The relationship between systemic disorders and anatomical outcomes after Descemet membrane endothelial keratoplasty / A relação entre distúrbios sistêmicos e resultados anatômicos para ceratoplastia endotelial da membrana de Descemet

ABSTRACT Purpose: The aim of this study was to investigate the association of anatomical outcomes and medications of patients with systemic diseases who underwent Descemet membrane endothelial keratoplasty with donor factors. Methods: Sixty nondiabetic donors of endothelial grafts and 60 patients who underwent operation by a single surgeon were included in this retrospective study. The patients' data, including the presence of diabetes mellitus and hypertension, antidiabetic-antihypertensive medications, and intracameral tamponades and anatomical outcomes, were recorded. The donor data were obtained from eye bank records. Results: Eighteen patients had type 2 diabetes mellitus (30%) and 34 had hypertension (56.6%). Among the patients with diabetes mellitus, 13 were receiving a single-agent antidiabetic drug, 4 were receiving dual oral antidiabetic therapy, and 1 was receiving insulin therapy. Among the hypertensive patients, 11 had monotherapy and 23 had dual antihypertensive therapy. Postoperatively, 35 patients (58.3%) had an endothelial attachment, 8 (13.3%) received reinjection, 7 (11.7%) required re-Descemet membrane endothelial keratoplasty, and 10 (16.7%) underwent penetrating keratoplasty. The mean donor age was 51.2 ± 14.1 years. The most common cause of donor death was cardiopulmonary arrest (36/60 cases; 60.0%). Regression analysis revealed that the presence of diabetes mellitus significantly disrupted graft attachment (p=0.034), while the presence of hypertension, antidiabetic and antihypertensive medication use, and the type of tamponade used in the patients, and the age, sex, cause of death, and specular endothelial cell count of donors were not statistically significantly associated with graft attachment (p>0.05). Conclusion: In this study, the anatomical outcomes of Descemet membrane endothelial keratoplasty surgery were affected by recipient and donor factors. The presence of diabetes mellitus in the recipient significantly negatively affected graft attachment.

RESUMO Objetivo: Investigar a associação de desfechos ana tômicos com doenças sistêmicas e medicamentos em casos submetidos à ceratoplastia endotelial da membrana de Descemet e fatores relativos aos doadores. Métodos: Foram incluídos neste estudo retrospectivo enxertos obtidos de doadores não diabéticos e 60 casos operados por um único cirurgião. Foram registrados os dados dos casos, incluindo a presença de diabetes mellitus e hipertensão, medicamentos antidiabéticos e anti-hipertensivos, tamponamentos intracamerais e desfechos anatômicos. Os dados dos doadores foram obtidos dos prontuários do banco de olhos. Resultados: Dezoito casos tinham diabetes mellitus tipo 2 (30%) e 34 tinham hipertensão (56,6%). Entre os casos de diabetes mellitus, 13 estavam em uso de uma medicação antidiabética de agente único, 4 estavam em terapia antidiabética oral dupla e 1 estava em insulinoterapia. Entre os hipertensos, 11 estavam em monoterapia e 23 em terapia anti-hipertensiva dupla. No pós-operatório, 35 pacientes (58,3%) submeteram-se a uma fixação endotelial, enquanto 8 casos (13,3%) receberam reinjeção, 7 casos (11,7%) necessitaram de ceratoplastia endotelial da membrana de Descemet e 10 casos (16,7%) foram submetidos a uma ceratoplastia penetrante. A média de idade dos doadores foi de 51,2 ± 14,1 anos. A causa mais comum de morte do doador foi parada cardiorrespiratória (36/60 casos; 60,0%). A análise de regressão revelou que a presença de diabetes mellitus causa distúrbios significativos na fixação do enxerto (p=0,034), enquanto a presença de hipertensão, o uso de medicamentos antidiabéticos e anti-hipertensivos, o tipo de tamponamento usado, a idade, o sexo, a causa da morte e a contagem de células endoteliais especulares dos doadores não demonstraram associações estatisticamente significativas com a fixação do enxerto (p>0,05). Conclusões: Os resultados anatômicos da cirurgia de ceratoplastia endotelial da membrana de Descemet são afetados por fatores do receptor e do doador. A presença de diabetes mellitus no receptor teve um significativo impacto negativo na fixação do enxerto.

