Comparison of changes in endothelial cell count and central corneal thickness after phacoemulsification and small-incision cataract surgery: A prospective observational study at a tertiary care center of eastern Uttar Pradesh

Purpose: Morphological stability and functional integrity of corneal endothelium are necessary to maintain long-term corneal transparency. When the number of endothelial cells drops below 450�0 cells/mm2, corneal edema, irreversible loss of corneal transparency, and decreased vision occur. There is concern regarding manual small-incision cataract surgery (MSICS) being more harmful to the endothelium in comparison to phacoemulsification. Our study aims to determine which technique maintains the corneal parameters closest to the normal physiological state. Methods: A prospective observational study was conducted over a period of 15 months on 100 eyes, out of which 43 patients underwent phacoemulsification surgery and 57 underwent MSICS. TOPCON SP-1P, Version 1.41, 50� Hz frequency, noncontact specular microscope with pachymeter was used to measure endothelial cell count (ECC) and central corneal thickness (CCT) on four occasions: 1 day prior to surgery and on day 1, 3rd week, and 6th week after surgery. Results: In total, 100 eyes of 100 subjects were studied with no dropout during the study period. The age range was 40� years. There was no statistically significant difference between the preoperative mean ECC and mean CCT in phacoemulsification and SICS groups. A statistically significant difference was observed in the postoperative mean ECC (P < 0.01) and mean CCT (P < 0.001) on day 1 and 3rd week between the phacoemulsification and SICS groups, respectively. The mean endothelial cell loss at 6 weeks was less with SICS but comparable with phacoemulsification. Conclusion: SICS is significantly faster, less expensive, less technology dependent, can deal with all types of cataracts, is relatively safe, and is more appropriate for advanced cataracts.

Evaluation of meibomian gland morphology and anterior segment parameters by Sirius topography systems in polycystic ovary syndrome

Purpose: To compare findings in specular microscopy, corneal topography, and noncontact meibography in polycystic ovary syndrome (PCOS) patients with healthy controls. Methods: A total of 40 women with PCOS and 32 healthy controls were enrolled in the study. Schirmer’s test, Ocular Surface Disease Index (OSDI), noninvasive tear break-up time (NITBUT), the mean keratometry (Km), maximum keratometry (Kmax), central (CCT), thinnest (TCT) and apical (ACT) corneal thicknesses, meibomian gland (MG) loss, meiboscores, morphology of MGs, endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells (PHEX) were analyzed. Correlations between anti-Mullerian hormone (AMH) and sex hormones and the findings of PCOS patients were evaluated. Results: Mean OSDI score, intraocular pressure, Km and Kmax values, the mean MG loss of upper and lower eyelids, lower eyelid meiboscore, and degree of morphological abnormalities of MGs were higher in cases with PCOS than healthy controls. There were no significant differences between groups in Schirmer results, first and average NITBUT, mean values of TCT, ACT, CCT, ECD, CV, and PHEX (P > 0.05, for all). There were correlations between plasma AMH level and Kmax, back Km and PHEX, and between estradiol (E2) and PHEX; there were negative correlations between E2 and total MG loss and CV and between total testosterone and ACT. Conclusion: Loss and morphological deterioration of the MGs are observed in PCOS patients, even if the tear parameters are not impaired yet. In eyes with PCOS, keratometry values become steeper in proportion to AMH levels. The PCOS patients should be followed carefully for the development of corneal ectasia.

A Study of Corneal Thickness in Type 2 Diabetes Mellitus with and without Diabetic Retinopathy

It is essential to assess the corneal thickness in diabetes patient.Introduction: diabetes mellitus is a major cause of blindness throughout the worldDiabetic retinopathy is the most importance given on day to day basics studies especially for ophthalmologist studied indicators in eye. However, functional oddities have been recognised in cornea too like changes in central corneal thickness.Objectives: 1. To estimate the central corneal thickness (CCT) of type 2 diabetes mellitus patients without diabetic retinopathy age/sex matched normal people. 2. To measure central corneal thickness (CCT) of type 2 diabetes mellitus patient with diabetic retinopathy with age/ sex matched normal person.Methods: This is a hospital based case control study.Expected Results: The central corneal thickness is more in type 2 diabetes patients than non-diabetic individual.

