Clinical features of infectious endophthalmitis in South Korea: a five-year multicenter study.

BACKGROUND: To investigate clinical features of infectious endophthalmitis over five years in a South Korean population. METHODS: Medical records of consecutive patients diagnosed with infectious endophthalmitis at eight institutions located in Gyeongsangnam-do and Pusan city between January 1, 2004 and July 31, 2010 were reviewed. RESULTS: A total of 197 patients were diagnosed and treated. An average of 30.0 infectious endophthalmitis per year was developed. The annual incidence rate of postoperative endophthalmitis during 2006~2009 was 0.037%. The ratios of male to female and right to left were 50.2%: 49.8 % and 54.8%: 43.2%, respectively. Eighth decade and spring were the peak age (36.6%) and season (32.0%) to develop the infectious endophthalmitis. The most common past history in systemic disease was hypertension (40.4%), followed by diabetes (23.4%). Cataract operation (60.4%) was the most common cause, among which most of them was uneventful phacoemulsification (95.9%). Corneal laceration (51.6%) and liver abscess (42.9%) were the most common causes of traumatic and endogenous endophthalmitis, respectively. The percentages of patients with initial and final visual acuity less than counting fingers were 62.6% and 35.2%, respectively. Treatment with vitrectomy with or without intravitreal antibiotics injection was administered to 72.6% of patients, while 17.3% received intravitreal antibiotics only. CONCLUSIONS: Our study revealed that the development of infectious endophthalmitis was related with seasonal variation and increased during our study period. Pars plana vitrectomy was preferred for the treatment of infectious endophthalmitis in South Korea.

Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery.

PURPOSE: To investigate the correlation of visual acuity with the ganglion cell layer and the photoreceptor layer using spectral-domain optical coherence tomography after surgery for idiopathic epiretinal membrane (ERM). METHODS: The medical records of 58 eyes were reviewed retrospectively to collect data on visual acuity (VA), ganglion cell complex thickness (GT) and photoreceptor reflectivity (PR) at baseline, 3 months, and 6 months after surgery. The GT was adjusted to compensate for tractional thickening by calculating the proportional thickness to the macular thickness (MT). The PR was adjusted to compensate for the shadowing effects from the inner retina, which was achieved by calculating the ratio to the retinal pigment epithelium reflectivity (RR). The relative GT (RGT = GT/MT) and relative PR (RPR = PR/RR) were analyzed to determine their correlation with visual acuity. RESULTS: The GT was segmented correctly in 13 eyes at baseline, and in all eyes after surgery. The RGT and RPR were significantly lower than the normal eye. Thinner RGT correlated with poorer VA at 3 months (R = -0.352, p = 0.007) and 6 months (R = -0.324, p = 0.013), but the RPR had correlation with visual acuity only at 6 months (R = -0.377, p = 0.004). The area under the receiver operating characteristic curve was significant for VA ≥ 20/30 in both the RGT and RPR, and this significance was present for visual acuity ≥ 0/25 only in the RGT. CONCLUSIONS: The postoperative ganglion cell layer was found to be correlated to postoperative VA more consistently than the photoreceptor layer after ERM surgery. The outer retinal damage was a determining factor in the poor VA group.

Comparison of scleral buckling and vitrectomy using wide angle viewing system for rhegmatogenous retinal detachment in patients older than 35 years.

BACKGROUND: To compare scleral buckling (SB) and pars plana vitrectomy (PPV) using a wide angle viewing system (WAVS) for uncomplicated phakic rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated phakic RRD were retrospectively reviewed. Eyes with pseudophakic or attached fovea were excluded. Patients treated with SB were classified as group B, and PPV using WAVS as group V. Primary success rate, visual acuity (VA), macular complications, and sustained subretinal fluid (SRF) were compared between groups. RESULTS: Seventy-two eyes were included in group B and 57 eyes in group V. Group B had better preoperative VA (1.38 ± 0.87 vs 1.84 ± 0.97 in LogMAR, P = 0.010), but worse final VA (0.51 ± 0.48 vs 0.30 ± 0.23, P = 0.012) than group V. The primary success rate of 94.7 % in group V was higher than 77.8 % in group B (P = 0.010). Final success rate was 100 % in both groups. There was no significant difference in macular complications between groups (P = 0.087). Sustained SRF was found in 22 eyes in group B (38.6 %), while only two eyes in group V exhibited sustained SRF (2.8 %, P < 0.001). CONCLUSIONS: Pars plana vitrectomy using WAVS was more efficacious than SB for treating uncomplicated phakic RRD.