Comparison of corneal endothelial cell loss during manual small-incision cataract surgery using viscoelastic-assisted nucleus removal versus continuous balanced salt solution plus technique - Randomized controlled trial

Purpose: The purpose of this study was to compare and analyze the endothelial cell loss during manual small-incision cataract surgery (MSICS) using the viscoelastic-assisted nucleus removal versus basal salt solution plus technique. Methods: This was a prospective randomized trial of 204 patients who underwent MSICS using viscoelastic-assisted nucleus removal (Group 1- OVD) versus basal salt solution plus technique (Group 2- BSS) at a tertiary eye care hospital in North India from January 2018 to 2021. Of these 204 patients, 103 (50.5%) and 101 (49.5%) were allocated to Group 1 and 2, respectively. The parameters assessed were detailed history, demographics, and anterior and posterior segment details. Visual acuity, intraocular pressure (IOP), keratometry, pachymetry, and endothelial cell density were evaluated preoperatively and postoperatively on day 1 and 30. Results: The mean age of the patients was 64.5 � 8.2 years (range 48� years). There were 129 (63.2%) males and 75 (36.8%) females. The mean LogMAR visual acuity for both groups on day 1 (Group 1- 0.3 � 0.1, Group 2- 0.5 � 0.2) and day 30 (Group 1- 0.1 � 0.2, Group 2- 0.1 � 0.1) was statistically significant (P < 0.001), and the mean IOP value showed a statistically significant value (P < 0.009) on day 1 in Group 2 (15.0 � 2.4 mmHg) and on day 30 (P < 0.001) in both the groups (Group 1- 13.6 � 1.8 mmHg, Group 2- 13.5 � 2 mmHg). The horizontal and vertical k values also showed a statistically significant difference on day 1 and day 30 (P < 0.001). The mean percentage change of central corneal thickness (CCT) in Group 1 was 17.7% and in Group 2 was 17.4% on day 1, and it was 1.1% on day 30 in both the groups, which was statistically significant (P < 0.001) compared to preoperative values. The percentage change in endothelial cell density on day 1 was 9% in Group 1 and 4.6% in Group 2, which was statistically significant (P < 0.001). On day 30, it was 9.7% and 4.8%, respectively, which was statistically significant (P < 0.001). Conclusion: Our study highlights statistically significant endothelial cell loss with viscoelastic-assisted nuclear delivery compared to BSS-assisted nuclear delivery during MSICS in a short follow-up of 1 month. The CCT values showed a slight increase, and the keratometry and IOP were unaffected compared to the preoperative parameters in both the groups

Comparison of corneal endothelial changes following phacoemulsification in diabetic and non-diabetic patients

Purpose: To study corneal endothelial changes post phacoemulsification in diabetic and non?diabetic patients. Methods: A comparative, prospective, observational study was conducted on 100 diabetic and 100 non?diabetics who underwent phacoemulsification. All patients were operated by the same surgeon by using the phaco chop technique to exclude any surgeon?related bias. Endothelial cell count, CCT, and coefficient of variance (CV) were measured with a specular microscope along with BCVA preoperatively and at 1 week, 4 weeks, and 3 months postoperatively. For statistical analysis, data were analyzed by using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA). Data were summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Chi square test, independent sample T test, and paired T test were used to compare the data. P ? 0.05 was considered statistically significant. Results: Postoperatively at 1 week, 4?week, and 3 months follow?up intervals, the mean endothelial cell count and coefficient of variance were significantly higher, and the mean percentage of hexagonal cells was significantly lower in non diabetic as compared to the diabetic group. A significant difference in mean central corneal thickness of the two groups was observed at 1?week and 4?weeks postoperative intervals; at both these intervals, the mean value was significantly higher in non diabetic as compared to the non?diabetic group. However, at 3?months post?operative interval, the difference between the two groups was not significant statistically. Mean BCVA values were significantly higher in diabetic as compared to the diabetic group at all three follow?up intervals. Conclusion: The findings of the present study show that endothelial cell characteristics are adversely affected in diabetic eyes as compared to non?diabetic patients undergoing phacoemulsification; this might also have an effect on the visual outcomes.