Microscopia endotelial manual y automatizada: estudio comparativo en adultos sin alteraciones corneales / Manual and automated endothelial microscopy in adults without corneal alterations

Objetivo: Comparar los resultados de los parámetros morfológicos y morfométricos del endotelio corneal a través de la microscopia especular a partir de la utilización del conteo manual y automatizado. Métodos: Se realizó un estudio descriptivo, observacional, de corte transversal de serie de casos en adultos sin alteraciones corneales, en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", en el periodo comprendido de enero de 2019 a enero de 2020. Se estudiaron un total de 50 adultos (100 ojos), de los cuales 50 fueron ojos derechos y 50 ojos izquierdos. Se emplearon los porcentajes y los números absolutos para resumir las variables cualitativas. En el caso de las cuantitativas, se utilizó la media con su desviación estándar. Resultados: El 46 por ciento fue del sexo femenino y el 54 por ciento del sexo masculino. Los parámetros morfométricos, como la paquimetría central, fue igual en ambos conteos. A su vez, se obtuvieron mayores valores de densidad endotelial con el conteo automatizado. En los parámetros morfológicos se registró que la hexagonalidad fue superior en el conteo manual y el coeficiente de variabilidad en el conteo automatizado. Las diferencias más marcadas resultaron en el tamaño mínimo, en el máximo y en el promedio de las células endoteliales corneales, con variaciones entre los dos conteos. Conclusiones: Queda demostrado que tanto el conteo manual como el automatizado para el estudio del endotelio corneal pueden ser aplicados en la práctica oftalmológica(AU)

Objective: Compare the results of morphological and morphometric parameters of the corneal endothelium using specular microscopy with manual and automated counting. Methods: A cross-sectional observational descriptive study was conducted of a case series of adults without corneal alterations attending the Refractive Surgery Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2019 to January 2020. A total 50 adults were studied (100 eyes: 50 right and 50 left). Percentages and absolute numbers were used to summarize qualitative variables, whereas quantitative variables were evaluated with means and standard deviations. Results: Of the patients studied, 46 percent were female and 54 percent were male. Morphometric parameters such as central pachymetry were the same in both countings. Automated counting yielded higher endothelial density values. Morphological parameters showed that hexagonality was greater in manual counting, whereas the coefficient of variability was greater in automated counting. The most obvious differences were observed in minimum size, maximum size and average corneal endothelial cells, with variations between the two countings. Conclusions: It was shown that both manual and automated counting may be used for examination of the corneal endothelium in ophthalmic practice(AU)

Um estudo de correlação entre a contagem endotelial da córnea em pacientes com diferentes estágios de ceratocone usando a microscopia especular / A correlation study between a corneal endothelial count in patients with different stages of keratoconus using specular microscopy

RESUMO Objetivo: Avaliar a contagem endotelial da córnea em pacientes com ceratocone (KCN) por microscopia especular e correlacionar com o estágio do ceratocone. Métodos: Noventa e três olhos de 61 pacientes com KCN foram incluídos neste estudo transversal. Os olhos foram classificados nos estágios 1 a 4 de KCN de acordo com a classificação de Amsler-Krumeich utilizando ceratometria obtida pela topografia de córnea e leituras de paquimetria obtidas pela microscopia especular. Resultados: A idade variou de 12 a 43 anos, média ± (desvio padrão) 22,1 ± 6,7 anos. A ceratometria média variou de 42,25 a 71,4 D (53,0 ± 6,1 D). A paquimetria variou de 350 a 606 µm, (461,7 ± 47,1 µm). Em relação a classificação, 23 pacientes (24,7%) apresentavam estágio 1, 24 (25,8%) estágio 2, 5 (6,5%) estágio 3 e 41 pacientes (44,1%) estágio 4. Não foi observada correlação linear entre ceratometria média e contagem de células endoteliais (Coeficiente de correlação de Pearson = -0,05). Nos estágios iniciais a moderados de KCN, a média da contagem de células endoteliais foi 2738,3 ± 285,4 cel/mm2, enquanto no grupo de KCN avançado (estágios 3 e 4) foi 2670,6 ± 262,7 cel/mm2, p= 0,24. Conclusões: Não há correlação entre a contagem de células endoteliais e o estágio do KCN.