Intravitreal pharmacokinetics after posterior subtenon triamcinolone acetonide injection in vitrectomized rabbit eyes.

PURPOSE: To investigate the intraocular pharmacokinetics of triamcinolone acetonide (TA) injected into the posterior subtenon of vitrectomized rabbit eyes. METHODS: Vitrectomy was performed on the right eyes of 35 rabbits. Triamcinolone acetonide (40 mg/mL) was injected into the posterior subtenon space of both eyes. Five rabbits each were killed at days 1, 3, 7, 14, 28, 56, and 84. Both eyes were enucleated. The vitreous was isolated, and TA concentration was measured. RESULTS: In vitrectomized eyes, the intravitreal concentrations of TA were 1763, 822.9, 321.5, 113.3, 35.5, 14.4, and 6.7 ng/mL, respectively, at the time points indicated above; the concentrations in nonvitrectomized eyes were 397.8, 360.4, 154.4, 48.5, 30.7, 15.2, and 8.0 ng/mL, respectively. Triamcinolone acetonide concentrations were significantly higher in the vitrectomized eyes at days 1, 3, 7, and 14. The terminal half-life of intravitreal TA was 23.3 days in the vitrectomized eyes and 28.9 days in the nonvitrectomized eyes. CONCLUSION: Intravitreal absorption and excretion of TA in the posterior subtenon space are increased after vitrectomy. Although the terminal half-life of TA was shorter, higher early concentration and similar effective duration were achieved in the vitrectomized eyes.

Effects of fluoroquinolone eye solutions without preservatives on human corneal epithelial cells in vitro.

AIMS: To evaluate the biologic effects of fluoroquinolone eye solutions without preservatives on cultured human corneal epithelial cells in vitro. METHODS: We studied the effect of diverse generations of topical fluoroquinolones such as ofloxacin 0.3%, levofloxacin 0.5%, tosufloxacin 0.3%, moxifloxacin 0.5% and gatifloxacin 0.3% on cultured human corneal epithelial cells. MTT-based calorimetric assay, lactate dehydrogenase leakage (LDH) assay and scratch wound test were performed. Corneal epithelial cell morphologies were examined by performing inverted light microscopy and transmission electron microscopy. RESULTS: In all topical fluoroquinolones, the metabolic activity of the corneal epithelial cells decreased in a time-dependent fashion and the LDH titer increased with longer exposure times. Especially, the LDH titers significantly increased after exposure to moxifloxacin 0.5% and gatifloxacin 0.3% compared with controls. The migration rates of the corneal epithelial cells were faster in ofloxacin 0.3% or levofloxacin 0.5% than other fluoroquinolones. Severe cellular morphological damage was observed after exposure to moxifloxacin 0.5% and gatifloxacin 0.3%. CONCLUSIONS: As moxifloxacin 0.5% and gatifloxacin 0.3% induced the toxic effect to the corneal epithelial cells, compared with other fluoroquinolones, the 4th fluoroquinolone eye solutions should be carefully used in case of the corneal epithelium is damaged by long duration of treatment or overdosage.

Effect of intravitreal triamcinolone injection during vitrectomy for idiopathic epiretinal membrane.