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)

A Comparative Study of Corneal Endothelial Cell Count and Central Corneal Thickness in Emmetropia and Axial Myopia

The main attributes of cornea which makes it optically important is its ability to maintain its dehydrated state. This corneal dehydration can be achieved and maintained by various factors among which corneal endothelial cell count and morphology play a significant role. Corneal attributes considered in this study i.e. the corneal endothelial cell count and central corneal thickness are extremely variable, and changes are seen even with smaller changes in anterior segment or overall structural changes in eyes. We wanted to compare central corneal thickness in emmetropia and axial myopia and compare corneal endothelial cell count in emmetropia and axial myopia. METHODSThe sample size was decided taking into consideration various prevalence studies. The patients were consecutively recruited for the study considering the inclusion and exclusion criteria. The subjects were divided into two groups emmetropia and axial myopia and were differentiated on the basis of the axial lengths. Specular microscopy was performed for the subjects and corneal endothelial cell count, morphology and central corneal thickness were measured, and comparative study was performed. RESULTSThis study of 80 eyes shows us that the difference between mean the corneal endothelial cell count between emmetrope (2812.80 cells / mm2) and axial myopes (2653 cells / mm2) is statistically significant where p was < 0.05 while the mean central corneal thickness measurements didn’t show statistically significant change between emmetrope (490.05 microns) and axial myope. (489.37 microns). CONCLUSIONSAxial length has an indirect correlation with the corneal endothelial cell count which is statistically significant. While significant correlation between the central corneal thickness and axial length cannot be established in this study.

Curative efficacy of aspheric intraocular lens implantation after manual nuclear fragmentation in treatment of cataract and its effects on visual acuity / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To study the curative efficacy of aspheric intraocular lens implantation after manual nuclear fragmentation in treatment of cataract and its effects on visual acuity. <p>METHODS: Totally 100 patients of cataract who received therapy from May 2013 to May 2016 in our hospital were selected. According to random number table, those patients were divided into the observation group(50 patients 68 eyes)and the control group(50 patients 67 eyes). The observation group was treated with small incision manual discectomy and aspheric intraocular lens implantation, the control group was treated with phacoemulsification cataract extraction and aspheric intraocular lens implantation, the operation effect of two groups were compared. <p>RESULTS: After operation, the corneal endothelial cell counts of the two groups decreased(<i>P</i><0.05); in the observation group, the results were higher than those of the control group at 1 and 3mo after operation(<i>P</i><0.05). In the observation group, the uncorrected visual acuity at 1mo after operation was better than that of the control group(<i>P</i><0.05); there was no significant difference between the two groups in postoperative visual acuity after operation 3mo(<i>P</i>>0.05). At 1mo after surgery, the corneal astigmatism in the observation group was higher than that of the control group(<i>P</i><0.05); there was no significant difference of corneal astigmatism between the two groups at 3mo after operation(<i>P</i>>0.05). The incidence of intraoperative complications and postoperative complications in the observation group were lower than that of the control group(<i>P</i><0.05). <p>CONCLUSION: Aspheric intraocular lens implantation after manual nuclear fragmentation is well for cataract, which can reduce the damage to corneal endothelial cells, the complications rate is low and the postoperative visual acuity recovered well.

Clinical Outcomes of Nd-YAG Laser Membranotomy in Retained Host Corneal Membrane after Keratoplasty

PURPOSE: To evaluate the clinical efficacy and shortcomings of neodymium-doped yttrium aluminum garnet (Nd-YAG) laser membranotomy in inadvertently retained host membrane. METHODS: Among 742 patients who underwent penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) surgery at Seoul St. Mary's Hospital between January 2007 and May 2013 by a single surgeon, 10 patients had a thin, opaque membrane in the anterior chamber observed under slit lamp examination and both a subjective decrease in visual acuity and decrease i best corrected visual acuity. A single surgeon performed membranotomy using the Nd-YAG laser at 4.9 months after graft surgery. In this study we compared the differences in visual acuity, endothelial cell count and correlations between distance from donor endothelium and retained host membrane and endothelial loss before and after the graft surgery. RESULTS: Patients who had Nd-YAG laser membranotomy performed on the retained host membrane showed significant improvements in visual acuity (p = 0.039). Donor endothelial cell count was significantly reduced 1 month after Nd-YAG laser. The average distance between donor endothelium and retained host membrane was 712.0 +/- 217.5 microm. The distance and the decreased donor endothelial cell count were not statistically correlated (R2 = 0.39, p = 0.072). There were no significant complications after the laser membranotomy. CONCLUSIONS: Inadvertently retained host membrane forms close to the donor endothelium as identified on optical coherence tomography (OCT) images. Nd-YAG laser membranotomy significantly affected clear vision but endothelial cell count loss was also observed.

