Corneal and anterior chamber morphology in patients with noninfectious intraocular inflammation / Morfologia da córnea e da câmara anterior em pacientes com inflamação intraocular não infecciosa

ABSTRACT Purpose: To evaluate the corneal and anterior chamber morphology in phakic eyes with noninfectious intraocular inflammation. Methods: This study included 59 eyes with active uveitis, 62 with inactive uveitis, and 95 healthy eyes. Corneal endothelial cell density, hexagonal cell ratio, coefficient of variation (CV), corneal thickness and volume, maximum keratometry, and anterior chamber volume and depth (ACD) measurements were performed using a specular microscope and Pentacam HR. Results: The mean duration of uveitis was 24.6 ± 40.5 (0-180) months. The mean number of uveitis attacks was 2.8 ± 3.0 (1-20). Coefficient of variation was significantly higher in the active uveitis group compared with inactive uveitis group (p=0.017, Post Hoc Tukey). Anterior segment parameters other than coefficient of variation were not significantly different between active/inactive uveitis and control groups (p>0.05). Multiple linear regression analysis showed that coefficient of variation was greater in active uveitis compared with inactive uveitis after adjusting for the duration of uveitis, type of uveitis, having a rheumatologic disease, and having immunosuppressive treatment (p=0.003). The duration of uveitis and number of attacks were not significantly correlated with ocular parameters (p>0.05, Spearman's correlation). The difference in parameters was not significant based on uveitis type (p>0.05). Conclusions: Coefficient of variation was higher in eyes with active uveitis than that in eyes with inactive uveitis, whereas corneal endothelial cell density and anterior chamber morphology did not significantly differ between active/inactive uveitis and control groups.(AU)

RESUMO Objetivo: Avaliar a morfologia da córnea e da câmara anterior em olhos fácicos com inflamação intraocular não infecciosa. Métodos: Esse estudo incluiu 59 olhos com uveíte ativa, 62 olhos com uveíte inativa e 95 olhos saudáveis. A densidade de células endoteliais da córnea, a proporção de células hexagonais, o coeficiente de variação, o volume e a espessura da córnea, a ceratometria máxima e o volume e profundidade da câmara anterior foram medidos com um microscópio especular e uma Pentacam HR. Resultados: A duração média da uveíte foi de 24,6 ± 40,5 (0-180) meses. O número médio de crises de uveíte foi de 2,8 ± 3,0 (1-20). O coeficiente de variação foi significativamente maior no grupo com uveíte ativa do que no grupo com uveíte inativa (p=0,017, Tukey post-hoc). Não houve diferença significativa nos demais parâmetros do segmento anterior entre os grupos com uveíte ativa, com uveíte inativa e controle (p>0,05). A análise de regressão linear múltipla demonstrou que o coeficiente de variação foi maior na uveíte ativa do que na uveíte inativa, após ajustes para a duração e tipo de uveíte e a presença ou não de doença reumática e de tratamento imunossupressor (p=0,003). A duração da uveíte e o número de crises não demonstraram correlação significativa com os parâmetros oculares (p>0,05, correlação de Spearman). A diferença nos parâmetros não demonstrou correlação significativa com o tipo de uveíte (p>0,05). Conclusões: O coeficiente de variação foi maior nos olhos com uveíte ativa do que naqueles com uveíte inativa, ao passo que a densidade de células endoteliais e a morfologia da câmara anterior não mostraram diferenças significativas entre os grupos com uveíte ativa, com uveíte inativa e controle.(AU)

Optimizing Visualization of Descemet Membrane Endothelial Keratoplasty Tissue: Assessing the Impact of Trypan Blue Exposure on Stain Duration and Corneal Endothelial Cell Function.

PURPOSE: To assess how trypan blue staining affects Descemet membrane endothelial keratoplasty (DMEK) graft visibility and corneal endothelial cell (CEC) mitochondrial respiration. METHODS: DMEK grafts (n = 20) were stained with trypan blue 0.06% for 1, 3, 5, or 10 minutes. Each graft was injected into an artificial anterior chamber. Surgery was simulated with tapping and sweeping motions on the corneal surface and injections of balanced salt solution (BSS). Graft visibility was assessed at 5, 10, 20, and 30 minutes. Effects of trypan blue on mitochondrial respiration were assessed using primary CECs cultured from donor corneas (n = 43). Treatment wells exposed to trypan blue 0.06% (1, 5, or 30 minutes) and donor-matched control wells to methylene blue 1% (1 minute) or BSS (1, 5, or 30 minutes) were assayed for key respiration parameters. RESULTS: After 5 minutes of surgical manipulation, grafts stained for 5 minutes were significantly more visible than grafts stained for 1 or 3 minutes; there was no added benefit of staining for 10 minutes. After 10 minutes of surgical manipulation, grafts stained for 3 minutes were more visible than grafts stained for 1 minute, without additional benefits of staining ≥5 minutes. No visibility differences were observed after ≥20 minutes of surgical manipulation. CEC mitochondrial respiration did not change significantly following trypan blue exposure for all intervals tested compared to BSS. CONCLUSIONS: Staining DMEK grafts with trypan blue for 3 to 5 minutes optimizes visibility during surgical manipulation without mitochondrial impairment. Corneal surgeons learning DMEK will benefit from optimizing this critical step.

In-vivo Three-dimensional Characteristics of Bowman's Layer and Endothelium/Descemet's Complex Using Corneal Microlayer Tomography in Healthy Subjects.