PURPOSE: To investigate the effect of intravitreal triamcinolone injections as an adjuvant of vitrectomy for idiopathic epiretinal membrane. METHODS: This study included 58 eyes of 58 patients who were diagnosed as having idiopathic epiretinal membrane and who underwent vitrectomy and membrane peeling. They were divided into 2 groups: 27 eyes in the injected group that received triamcinolone injection during the surgical procedure and 31 eyes in the control group that did not receive injection. The best-corrected visual acuity, foveal thickness, and complications were compared between the two groups. RESULTS: Average visual acuity of the injected group improved from 0.70 logarithm of the minimal angle of resolution (logMAR) (Snellen equivalent, 20/100; range, 20/25-20/200) at baseline to 0.59 logMAR (20/80; range, 20/40-20/200) at 1 month and 0.55 logMAR (20/70; range, 20/30-20/200) at 3 months. Foveal thickness reduced from 456.9 µm (range, 307-740 µm) to 387.9 µm (range, 238-584 µm) at 1 month and 336.4 µm (range, 225-529 µm) at 3 months, respectively. In the control group, average visual acuity improved from 0.63 logMAR (20/80; range, 20/40-20/300) to 0.48 logMAR (20/60; range, 20/25-20/125) and 0.43 logMAR (20/50; range, 20/25-20/160) at 1 month and 3 months, respectively. Foveal thickness reduced from 467.1 µm (range, 328-621 µm) to 376.1 µm (range, 271-429 µm) and 375.1 µm (range, 236-475 µm) at 1 month and 3 months, respectively. There were no significant differences in the visual acuity, foveal thickness, and any complications between the two groups during follow-up. CONCLUSION: Intravitreal injection of triamcinolone combined with vitrectomy for idiopathic epiretinal membrane did not affect postoperative foveal thickness and functional recovery.

Photoreceptor layer assessed in tissue layer image using spectral-domain optical coherence tomography after surgical closure of macular hole.

PURPOSE: To investigate changes in the photoreceptor layer in tissue layer images using spectral-domain optical coherence tomography after macular hole surgery. METHODS: Visual acuity and spectral-domain optical coherence tomography scans were obtained in 24 eyes with surgically closed macular holes prospectively at 1, 2, 4, and 6 months after surgery. The scanned data were processed to generate tissue layer images of the photoreceptor layer, namely, photoreceptor layer map. Hyporeflective area and reflectivity at the fovea were analyzed to find a correlation with visual acuity. RESULTS: Mean visual acuity improved from 48.1 letters preoperatively to 62.5 letters at 1 month and to 73.8 letters at 6 months. Hyporeflective area in the photoreceptor layer map corresponded to attenuated signals from the junction of the inner and outer segments of the photoreceptors. Hyporeflective area decreased from 1.54 mm at 1 month to 0.60 mm at 6 months. Foveal reflectivity increased from 0.77 to 0.85. Visual acuity correlated with the hyporeflective area (r = 0.43-0.63) and foveal reflectivity (r = 0.35-0.61). CONCLUSION: After macular hole closure, attenuated signal from the junction of the inner and outer segments of the photoreceptors representing disorganization of the photoreceptor layer was shown in the photoreceptor layer map as a hyporeflective area, which correlated with the postoperative visual acuity. Hyporeflectivity decreased gradually with concurrent improvement in visual acuity.

Results of vitrectomy for breakthrough vitreous hemorrhage associated with age-related macular degeneration and polypoidal choroidal vasculopathy.

PURPOSE: The purpose of this study was to evaluate the results of vitrectomy in patients with vitreous hemorrhage associated with age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS: A retrospective review was conducted of consecutive cases of patients undergoing pars plana vitrectomy for nonclearing vitreous hemorrhage associated with neovascular AMD or PCV. RESULTS: Twenty-four eyes of 23 patients were included. The mean length of time from the onset of vitreous hemorrhage to operation was 4.3 months. Twelve eyes had AMD, and 12 eyes of 11 patients had PCV. Additional treatments for active choroidal neovascularization or PCV were required in 12 eyes during follow-up. The mean visual acuity improved significantly from a logarithm of the minimum angle of resolution of 2.79 +/- 0.85 before operation to 1.61 +/- 0.98 at 2 months after operation (P < 0.001). Visual acuity was >or=20/200 in 9 eyes (37.5%) at 2 months after operation; 1 eye was in the AMD group, and the other eyes were in the PCV group. Improvement was more frequently observed in the PCV group (P = 0.005). CONCLUSION: In this series, the functional outcomes of vitrectomy for vitreous hemorrhage associated with AMD were inferior to outcomes of the PCV group. Vitrectomy is beneficial for improving visual function in select cases of breakthrough vitreous hemorrhage.