ABSTRACT Objective: To evaluate the corneal endothelial count in patients with keratoconus (KCN) by specular microscopy and correlate with the stage of keratoconus. Methods: Ninety-three eyes from 61 patients with KCN were included in this cross-sectional study. The eyes were classified into KCN stages 1 to 4 according to the Amsler-Krumeich classification using keratometry obtained by corneal topography and pachymetry readings obtained by specular microscopy. Results: Age ranged from 12 to 43 years, mean ± (standard deviation) 22.1 ± 6.7 years. The average keratometry ranged from 42.25 to 71.4 D, (53.0 ± 6.1 D). Pachymetry ranged from 350 to 606 µm, (461.7 ± 47.1 µm). Regarding the Amsler classification, 23 patients (24.7%) had stage 1, 24 (25.8%) stage 2, 5 (6.5%) stage 3 and 41 patients (44.1%) stage 4. No linear correlation was observed between mean keratometry and endothelial cell count (Pearson's correlation coefficient = -0.05). In the early to moderate stages of KCN, the mean endothelial cell count was 2738.3 ± 285.4 cell / mm2, while in the advanced KCN group (stages 3 and 4) it was 2670.6 ± 262.7 cell / mm2 , p = 0.24. Conclusions: No correlation was found between the endothelial cell count and the KCN stage.

20% ethanol assists the excision of primary pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To introduce a technique to improve the excision of primary pterygium and evaluate the surgical outcomes.<p>METHODS: Recorded of consecutive cases were reviewed of pterygium patients treated with pterygium removal between March 2015 and February 2016 in People's Hospital of Guangxi Zhuang Autonomous Region, China. Primary nasal pterygium patients with at least 3mo follow-up periods were included. Finally, 85 patients(85 eyes)were investigated, 44 eyes were operated with 20% ethanol(the study group)and 41 eyes were operated without 20% ethanol(the control group).<p>RESULTS: All of the 85 patients enrolled had no intraoperative and postoperative complications. The mean healing time of the corneal epithelium for the study group was statistically significant different of 2.84±0.43d compared with the control group of 3.12±0.64d(<i>P</i><0.05). Overall, postoperative symptoms(pain, irritation, foreign body sensation and epiphora)were significantly different in postoperative 3d between the two groups(<i>P</i><0.05). No statistically significant differences in corneal endothelium morphologies were found in two groups between preoperative and 2wk, 1 and 3mo postoperative, or between the two groups at any corresponding time point(all <i>P</i>>0.05). Between the two groups, there were no statistically significant differences in best-corrected visual acuity(BCVA)at preoperative, postoperative 2wk and 1mo(all <i>P</i>>0.05), but statistically significant difference was found in BCVA at the 3mo after surgery(<i>P</i><0.05).<p>CONCLUSION: The removal of primary pterygium with 20% ethanol is a simple and safe technique that helps to establish a clear separation plane between the pterygium and the underlying cornea.

Corneal endothelium in unilateral Fuchs heterochromic iridocyclitis

Purpose: To assess the corneal endothelium in patients with Fuchs heterochromic iridocyclitis (FHI) and compare it with the normal fellow eye. Methods: Retrospective, observational, cross-sectional study of 31 patients seen between Jan 2016 to Dec 2018, with clinical diagnosis of Fuchs heterochromic iridocyclitis, was performed. Specular microscopic examination was documented in both eyes. The affected eyes formed the study group and the fellow healthy eyes served as controls. Results: The mean age of the patients was 29.9 ± 8.2 years. The endothelial cell density (P = 0.0001) was significantly lower, whereas average cell size (P = 0.0001), coefficient of variation (P = 0.004), and maximum cell area (P = 0.01) were significantly higher in the affected eye compared to the control eye. In three patients, the affected eye showed guttae, while the healthy fellow eye revealed a normal specular mosaic. Conclusion: Specular microscopic analysis shows endothelial alterations in the affected eyes in FHI.

