. On the basis of these results, the local temperature distribution inside a porcine eye was computed time dependently using the finite-element method. Two different amplitude settings were compared with respect to the temperature increase at the corneal endothelium. Various conclusions on the mitigation of thermal exposure during treatment can be drawn from this finite-element simulation.
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Affiliation(s)
| | - Christian Koch
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - Jörn von Eicken
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Helmut Höh
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
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Lass JH, Benetz BA, Gal RL, Kollman C, Raghinaru D, Dontchev M, Mannis MJ, Holland EJ, Chow C, McCoy K, Price FW, Sugar A, Verdier DD, Beck RW. Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: Specular Microscopy Ancillary Study. Ophthalmology 2014; 120:2428-2435. [PMID: 24246826 DOI: 10.1016/j.ophtha.2013.08.044] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). DESIGN Multicenter, prospective, double-masked clinical trial. PARTICIPANTS We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). METHODS Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). MAIN OUTCOME MEASURES Endothelial cell density at 10 years. RESULTS Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P<0.001) and larger donor tissue size (P<0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm(2) at 10 years and only 24 (14%) had an ECD of >1000 cells/mm(2). CONCLUSIONS Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.
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Affiliation(s)
- Jonathan H Lass
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
| | - Beth Ann Benetz
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | | | - Mark J Mannis
- University of California Davis, Sacramento, California
| | - Edward J Holland
- Department of Ophthalmology and Visual Sciences, Cincinnati Eye Institute, Cincinnati, Ohio
| | | | | | | | - Alan Sugar
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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Orski M, Synder A, Pałenga-Pydyn D, Omulecki W, Wilczyński M. The effect of the selected factors on corneal endothelial cell loss following phacoemulsification. Klin Oczna 2014; 116:94-99. [PMID: 25345285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Corneal endothelium is a single layer of cells, which do not regenerate. Damage to the endothelium can take place in the course of certain diseases and after intraocular operations. When the number of endothelial cells decreases, corneal decompensation can occur. Pre- and postoperative measurement of the number of the corneal endothelial cells can help assess the degree of corneal damage during the surgery. PURPOSE To compare the effect of various factors, such as: sex, age, corneal incision, intraocular pressure, cataract density, visual acuity and surgeon's experience on corneal endothelial cell loss following uneventful phacoemulsification. MATERIAL AND METHODS 365 patients (114 men and 251 women aged 19 to 91 years) undergoing phacoemulsification were examined preoperatively and postoperatively at 4 weeks. 68 eyes underwent phacoemulsification through a 1.8 mm microincision and 297 eyes through a standard 2.75 mm incision. Patients were operated on by four surgeons. RESULTS There was a significant difference in the postoperative endothelial cell loss relative to the degree of cataract hardness (p < 0.001). Endothelial cell loss was significantly higher in patients aged 71 and above than in the remaining age groups. Significant differences in the postoperative endothelial cell loss were observed in relation to the clear corneal incision size (p < 0.01). Preoperative best corrected visual acuity influenced the postoperative endothelial cell loss in a statistically significant way (p < 0.05). Endothelial cell loss was strongly influenced by the surgeon's experience. CONCLUSIONS Surgeon's experience, hardness of cataract, type of corneal incision, age and preoperative visual acuity influenced endothelial cell loss at 4 weeks following uneventful phacoemulsification, however such factors as sex and intraocular pressure showed no statistically significant influence on corneal endothelial cell loss.
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Kohnen T. [After corneal PIOL-implantation, watch endothelium strongly]. Ophthalmologe 2013; 110:1131. [PMID: 24482813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Khor WB, Han SB, Mehta JS, Tan DTH. Descemet stripping automated endothelial keratoplasty with a donor insertion device: clinical results and complications in 100 eyes. Am J Ophthalmol 2013; 156:773-9. [PMID: 23831219 DOI: 10.1016/j.ajo.2013.05.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/10/2013] [Accepted: 05/16/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE To study the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with the EndoGlide donor insertion device. DESIGN Retrospective interventional case series. METHODS We included 100 eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy (PBK) at a single institution. Eyes with anterior segment pathology or previous intraocular surgery (except for uncomplicated cataract surgery) were excluded. Preoperative data included visual acuity and donor endothelial cell density by specular microscopy. The main outcome measures were postoperative best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss at 3, 6, and 12 months. RESULTS There were 59 eyes with Fuchs dystrophy and 41 eyes with PBK. In eyes without vision-limiting pathology, the median postoperative BSCVA was consistently 20/40 (range 20/20-20/400) at 3 months (n = 61 eyes), 6 months (n = 55 eyes), and 12 months (n = 48 eyes). Endothelial cell loss was 13.7% at 3 months (n = 57), 13.5% at 6 months (n = 61), and 14.9% at 12 months (n = 53). Primary graft failure occurred in 1 eye, attributable to incorrect use of the insertion device. Two eyes with complete donor dislocation were rebubbled successfully. The most common complication was glaucoma/ocular hypertension in 29 eyes (34.1%) without prior glaucoma and treatment escalation in 6 eyes (40.0%) with prior glaucoma. Of the 78 eyes with 12 months follow-up, 2 (2.6%) developed endothelial rejection, and 1 (1.3%) subsequently failed. CONCLUSIONS The use of this donor insertion device during DSAEK demonstrates good outcomes and potentially low endothelial cell loss at up to 12 months after surgery.