Safety of intracameral moxifloxacin/dexamethasone fixed-dose formulation on the corneal endothelium in a rabbit model

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin.</p> <p style="text-align: justify;"><strong>METHODS:</strong> This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.</p>

Safety of Intracameral Moxifloxacin/Dexamethasone fixed-dose formulation on the Corneal Endothelium in a rabbit model

Objective@#To determine the safety of intracamerally injected preservative-free 0.5% moxifloxacin/0.1% dexamethasone fixed-dose combination on the corneal endothelium in a rabbit model and compare it to intracamerally injected preservative-free 0.5% moxifloxacin. @*Methods@#This experimental study included twenty eyes from ten albino rabbits. The eyes were assessed for baseline corneal clarity and anterior chamber (AC) inflammation using slit-lamp biomicroscopy. A specular microscope measured the corneal endothelial cell density (ECC) and corneal thickness (CT). Intracameral injections of 0.1 mL 0.5% moxifloxacin ophthalmic solution were administered to the 10 right eyes (IPFM group) and 0.1 mL of 0.5% moxifloxacin/0.1% dexamethasone fixed-dose preparation were administered to the 10 left eyes (IPFMDex group). In both groups, ECC, CT, corneal clarity, and AC inflammation at Day 1 (one day post-injection) and Day 7 (seven days post-injection) were compared with Day 0 (baseline). The IPFMDex group was also compared with the IPFM group at Days 0, 1, and 7. The endothelial cells of harvested corneas from both groups at Day 1 and 7 were stained with trypan blue and alizarin red, and compared for endothelial cell damage (ECD). Data were analyzed using paired and independent sample t-tests.@*Results@#In both the IPFM and IPFMDex groups, ECC and CT at Day 1 (IPFM: ECC p=0.07, CT p=0.76; IPFMDex: ECC p=0.41, CT p=0.94) and Day 7 (IPFM: ECC p=0.95, CT p=0.28; IPFMDex: ECC p=0.29, CT p=0.34) were not different from Day 0 (baseline). No significant difference in ECC, CT, and ECD were found between the IPFM and IPFMDex groups at Day 1 (ECC p=0.82, CT p=0.36, ECD p=0.96) and Day 7 (ECC p=0.95, CT p=0.22, ECD p=0.61). Throughout the study, the cornea in both groups were clear and showed no signs of AC inflammation. @*Conclusion@#Intracameral injection of preservative-free moxifloxacin/dexamethasone fixed-dose formulation was safe on the rabbit corneal endothelium and was no different from preservative-free moxifloxacin.

Endothelial cell study in a case of Werner's syndrome undergoing phacoemulsification and Yettrium-Aluminum-Garnet laser capsulotomy.

Werner's syndrome (WS) is a rare autosomal recessive disorder with multisystem manifestations of premature aging from the second decade of life. Cataract is one of the features of WS. Cataract surgery is complicated with postoperative wound dehiscence and bullous keratopathy when the surgery is done by intracapsular or conventional extracapsular method. We report the short-term result of phacoemulsification and Neodymimum Yettrium-Aluminum-Garnet laser (Nd YAG) capsulotomy in a case of WS with bilateral cataracts. Postoperatively and post capsulotomy, there was no change in the endothelial cell morphology. There was an 8.6% decrease in endothelial cell count at the end of 15 months postoperatively and 11 months post YAG capsulotomy. This decrease is within the acceptable range of cell loss after phacoemulsification and YAG capsulotomy. To the best of our knowledge, this is the first reported case of YAG laser capsulotomy in WS.