Concordancia entre los diferentes conteos celulares según los parámetros morfológicos y morfométricos del endotelio corneal / Concordance between different cell counts according to morphologic and morphometric parameters of the corneal endothelium

RESUMEN Objetivo: Estimar los valores morfológicos y morfométricos del endotelio corneal según la cantidad de células y evaluar la concordancia interobservadores para los diferentes parámetros, considerados según los diferentes conteos celulares en adultos sin alteraciones corneales. Métodos: Se realizó una investigación observacional, descriptiva y transversal de serie de casos en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" en dos años de estudio. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 200 ojos de 100 pacientes adultos sin alteraciones corneales. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad y coeficiente de variabilidad) y morfométricos (densidad celular), así como el promedio del tamaño celular corneal según cantidad de células evaluadas. Resultados: Según la cantidad de células endoteliales evaluadas, no existieron diferencias significativas de las variables morfológicas y morfométricas (p> 0,05) en ambos ojos. La concordancia entre los diferentes conteos celulares según los valores de los coeficientes de correlación intraclase fueron todos altos. La concordancia interobservadores (excepto para la hexagonalidad) y los coeficientes de correlación intraclase fueron altos. Conclusiones: Los valores morfológicos y morfométricos del endotelio corneal según cantidad de células evaluadas, son similares en todos los conteos celulares. Se demuestra una buena concordancia entre los diferentes conteos celulares estudiados para los diferentes parámetros estimados(AU)

ABSTRACT Objective: To estimate the morphological and morphometric values of the corneal endothelium according to the number of cells and evaluate the interobserver concordance for the different parameters, estimated according to the different cell counts in adults without corneal alterations. Methods: An observational, descriptive and cross-sectional case series research was carried out in the Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology during two years of study. After applying the exclusion criteria, the sample was made up of 200 eyes of 100 adult patients without corneal alterations. Non-contact endothelial microscopy SP-3000P was performed to identify morphological values (hexagonality and coefficient of variability) and morphometric values (cell density), as well as the average corneal cell size according to the number of cells evaluated. Results: According to the amount of endothelial cells evaluated, there were no significant differences between morphological and morphometric variables (p>0.05) in both eyes. The agreement between the different cell counts according to the values of the interclass correlation coefficients (ICC) were all high. The interobserver concordance and ICCs were also high, except for hexagonality. Conclusions: The morphological and morphometric values of the corneal endothelium, according to the number of cells evaluated, are similar in all cell counts. Good concordance between the different cell counts studied for the different estimated parameters is demonstrated(AU)

Iridocorneal Endothelial Syndrome with Features of Posterior Polymorphous Corneal Dystrophy

PURPOSE: To report a case of iridocorneal endothelial syndrome, which overlapped with some of the features of posterior polymorphous corneal dystrophy. CASE SUMMARY: A 61-year-old female presented with tearing pain and blurred vision in her left eye, which was aggravated in the morning. The symptom started approximately 1 year prior to her visit. At the initial visit, the visual acuities were 1.0 in both eyes and the intraocular pressures were normal. On slit-lamp examination, a single pair of horizontal parallel lines was observed at the central corneal endothelial layer in the right eye. In contrast, multiple pairs of oblique parallel lines were observed in the left eye. The lines of the lesions were more prominent and wavier in the left eye than those of the right eye. The overlying cornea was clear, and the corneal thicknesses were in the normal range in both eyes. Using a gonioscopic examination, localized peripheral anterior synechiae were observed only in the left eye. The pupil and iris were normal in both eyes. On specular microscopic examination, the corneal endothelial cell size in the right eye increased and the corneal endothelial density decreased to 668 cells/mm². In the left eye, multiple abnormal endothelial cells with dark-light reversal were observed. In conclusion, the patient was subsequently diagnosed with iridocorneal syndrome, rather than posterior polymorphous corneal dystrophy. CONCLUSIONS: Posterior polymorphous corneal dystrophy and iridocorneal endothelial syndrome may present with many similarities. Therefore, in cases of uncertain diagnosis, an understanding of the clinical features is important for proper diagnosis.