The effect of the YK lens in keratoconus.

PURPOSE: To report the clinical results of the use of the YK contact lens (Lucid Co., Seoul, Korea) for keratoconus. METHODS: One hundred and twenty nine keratoconic eyes were fitted with a YK lens which has one base curve and three peripheral curves. A light feather touch fluorescein pattern was obtained based on topographic indices. Visual acuity, comfort, mean wearing time, and ocular tissue changes were evaluated. Mean follow up was 17.5 +/- 13.8 months (range 6-75). RESULTS: One hundred and twenty six (97.6%) eyes tolerated the contact lenses. A total of 94.5% of the eyes achieved a visual acuity of 20/40 or better (average 0.79 +/- 0.21), and flatter base curve radius (BCR) was related to better visual acuity. One hundred and seventeen (90.7%) eyes reported that the lenses were comfortable. Mean wearing time was 12.1 h per day (range 4-18). Changes in keratometric values were not significant between baseline and final follow-up visit. CONCLUSIONS: The YK lens can provide successful visual outcome, with comfort, and no significant influence on the progression of keratoconus.

Evaluation of differentially expressed genes identified in keratoconus.

PURPOSE: To identify the differentially expressed genes (DEGs) in the human keratocytes in keratoconus. METHODS: Total RNA extracted from cultured corneal stromal fibroblasts from normal and keratoconic corneas were used for the synthesis of cDNA. DEGs were screened by an annealing control primer(TM)-based PCR method using GeneFishing() DEG kits. The differentially expressed bands were sequenced and analyzed. The genes identified were further evaluated by reverse transcriptase PCR and quantitative real-time PCR. RESULTS: Overexpression of bone morphogenetic protein 4 (BMP4), cofilin 1 (CFL1), and JAW1-related protein (MRVI1) and underexpression of actin, alpha 2 (ACTA2), gene rich cluster, and C 10 gene (GRCC10), tissue inhibitor of metalloproteinase 3 (TIMP3), tissue inhibitor of metalloproteinase 1 (TIMP1), and somatostatin receptor 1 (SSTR1) were verified, and these results were confirmed by reverse transcriptase PCR and quantitative real-time PCR. CONCLUSIONS: Eight genes were identified to be differentially expressed in keratoconus and related with apoptosis, the cytoskeleton, wound healing, and nerve fibers. The genes identified may be involved in the mechanism underlying stromal thinning; thus, they could be important and deserve further investigation.

Effect of fat embolism with triolein emulsion on blood-retinal barrier.

BACKGROUND: Triolein emulsion is under investigation for supplemental use to open the blood-brain barrier during chemotherapy. The effects of triolein emulsion on the blood-retinal barrier (BRB) were investigated. METHODS: Fat emboli were induced in 20 cats by injecting triolein emulsion through the carotid artery. At 30 min, 4, 12 and 48 h after embolization, electroretinography (ERG) and fluorescein angiography (FA) were performed. The eyeballs were enucleated for transmission electron-microscopic study. RESULTS: FA revealed multiple leaking points at 30 min, and prominent diffuse leakage at 4 h when scotopic b-waves showed significant differences between the study and control eyes. Multiple focal disruptions of the blood vessels by fat vacuoles were found with electron microscopic study. ERG improved at 12 and 48 h, and the BRB appeared to be recovered on FA and electron microscopic studies after 48 h. CONCLUSION: An experimental embolism with triolein emulsion disrupted the blood retinal barrier. Delayed maximal change was observed, and it could be implicated in the latent interval of clinical fat embolism syndrome.

Reorganization of photoreceptor layer on optical coherence tomography concurrent with visual improvement after macular hole surgery.