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Affiliation(s)
- Wei-Boon Khor
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
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Little B, Scharioth GB, Kleinmann G, Tam DY, Cabot F, Yoo SH, Miller KM, Mester U, Konen W. Cataract surgical problem: March consultation. J Cataract Refract Surg 2013; 39:810-5. [PMID: 23608573 DOI: 10.1016/j.jcrs.2013.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Assia E, Bellucci R, El Danasoury A, Snyder ME, Cochener B, Kohnen T, Moshirfar M, Edmonds JN, Güell JL. Refractive surgical question: March consultation. J Cataract Refract Surg 2013; 39:475-80. [PMID: 23506927 DOI: 10.1016/j.jcrs.2013.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kalinina Ayuso V, Scheerlinck LM, de Boer JH. The effect of an Ahmed glaucoma valve implant on corneal endothelial cell density in children with glaucoma secondary to uveitis. Am J Ophthalmol 2013; 155:530-5. [PMID: 23218690 DOI: 10.1016/j.ajo.2012.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the effect of Ahmed glaucoma valve implants on corneal endothelial cell density (ECD) in children with uveitic glaucoma. DESIGN Cross-sectional study. METHODS setting: Institutional. patientpopulation: Eighty eyes from 42 patients diagnosed with uveitis before the age of 16. Twenty-eight eyes had an Ahmed glaucoma valve implant because of secondary glaucoma. Fifty-two eyes without an implant served as controls. intervention orobservationprocedure(s): Corneal ECD was examined cross-sectionally using a noncontact specular microscope. Univariate and multivariate generalized estimating equations analyses with correction for paired eyes were performed. mainoutcomemeasure(s): Correlation of ECD with the presence of an Ahmed glaucoma valve implant and with the time following implantation. RESULTS ECD was significantly lower in the Ahmed glaucoma valve group than in controls (2359 and 3088 cells/mm(2), respectively; P < .001) following an average of 3.5 years after Ahmed glaucoma valve implantation. Presence of an Ahmed glaucoma valve implant, previous intraocular surgery, age, duration of uveitis, and history of corneal touch by the implant tube were all significantly associated with decreased ECD. Following a multivariate analysis, presence of an Ahmed glaucoma valve implant (B = -340; adjusted P < .011) and older age (B = -58; adjusted P = .005) remained independently associated with decreased ECD. Within the implant group, the age-adjusted time interval following Ahmed glaucoma valve implantation was highly correlated with decreased ECD (B = -558, P < .001). CONCLUSIONS Ahmed glaucoma valve implants in children with uveitic glaucoma are independently associated with decreased ECD, and this effect is associated with the time interval following Ahmed glaucoma valve implantation.
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Affiliation(s)
- Viera Kalinina Ayuso
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Stănilă DM, Stănilă A, Mihai E, Sîrbu NG, Stupariu AL. [Effect of phacoemulsification on the cornea]. Oftalmologia 2013; 57:52-57. [PMID: 24701815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Cataracta is the more common surgical diesease of the eye. The removal of the cataract is done my phacoemulsification. PURPOSE To evaluate the effect of phacoemulsifcation on the cornea. MATERIAL AND METHOD We have studied 80 patients with cataract that underwent cataract surgery by phacoemulsification. We measured the corneal thickness and the number of endothelial cell before and after the surgery. REZULTS AND DISCUSSIONS: Corneal thickness grew with 3% and the number of endothelial cells decresed with 13%. CONCLUSIONS Phacoemulsification with the use of vascoelastic substancees is a very safe method of lens extraction
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Razzaq L, Marinkovic M, Jager MJ, Bleeker J, Luyten GPM, de Keizer RJW. Corneal endothelial cell density after ruthenium plaque radiation therapy for iris melanoma patients. Acta Ophthalmol 2012; 90:e577-9. [PMID: 23106862 DOI: 10.1111/j.1755-3768.2012.02389.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baydoun L, Tong CM, Tse WW, Chi H, Parker J, Ham L, Melles GRJ. Endothelial cell density after descemet membrane endothelial keratoplasty: 1 to 5-year follow-up. Am J Ophthalmol 2012; 154:762-3. [PMID: 22995566 DOI: 10.1016/j.ajo.2012.06.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 06/21/2012] [Accepted: 06/22/2012] [Indexed: 11/27/2022]
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Veldman PB, Behlau I, Soriano E, Starling JC, Pineda R. Two Cases of Cosmetic Iris Implant Explantation Secondary to Uveitis, Glaucoma, and Corneal Decompensation. ACTA ACUST UNITED AC 2012; 130:787-9. [PMID: 22801843 DOI: 10.1001/archophthalmol.2011.2594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter B Veldman
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
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Bourkiza R, Sykakis E, Parmar DN. Bevel-up versus bevel-down phacoemulsification tip. J Cataract Refract Surg 2012; 38:1114-5; author reply 1115. [PMID: 22624927 DOI: 10.1016/j.jcrs.2012.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Indexed: 11/30/2022]