Angle-supported intraocular-lens implantation for the correction of moderate to high myopia

Objectives@#This study evaluated the efficacy and safety of an angle-supported phakic intraocular lens (PIOL) for the treatment of moderate to high myopia.@*Methods @#This is a case series of 13 eyes of 8 patients with moderate to high myopia that underwent implantation of an acrylic, angle-supported PIOL. The main outcome measures were manifest refraction, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), endothelial-cell count (ECC), intraocular pressure (IOP), and adverse events.@*Results@#The mean spherical equivalent (SE) improved from –11.79 ± 4.12 diopters (D) preoperatively to –0.08 ± 0.58 D postoperatively (p = 0.000), UCVA from 0.016 ± 0.015 to 0.79 ± 0.29 postoperatively (p = 0.000), and BCVA from 0.76 ± 0.33 to 0.86 ± 0.27 (p = 0.017). The ECC slightly decreased from 3033.57 ± 367.71 cells/mm2 preoperatively to 2947 ± 279.86 cells/mm2 (2.8% loss) postoperatively (p = 0.400). The mean preoperative IOP was 16.36 ± 3.53 mm Hg while the mean three-month postoperative IOP was 15.72 ± 4.15 mm Hg (p = 0.659). Two (15%) eyes experienced transient postoperative IOP rise on the day of the surgery, which resolved by postoperative day 1 using topical timolol maleate. The mean follow-up was 2.54 ± 1.39 months (range, 1 to 5 months).@*Conclusion@#Acrylic angle-supported phakic intraocular lens (PIOL) implantation is an effective and safe method of correcting moderate to high myopia.

Comparison Between Bimanual Microincisional Cataract Surgery and Conventional Coaxial Phacoemulsification

PURPOSE: To evaluate corneal endothelial cell changes after conventional coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). METHODS: Forty patients were divided into 2 groups, coaxial phacoemulsification (Group 1, n=20), and MICS (Group 2, n=20). To evaluate corneal endothelial cell changes after coaxial phacoemulsification and bimanual MICS, intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS(R), Alcon, U.S.A) were measured. Central corneal thickness and endothelial cell count were also evaluated, preoperatively and at 1 week, and 2 months postoperatively. RESULTS: Between the 2 groups, there was no statistically significant difference in intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS(R), Alcon, U.S.A.) (p>0.05). In addition, there was no statistically significant difference between the 2 groups in endothelial cell count and central corneal thickness (p>0.05). CONCLUSIONS: When comparing bimanual MICS and conventional coaxial phacoemulsification, bimanual MICS appears to have similar endothelial cell changes. In conclusion, MICS has the same safety as compared to coaxial phacoemulsification.

Efficacy and Safety of Commerical Used Viscoelastics: Healon(R), Provisc(R), Viscorneal(R), Hyal 2000(R), Biolon(R), Viscoat(R)

Several different viscoelastic substances are widely used in many ophthalmologic fields. In our study, the efficacy and safety of the different kinds of viscoelastics -Healon(R), Provisc(R), Viscorenal(R), Hyal-2000(R), Viscoat(R) and Biolon(R)-was evaluated in undergoing phacoemulsification and posterior intraocular lens implantation, corneal transplantation and ocular trauma surgery. We evaluated and the facility of the injection the foreign materials during injection of viscoelastics through the microscopy. We measured the changes of intraocular pressure at the postoperative 1 day and corneal endothelial cell count at the postoperative 2 month. The mean endothelial cell loss after phacoemulsification and posterior intraocular lens implantation was 13.71% at postoperative 1 day and there was no significantly different among groups. The incidence of the foreign materials including air bubles in viscoelastics in the operating microscope was Provisc(R), Hyal 2000 Viscorneal(R), Biolon(R), Healon(R) in order. The mean incidence of the intraocular pressure above 25 mmHg after cataract surgery at postoperative 1 day was 3.94%and was Hyal 2000(R), Biolon(R), Viscorneal(R), Healon(R), Provisc(R) in order. The incidence of the additional use of the antiglaucoma drugs in keratoplasty patients was 76%in Healon(R) group, 26.7%in Viscoat(R) group, 69.2%in Provisc(R) group respectively. From the results of this report, we conclude that it is desirable to use the proper viscoelastics according to the chemical and physical properties in special situations, but there is no significant difference in the same viscoelastic substance.