Comparison of Central Corneal Thickness Measurements between Noncontact Specular Microscopy and Ultrasound Pachymetry

PURPOSE: We compared and analyzed central corneal thickness (CCT) measurements according to the corneal thickness obtained with noncontact specular microscopy (NCSM) and ultrasound pachymetry (USP). METHODS: CCT was measured in the order of NCSM and USP by a single optometrist in 120 eyes of 120 healthy subjects. The measurements were compared between the devices and the measurement agreements and correlations between the devices were analyzed. To determine if the measurements differed depending on the thickness of the cornea, the patients were divided into three tertile groups from the thinnest patient by CCT measurement using USP, and then the differences in CCT measured by the two devices were analyzed. RESULTS: The CCT measurements using NCSM and USP were 548.25 ± 4.64 µm and 533.09 ± 35.96 µm, respectively. NCSM measurements were found to be thicker, showing statistically significant differences between the measurements (p < 0.001). The two examinations showed a high degree of correlation (r = 0.878; p < 0.01). In the three groups, the differences in CCT measurements between NCSM and USP were 12.93 ± 21.88 µm, 16.85 ± 15.89 µm, and 15.70 ± 20.46 µm, respectively, but the differences between the three groups were not statistically significant (p = 0.655). CONCLUSIONS: Our results show that although the differences in CCT measurements using NCSM and USP were consistent regardless of the corneal thickness, the CCT measurements by NCSM and USP were highly correlated.

Comparison of endothelial cell changes by specular microscopy between Ringer's and Ringer's lactate during phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the difference between using Ringer's and Ringer's lactate(RL)solutions as irrigating solutions during phacoemulsification and investigate their effect on corneal endothelium.<p>METHODS: This was a prospective interventional double blinded clinical study that included 100 eyes of 100 patients aged between 50 to 65 years suffering from a visually significant age-related cataract and scheduled for routine uncomplicated phacoemulsification. The included eyes were randomly divided into two equal groups(each group included 50 eyes). Group 1 received Ringer's solution and group 2 received Ringer's lactate as an irrigating solution.<p>RESULTS: The first group with Ringer's solution had a mean age of 57.5±8 years and the second group with RL solution had a mean age of 58.6±9 years. After 3mo, endothelial cell density decreased in group 1 by a mean of 8.5%, and in group 2 by a mean of 3.6%(<i>P</i>=0.013). Additionally, central corneal thickness increased in group 1 by a mean of 6.9% and in group 2 by a mean of 1.5%(<i>P</i>=0.006). By correlating the percentage of change in pachymetry and specular microscopic parameters with volume of irrigation solution used, there was no significant correlation.<p>CONCLUSION: The use of Ringer's lactate as an irrigating solution is associated with less endothelial cell loss postoperatively in comparison to Ringer's solution and also associated with decreased postoperative edema.

Corneal endothelial changes in patients with vitamin D deficiency

Purpose: The purpose of this study is to evaluate the effect of vitamin D deficiency on corneal endothelial layer using specular microscopy. Methods: Fifty-eight eyes of 58 patients whose vitamin D level was below 15 ng/ml and who had no ocular pathology were included in the study (Group 1). Forty eyes of 40 age-and sex-matched subjects were enrolled as control group (Group 2). Corneal endothelial cell density (CD), coefficient of variation (CV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical Inc., Nishinomiya, Japan). The obtained data were compared between the groups. Results: There was no significant difference between the groups in terms of age and gender (P = 0.344, P = 0.399, respectively). The mean CD value was 2772.79 ± 202.21 cells/mm2 in Group 1 and 2954.97 ± 116.89 cells/mm2 in Group 2 (P = 0.001). The mean CV value was 30.31 ± 3.65 in Group 1 and 28.20 ± 2.71 in Group 2 (P = 0.003). The mean HEX value was 46.56 ± 6.32 in Group 1 and 51.07 ± 5.28 in Group 2 (P = 0.001). The mean CCT value was 555.87 ± 36.90 ? in group 1 and 549.0 ± 37.39 ? in Group 2 (P = 0.96). Conclusion: Vitamin D deficiency may affect the corneal endothelial layer. Patients with vitamin D deficiency should be evaluated for endothelial parameters in particular before an intraocular surgery. Further studies are needed to confirm our results.