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Osher RH. Here's a good tip. J Cataract Refract Surg 2012; 38:1113-4; author reply 1114. [PMID: 22624924 DOI: 10.1016/j.jcrs.2012.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Indexed: 11/27/2022]
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Abstract
PURPOSE To analyze the effects of soft contact lenses on central corneal thickness and morphologic characteristics of the corneal endothelium in diabetic patients. MATERIALS AND METHODS Ultrasound pachymetry and noncontact specular microscopy were performed on 26 diabetic patients who regularly use soft contact lenses (group 1), 27 diabetic patients who do not use soft contact lenses (group 2) and 30 normal subjects (group 3). We compared the values in each group using the Mann-Whitney test. RESULTS The central cornea was found to be thicker in diabetic patients, both those who use and do not use contact lenses, than in the normal control group. The central corneal thickness was significantly higher in group 1 (564.73 ± 35.41 μm) and group 2 (555.76 ± 45.96 μm) than in the control group (534.05 ± 27.02 μm), but there was no statistically significant difference between groups 1 and 2. Endothelial cell density was significantly different between the groups, and was smallest in the group of diabetic patients using contact lenses. The coefficient of variation of cell size was significantly higher and the percentage of hexagonal cells was significantly lower in contact lens using diabetic patients than in non-contact lens using diabetic patients and in the control group. CONCLUSION Central corneal thickness and endothelial cell density is more affected by diabetes mellitus, and corneal endothelial cell morphology is more affected by contact lens use, when compared with normal subjects.
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Affiliation(s)
- Hyun Sung Leem
- Department of Optometry, Eulji University, Seongnam, Korea
| | - Koon Ja Lee
- Department of Optometry, Eulji University, Seongnam, Korea
| | - Ki Cheul Shin
- Department of Ophthalmology, College of Medicine, Konkuk University, Seoul, Korea
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Abstract
PURPOSE This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. METHODS We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. RESULTS Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant-iris and implant-endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet's stripping endothelial keratoplasty. CONCLUSIONS Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists.
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Affiliation(s)
- Justin E Anderson
- Department of Ophthalmology and Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York 10003, USA
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Ham L, Dapena I, Van Der Wees J, Melles GRJ. Endothelial cell density after descemet membrane endothelial keratoplasty: 1- to 3-year follow-up. Am J Ophthalmol 2010; 149:1016-7. [PMID: 20510695 DOI: 10.1016/j.ajo.2010.01.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 01/25/2010] [Indexed: 11/30/2022]
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Price MO, Bidros M, Gorovoy M, Price FW, Benetz BA, Menegay HJ, Debanne SM, Lass JH. Effect of incision width on graft survival and endothelial cell loss after Descemet stripping automated endothelial keratoplasty. Cornea 2010; 29:523-7. [PMID: 20299973 PMCID: PMC2860043 DOI: 10.1097/ico.0b013e3181c11e5d] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effect of incision width (5.0 and 3.2 mm) on graft survival and endothelial cell loss 6 months and 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS One hundred sixty-seven subjects with endothelial decompensation from a moderate-risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) underwent DSAEK by 2 experienced surgeons. The donor was folded over and inserted with single-point fixation forceps. This retrospective analysis assessed graft survival, complications, and endothelial cell loss, which was calculated from baseline donor and 6-month and 1-year postoperative central endothelial images evaluated by an independent specular microscopy reading center. RESULTS No primary graft failures occurred in either group. One-year graft survival rates were comparable (98% vs 97%) in the 5.0- and 3.2-mm groups, respectively (P = 1.0). Complications included graft dislocation, graft rejection episodes, and elevated intraocular pressure and occurred at similar rates in both groups (P > or = 0.28). Pupillary block glaucoma did not occur in either group. Mean baseline donor endothelial cell density did not differ: 2782 cells per square millimeter in the 5.0-mm (n = 64) and 2784 cells per square millimeter in the 3.2-mm (n = 103) groups. Percent endothelial cell loss was 27% +/- 20% (n = 55) versus 40% +/- 22% (n = 71; 6 months) and 31% +/- 19% (n = 45) versus 44% +/- 22% (n = 62; 12 months) in the 5.0- and 3.2-mm incision groups, respectively (both P < 0.001). CONCLUSIONS One year after DSAEK, overall graft success was comparable for the 2 groups; however, the 5.0-mm incision width resulted in substantially lower endothelial cell loss at 6 and 12 months.
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Affiliation(s)
- Marianne O Price
- Cornea Research Foundation of America, Indianapolis, IN 46260, USA.
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