The Effect of Extracapsular Cataract Extraction Using Nucleus Dislocation into Anterior Chamber on Corneal Endothelium

The nucleus delivery method using nucleus dislocation into the anterior chamber is more safe and easier to maintain a intact lens capsule than conventional "push and pull" method when the continous circular capsulorhexis(CCC) has been performed. To investigate the effect on the corneal endothelium of nucleus dislocation method, time analysis on the changes of central corneal endothlial cell density(CECD) in two groups-extracapsular cataract extraction(ECCE) using nucleus dislocation into the anterior chamber group and a conventional ECCE group-was studied for two months. The study was performed on 18 eyes of 18 cataract patients who were operated on with ECCE using nucleus dislocation into the anterior chamber method, and 10 eyes of 10 cataract patients who were operated on with the conventional ECCE method. Central corneal endothelial cell density(CECD) was measured using specular microscopy, preoperatively and at 1 month and 2 months of postoperation. The average postoperative endothelial cell loss at 1 month was 7.20 +/- 2.98% in the experimental group and 7.88 +/- 2.93% in the control group, and at 2 months postoperation was 9.05 +/- 2.96% in the experimental group and 9.34 +/- 2.95% in the control group. The change in CECD between the two groups was not statistically significant.

The effect of extracapsular cataract extraction using nucleus dislocation into anterior chamber on the corneal endothelium

When the continuous circular capsulorhexis (CCC) is being performed, the nucleus delivery using nucleus dislocation into the anterior chamber is safer and easier than using conventional "push and pull" method to maintain an intact lens capsule. This method include such procedures that after CCC, the nucleus being freed in the capsular bag by hydrodissection and hydrodelineation, then hooked with a Sinskey hook and drawn out to the anterior chamber by rotation. It may damage the corneal endothelium because of the manipulation in the anterior chamber. To investigate an effect of this method on the corneal endothelium, we performed two months time analysis of changes of the central corneal endothelial cell density (CECD) in two groups--a group with an extracapsular cataract extraction (ECCE) using nucleus dislocation into the anterior chamber and a group with a conventional ECCE. Eighteen eyes of 18 cataract patients who were operated on with ECCE using nucleus dislocation into the anterior chamber method, and ten eyes of 10 cataract patients who were operated on with a conventional ECCE method were included. The CECD was measured by specular microscopy, preoperatively, postoperatively at 1 month and 2 months. The average endothelial cell loss at postoperative 1 month was 7.20 +/- 2.98% in the experimental group and 7.88 +/- 2.93% in the control group, and at postoperative 2 months was 9.05 +/- 2.96% in the experimental group and 9.34 +/- 2.95% in the control group. The change in CECD between two groups was not statistically significant.

The Corneal Endothelial Cell Density in Korean by the Different Types of Specular Microscopy

The normal corneal endothelial cell count was measured by the non-contact(Nikon, AS-1, Japan) and contact type(Bio-optic, LSM 2000, USA) specular microscopy. The results of two types were compared to investigate the possible differences in types of specular microscopy. No statistically significant differences were found between the results from the non-contact type and those from the contact type; the mean number of normal Korean corneal endothelial cells according to the age was 2795 in the 2nd decade, 2615 in the 3rd decade, 2463 in the 4th decade, 2283 in the 5th decade, 2119 in the 6th decade, 2019 in the 7th decade and 1920 over the 8th decade.

Clinical experience of hydrogel soft intraocular lenses

Twenty-six soft intraocular lenses were implanted in twenty-six senile cataract patients from luly 16, 1987, to April 15, 1988 at Kangnam St. Mary's Hospital, Seoul, Korea. The average age of the patients was seventy-six with a range from fifty-five to eight nine years old. Of the twenty-six patients at the 12 months follow up 87.5% have arhieved visual acuity of 20/40 or better. The average central corneal endothelial cell loss at postoperative 7 days and 3 months were 9.8% and 12.3% respectively. Complications were observed in six patients. Two patients had preexisting retinal and optic diseases and one had a fibrinous membrane. Three patients had transient pigmentary precipitates on IOL surface.