Cornea and anterior eye assessment with slit lamp biomicroscopy, specular microscopy, confocal microscopy, and ultrasound biomicroscopy

Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple, and several devices and technologies show signs that help in identification of different diseases thereby, helping in diagnosis, management, and follow-up of patients. The purpose of this review is to present and update readers on the evaluation of cornea and ocular surface. This first part reviews a description of slit lamp biomicroscopy (SLB), endothelial specular microscopy, confocal microscopy, and ultrasound biomicroscopy examination techniques and the second part describes the corneal topography and tomography, providing up-to-date information on the clinical recommendations of these techniques in eye care practice. Although the SLB is a traditional technique, it is of paramount importance in clinical diagnosis and compulsory when an eye test is conducted in primary or specialist eye care practice. Different techniques allow the early diagnosis of many diseases, especially when clinical signs have not yet become apparent and visible with SLB. These techniques also allow for patient follow-up in several clinical conditions or diseases, facilitating clinical decisions and improving knowledge regarding the corneal anatomy.

Comparison of central corneal thickness measurements by PachPen ultrasonic pachymetry and the other two optical measuring instruments / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To compare the similarities and differences of central corneal thickness (CCT) measured by different devices, so as to provide a safe, effective, simple and accurate method for measuring corneal thickness. ·METHODS: Totally 95 eyes of 95 cataract patients enrolled continuously for preoperative examination in ophthalmology department of Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2016 to December 2016. Handheld automatic PachPen ultrasonic pachymetry (USP), anterior segment optical coherence tomography (AS-OCT) and specular microscopy were respectively used to measure the central corneal thickness,and intraocular pressure was measured at the same time. The similarities and differences of these three different devices to measure the central corneal thickness and their correlations with intraocular pressure were observed. Then the data were analyzed statistically. · RESULTS: The CCT value measured by PachPen ultrasonic pachymetry was 544. 43 ± 36. 61μ m, the CCT value measured by AS-OCT was 527.09 ± 35.54μ m, and the CCT value measured by specular microscopy was 533.20 ± 30. 17μ m. There was significant difference between these three groups(F=6.272,P=0.002),and the CCT value measured by PachPen ultrasonic pachymetry was significantly higher than the other two groups. The correlation coefficients between the CCT values of these three groups and intraocular pressure were 0.290, 0.277 and 0.204 (P<0.05) respectively, of which the correlation between the CCT measured by PachPen ultrasonic pachymetry and the intraocular pressure was the highest. There was statistically significant correlation between the CCT values measured by these three measurements (P<0.001). ·CONCLUSION: The CCT value measured by PachPen ultrasonic pachymetry is the highest. The second CCT value is measured by specular microscopy, and the smallest CCT value is measured by AS-OCT. Obvious correlation and good consistency were found in the CCT values measured by three types of devices, and the CCT values were all correlated with intraocular pressure. Therefore,we should take more attention in clinic.

Morfología y morfometría del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas / Morphology and morphometry of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells

Objetivo: describir las características morfológicas y morfométricas del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas atendidos en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido de enero a febrero del año 2016. Métodos: se realizó una investigación descriptiva de corte transversal de serie de casos atendidos en el Servicio de Cirugía Refractiva. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 90 ojos de 45 pacientes adultos sanos. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad y coeficiente de variabilidad) y morfométricos (densidad celular y paquimetría), así como el promedio del tamaño celular corneal según cantidad de células evaluadas. Resultados: según la cantidad de células endoteliales evaluadas no hubo diferencias en cuanto a la paquimetría en ambos ojos (p> 0,05). En relación con la densidad no existieron diferencias significativas entre la cantidad de células evaluadas en ambos ojos (p> 0,05). Los valores de hexagonalidad, coeficiente de variabilidad y tamaño celular promedio no mostraron diferencias significativas (p> 0,05) en ambos ojos según la cantidad de células evaluadas. Conclusiones: el estudio del endotelio corneal mediante la utilización del microscopio especular constituye un método efectivo que permite conocer las características de las células endoteliales sin existir variaciones según la cantidad de células evaluadas(AU)