To report three cases in which reorganization of the photoreceptor layer on optical coherence tomography (OCT) was concurrent with long-term visual recovery after macular hole surgery. Serial OCT scans of three eyes in which visual acuity continued to improve for 1 or more years after successful macular hole surgery were reviewed. Case 1. At postoperative four weeks, visual acuity was 20/100 with disorganized photoreceptor layer on OCT. The photoreceptor layer had been reorganized and visual acuity had improved to 20/25 by 1 year. Case 2. Two weeks after the operation, visual acuity was 20/125 and disorganization of the photoreceptor layer was noted. Visual acuity improved to 20/50 by four months. The photoreceptor layer had been partly reorganized and had appearance of a broken line. Visual acuity had improved to 20/40 and the photoreceptor layer had been reorganized further with a residual defect on OCT by 15 months. Case 3. Visual acuity at two weeks was 20/100. OCT revealed disorganization of the photoreceptor layer. Six months after the operation, the partly reorganized photoreceptor layer appeared as a broken line and visual acuity had reached 20/80. Visual acuity had improved further to 20/40 by 1 year, concurrent with improved organization of the photoreceptor layer. The reorganization of the photoreceptor layer plays a part in long-term improvement of visual acuity after macular hole surgery.

Methicillin-resistant Staphylococcus aureus sclerokeratitis after pterygium excision.

PURPOSE: To report a case of methicillin-resistant Staphylococcus aureus (MRSA) sclerokeratitis after pterygium excision. METHODS: Case report. RESULTS: A 72-year-old woman who had undergone pterygium excision 6 months ago was referred for severe pain and decreased visual acuity. Although infectious scleritis caused by Pseudomonas was diagnosed clinically, and intravenous amikacin and ceftazidime and topical ciprofloxacin were started, there was no improvement. MRSA was grown in a cultured test, and topical and systemic vancomycin was applied and resolved the corneoscleral inflammation. Scleral patch graft and sliding conjunctival flap were performed, and no complications or recurrences were found through 14 months after treatment. CONCLUSIONS: MRSA should be considered as a possible organism in infectious scleritis after pterygium excision, especially when beta-lactam antibiotic therapy is ineffective.

Cysticidal effect on acanthamoeba and toxicity on human keratocytes by polyhexamethylene biguanide and chlorhexidine.

PURPOSE: To evaluate the cysticidal effect of polyhexamethylene biguanide (PHMB) and chlorhexidine on Acanthamoeba and its toxic effect on cultured human keratocytes. METHODS: Each well of a twofold-diluted Acanthamoeba cyst-containing suspension of 5 x 10(4) cysts/mL was treated with PHMB and chlorhexidine for 8, 24, and 48 hours to determine the minimal cysticidal concentration (MCC) of each disinfectant. Human corneal keratocytes (5 x 10(4) cells/mL) were exposed to PHMB and chlorhexidine for the same time to determine the survival rate of keratocytes. Inverted phase-contrast and electron microscopy were used to observe the morphologic changes. RESULTS: The mean MCC of PHMB for 8, 24, and 48 hours was 9.42, 5.62, and 2.37 microg/mL, respectively. The mean MCC of chlorhexidine for 8, 24, and 48 hours was 24.32, 10.02, and 7.02 microg/mL, respectively. The respective survival rate of keratocytes at the MCC was 91.7%, 64.6%, and 49.7% for PHMB and 95.7%, 90.6%, and 78.1% for chlorhexidine, respectively. The cysts and keratocytes showed more damaged appearances after treatment with PHMB than chlorhexidine. CONCLUSIONS: PHMB and chlorhexidine showed a similar amoebicidal efficacy. However, PHMB seemed to be more toxic to keratocytes than chlorhexidine.

Capsulorhexis assisted by slit illuminator for white cataract without a red reflex.

The authors investigated the clinical efficacy of a slit illuminator in a surgical microscope during capsulorhexis for white cataract. After staining the anterior capsule, the slit illuminator was adjusted to a width of 3 mm and a height of 12 mm using the slider to obtain a high-contrast image of the anterior capsule, and an angle of 30 degrees to both the left and right was possible using the arc guide. After the anterior capsular puncture was done, a capsulorhexis forceps was used to grasp the capsular edge and a continuous curvilinear capsulorhexis was successfully performed in all 10 cases. Using a slit illuminator in a surgical microscope seems to be a valuable technique for performing a continuous curvilinear capsulorhexis on a mature or intumescent cataract that has no red reflex and high intralenticular pressure.

Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment.

PURPOSE: The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. RESULTS: This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). CONCLUSIONS: Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

A comparative study for mesopic contrast sensitivity between photorefractive keratectomy and laser in situ keratomileusis.

BACKGROUND AND OBJECTIVE: To compare the effect on visual performance of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) with mesopic contrast sensitivity. PATIENTS AND METHODS: Postoperative visual performance for 40 eyes undergoing PRK and 40 eyes undergoing LASIK was compared with mesopic contrast sensitivity at 1, 3, and 6 months postoperatively. Eyes were divided into two groups (< -6.0 D and > -6.25 D). Mesopic contrast sensitivity was performed with the patient's best-corrected visual acuity of 20/20 or better under photopic conditions. RESULTS: A significant decrease in mesopic contrast sensitivity from preoperative baseline was obtained at all spatial frequencies for the PRK and LASIK groups (P < .05). There was no statistically significant difference at 1 or 3 months postoperatively in both groups (P > .05). At 6 months postoperatively, LASIK significantly decreased mesopic contrast sensitivity more than PRK in myopia with a refractive error of less than -6.0 D, especially at the middle and high spatial frequencies of 6, 9, and 12 cycles per degree (P < .05). However, no statistically significant differences in mesopic contrast sensitivity between PRK and LASIK were found in myopia with a refractive error of greater than -6.25 D (P > .05). CONCLUSIONS: In broad-beam excimer laser refractive surgery, PRK seemed to have a more significant effect on mesopic contrast sensitivity than LASIK for myopia with a refractive error of less than -6.0 D at 6 months postoperatively.

Triamcinolone-induced intraocular pressure elevation: intravitreal injection for macular edema and posterior subtenon injection for uveitis.

PURPOSE: To assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP). METHODS: we reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed. RESULTS: The lOP increased significantly (p < 0.001) from 16.3 +/- 2.5 mmHg preoperatively to a mean maximum of 21.7 +/- 5.3 mmHg in the IVTA group, and from 15.3 +/- 4.5 mmHg to 20.6 +/- 3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline lOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks. CONCLUSIONS: Both developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.

Corneal endothelial cell change after phacoemulsification relative to the severity of diabetic retinopathy.

PURPOSE: To investigate the differences in corneal endothelial cell morphology between diabetic patients who were divided by the degree of the severity of diabetic retinopathy and normal patients after phacoemulsification with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, College of Medicine, Pusan National University, Pusan, Korea. METHODS: Before and 6 months after phacoemulsification, specular microscopy was used to evaluate the number and morphology of endothelial cells in patients with diabetic retinopathy. The patients were divided into 3 groups: group I (n=30 eyes), without diabetes; group II (n=30 eyes), diabetes with severe nonproliferative diabetic retinopathy; group III (n=30 eyes), diabetes with high-risk proliferative diabetic retinopathy (PDR). RESULTS: Postoperative corneal endothelial cell density and hexagonality were significantly decreased and the coefficient of variation in cell size increased in all groups, in contrast to the preoperative state (P<.05). During the postoperative 6 months, the percentage of hexagonal cells showed a tendency to decrease progressively, and this was a significant difference between the 3 groups (P<.05). However, the patterns of change in endothelial cell density and the coefficient of variation in cell size were not different between the groups (P>.05). At the postoperative 6 months, the corneal endothelial cell density and the coefficient of variation in cell size of high-risk PDR patients were statistically changed compared with normal persons (P<.05). However, the percentage of hexagonal cell was not significantly difference between diabetic retinopathy patients and normal patients (P>.05). CONCLUSIONS: Corneal endothelial cell density significantly decreased and the coefficient of variation in cell size significantly increased for high-risk PDR patients undergoing phacoemulsification, in contrast to normal persons at the postoperative 6 months.