Objective: to describe the morphological and morphometric characteristics of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells, who had been seen at the refractive survey service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to February, 2016. Methods: descriptive, cross-sectional case-series research study of patients seen at the refractive surgery service. After applying the exclusion criteria, the sample was finally made up of 90 eyes from 45 healthy adult patients. SP-3000P non-contact endothelial microscopy was performed to determine the morphological (hexagonality and variability coefficient) and morphometric (cell density and pachymetry) values and the average of the average cellular corneal size according to the number of evaluated cells. Results: according to the number of evaluated endothelial cells, there were no differences as for the pachymetry in both eyes (p> 0.05). Regarding the cell density, there were no significant differences among the number of evaluated cells in both eyes (p> 0.05). The hexagonality, variability coefficient and average cell size did not show significant differences (p> 0.05) in both eyes according to the number of evaluated cells. Conclusions: the study of the corneal endothelium using the specular microscope is an effective method that allows to know the characteristics of the endothelial cells without no previous variations, according to the number of evaluated cells(AU)

Specular microscope as an accurate tool foranalysingcorneal endothelial cell changes in patientswithtype 2 diabetes mellitus at tertiary care hospital set up in Kanchipuram District

Background: Diabetic eye disease comprises a group of eye conditions that affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema (DME), cataract, and glaucoma. All forms of diabetic eye disease have the potential to cause severe vision loss and blindness. Animal studies have also shown that corneal endothelial cells in diabetic rats have morphological abnormalities. These abnormalities include a decrease in endothelial cell density (CD) and hexagonality, as well as increased polymegathism, polymorphism, and central corneal thickness (CCT). Aim: To compare corneal endothelial cell changes such as endothelial cell density (ECD) percentage of polymegathism (coefficient of variation) along with central corneal thickness (CCT) in patients with type 2 diabetes mellitus with age-matched control subjects. Materials and methods: Totally 40 patients among them 20 Patients (40 eyes) with type 2 DM and 20 control (non-diabetic) subjects (40 eyes). The corneal endothelial structure and CCT were examined in all eyes by noncontact specular microscopy using KONAN MEDICAL Specular D. Sundararajan, N. Sathish Kumar. Specular microscope as an accurate tool for analysing corneal endothelial cell changes in patients with type 2 diabetes mellitus at tertiary care hospital set up in Kanchipuram District. IAIM, 2017; 4(10): 188-193. Page 189 Microscope. The endothelial structure was studied for ECD, the coefficient of variation of cell area (CV), and percentage of hexagonal cells. Results were analyzed accordingly. Results: In our study, 20 patients (40) eyes with HbA1c were 8.5% (Group I) and 20 patients (40) eyes with HbA1c. 4.5% (Group II) Endothelial cell density was significantly lower in the diabetic cornea than in control group (P=0.34). In (Group I) CV was higher in the diabetic cornea (P=0.003). The diabetic cornea group had a lower percentage of hexagonal cells than the control group (II), but the difference was not statistically significant (P=0.503). Also, the diabetic cornea was thicker in (Group I) than the control group, (Group II) but not statistically significant (P=0.210). Conclusion: This study documented that type 2 DM causes a significant reduction of endothelial cell density and increased coefficient of variation (polymegathism). Also, the diabetic cornea has increased central corneal thickness and a lower percentage of hexagonal cells than normal subjects, but without statistical significance

Assessment of corneal endothelial cell density and morphology in low and moderate myopic eyes in rural south Indian population

Background: Myopia is a common pathologic change of the eye, especially in Asian countries undergoing rapid development. It is known that Asian people have a higher prevalence of myopia. High levels of myopia are associated with increased risk of cataract, posterior vitreous detachment, retinal tears and retinal detachment, increased risk of choroidal neovascularization, and myopic macular degeneration. Aim: To describe the corneal endothelial density and morphology in patients of low and moderate myopic in rural south Indian population and the relationship between endothelial cell parameters and other factors. Materials and Methods: Totally 100 patients were included. Noncontact specular microscopy was performed after taking a history and testing the visual acuity, intraocular pressure measurement, Schirmer’s test and routine eye examination by slit lamp microscope. The studied parameters included mean endothelial cell density (MCD), the coefficient of variation (CV), and percentage of hexagonality. Results: In low myopic eyes the MCD was 2892. 0±146.2/mm2 , the mean CV was 38.4± 0.4 and the mean hexagonal appearance of the cell was 53.9± 0.9%. In moderate myopic eyes, the MCD was 35716± 142.0 mm2 , the mean CV was 37.9± 3.4% and mean the hexagonal appearance of the cell was N. Sathish Kumar, D. Sundararajan, S. Veluchamy. Assessment of corneal endothelial cell density and morphology in low and moderate myopic eyes in rural south Indian population. IAIM, 2017; 4(10): 93-96. Page 94 59.83± 3.6. There were statistically significant differences in MCD (p<0.000) and hexagonal appearance of the cell (p<0.005) between low and moderate myopic eyes. Conclusion: The normative data of the corneal endothelium of eyes indicated that statistically, MCD decreased significantly with age. Previous studies have reported no difference in MCD, the percentage of CV, and percentage of hexagonality between genders. Nevertheless, significantly different percentages of CV between genders were presented in this study.

The Effect of Intravitreal Injection on the Corneal Endothelium

PURPOSE: To evaluate the effect of intravitreal injection on the corneal endothelium according to the injected drug. METHODS: The present study included 118 eyes of 113 patients who received intravitreal injection. Before each injection and 1 month after the injection, specular microscopy was performed to evaluate the corneal endothelial changes and central corneal thickness. We classified the patients according to the injected drug (bevacizumab 21 eyes, ranibizumab 20 eyes, aflibercept 47 eyes, dexamathasone implant 30 eyes), phakic or pseudophakic eyes, single or multiple injections and analyzed them retrospectively. RESULTS: The mean corneal endothelial cell density was 2,693.2 ± 298.2 cells/mm² before injection and 2,686.8 ± 288.7 cells/mm² 1 month after injection, and there was no statistically significant difference (p = 0.731). According to the kind of drug, the mean corneal endothelial cell density and central corneal thickness were not significantly different before and 1 month after injection in any of the 4 groups. CONCLUSIONS: There were no significant changes in corneal endothelium before and 1 month after intravitreal injection of the various drugs.

Morfología y morfometría del endotelio corneal en adultos sin alteraciones corneales / Morphology and morphometry of the corneal endothelium in adults without corneal alterations

Objetivo: describir las características morfológicas y morfométricas del endotelio corneal en adultos sin alteraciones corneales atendidos en el Servicio de Córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido de enero a julio del año 2015. Métodos: se realizó una investigación descriptiva de corte transversal de serie de casos, en el Servicio de Córnea. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 324 ojos de 162 pacientes adultos. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad-coeficiente de variabilidad) y morfométricos (densidad celular-paquimetría) y el promedio del tamaño celular. Resultados: según los grupos de edades, no hubo diferencias en cuanto a la paquimetría en ambos ojos (p> 0,05). En relación con la densidad, existieron diferencias significativas entre los diferentes grupos de edades en ambos ojos (p< 0,001). Los valores de las medias de la hexagonalidad y del coeficiente de variabilidad no mostraron diferencias significativas (p> 0,05) en ambos ojos. Los valores de las medias del tamaño celular promedio según grupos de edades fueron diferentes de forma significativa en ambos ojos (p< 0,001). No existieron diferencias significativas (p< 0,05) entre los sexos según ojos derecho e izquierdo. Conclusiones: el estudio del endotelio corneal mediante la utilización del microscopio especular constituye un método efectivo que permite conocer las características de las células endoteliales(AU)

Objective: to describe the morphological and morphometric characteristics of the corneal endotelium in adults without corneal alterations at the cornea care service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period of January to July 2015. Methods: descriptive, cross-sectional case series study conducted in a final sample of 324 eyes from 162 adult patients at the cornea care service after using the exclusion approaches. SP-3000P non-contact endothelial microscopy was performed to identify the morphological (hexagonality and variability coefficient) and morphometric (cellular density-pachymetry) values as well as the average cell size. The analyzed period embraced from January to July of 2015. Results: there were no differences as for the pachymetry in both eyes (p>0,05) by age groups. Regarding density, significant differences in both eyes among the different group ages (p< 0,001) were found. The mean values of hexagonality and the variability coefficient did not show significant differences (p> 0.05) in both eyes. The mean values of the average cell size by age groups were significantly different in both eyes (p< 0.001). Significant differences were not found (p< 0.05) between sexes in terms of the left and right eyes. Conclusions: the study of the corneal endothelium by means of the specular microscope is an effective method that allows identifying the endothelial cell characteristics(AU)