Purpose: To characterize the three-dimensional (3D) thickness profile and age-related changes of Bowman's layer (BL), and endothelium/Descemet's membrane (En/DM) complex among healthy individuals using Corneal Microlayer Tomography (CML-T), and to describe its repeatability and accuracy.Methods: Sixty-six eyes of 41 healthy volunteers; 27 eyes (< 40 years old), and 39 eyes (>40 years old) were imaged using HD-OCT. Automatic and manual segmentation of the corneal layers was performed, and 3D thickness maps were generated, using custom-built CML-T software. A regional analysis of mean thickness parameters between the 2 age groups was performed. A regression analysis was used to assess the correlation between age, and thickness maps. Intraclass Correlation Coefficients (ICC), Coefficients of Variation (COV), and Bland-Altman plots were used to assess the reliability of the repeated measurements in 198 locations.Results: CML-T successfully mapped the BL and En/DM in all included eyes. Thickness maps showed a significant increase in corneal thickness (CT), BL thickness (BMT), and En/DM complex thickness (DMT) toward the periphery with a mean difference 28 µm (p < .001), 1.1 µm (p < .001), and 1.4 µm (p < .001), respectively. There was a strong correlation between age and central DMT (r = 0.61; p < .001), while there was no correlation between age and both CT, and BMT. ICC values ranged from 0.9 (BMT) to 0.997 (DMT), and from 0.808 (BMT) to 0.979 (CT) for intraoperator repeatability of manual measurements, and the accuracy of auto matic measurements, respectively. COV values were lower than 7.5% in all cases.Conclusion: CML-T is a novel tool that can generate 3D-thickness maps of both BL and En/DM. CT, BMT, and DMT increase toward the periphery in healthy corneas. DMT increases with aging, while BMT does not. We also report excellent repeatability, accuracy and good agreement between automatic and manual measurements.

'Acute-angled bevel' sign to assess donor lenticule orientation in ultra-thin descemet stripping automated endothelial keratoplasty.

A 6.5-year-old boy with congenital hereditary endothelial dystrophy underwent clear corneal ultra-thin descemet stripping automated endothelial keratoplasty (DSAEK). After graft insertion, it was difficult to assess graft orientation due to hazy cornea. Intraoperative optical coherence tomography (iOCT) showed a well-attached graft and the bevelled edge of donor lenticule made an acute angle with the overlying stroma. Postoperative anterior segment OCT confirmed the presence of acute-angled bevel sign. A wetlab experiment was performed with experimental corneoscleral tissues to confirm the findings. Donor lenticule was injected in the artificial chamber with stromal-side up as well as stromal side-down. 'Acute-angled bevel sign' was observed on iOCT in the experimental cases with stromal-side up. In inverse graft, the acute-angled bevel was not observed, instead the configuration was obtuse angled. Identifying the 'acute-angled bevel sign' on iOCT confirms correct graft orientation after unfolding and is extremely useful for hazy corneas and ultrathin DSAEK lenticules.

Corneal thickness, endothelial cell density, and morphological and morphometric features of corneal endothelial cells in goats.

OBJECTIVE To determine corneal thickness (CT), endothelial cell density (ECD), and morphological and morphometric features of caprine eyes and to assess effects of aging on these variables. SAMPLE 27 healthy eyes of 19 Murciano-Granadina goats. PROCEDURES Goats were classified into 2 age groups (kids, 14 months old [14 eyes]; and adults, 7 to 10 years old [13 eyes]). The ECD and CT were calculated in the central cornea and 4 peripheral quadrants. Mean cell area (MCA), pleomorphism (percentage of hexagonal cells), and polymegathism were evaluated in the central cornea. RESULTS Median values for kids were determined for ECD (3,831 cells/mm2; inter-quartile [25th to 75th percentile] range [IQR], 3,669 to 4,011 cells/mm2), CT (608 µm; IQR, 573 to 655 µm), MCA (255 µm2; IQR, 243 to 272 µm2), pleomorphism (80.53%; IQR, 78.83% to 83.30%), and polymegathism (19; IQR, 18 to 22). Median values for adults were determined for ECD (2,101 cells/mm2; IQR, 1,966 to 2,251 cells/mm2), CT (706 µm; IQR, 670 to 730 µm), MCA (466 µm2; IQR, 425 to 507 µm2), pleomorphism (67.80%; IQR, 65.50% to 70.00%), and polymegathism (21; IQR, 15 to 26). Values differed significantly between the 2 groups for all variables, except polymegathism. For both groups, the dorsal and temporal quadrants were the thickest and thinnest, respectively. Ventral ECD was the lowest for both groups. CONCLUSIONS AND CLINICAL RELEVANCE ECD decreased with age, whereas MCA, pleomorphism, and CT increased. Moreover, differences among regions of the cornea indicated that the central cornea should not be considered as representative of the entire cornea.

Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty Grafts With Endothelium Tri-Folded Inwards.

PURPOSE: To evaluate the initial outcomes and complications of Descemet membrane endothelial keratoplasty (DMEK) using donor tissues tri-folded with the endothelium inwards, preloaded at the Eye Bank, and delivered with bimanual pull-through technique. DESIGN: Prospective, noncomparative, interventional case series. METHODS: Setting: Eye bank and tertiary care eye department. PATIENT POPULATION: Forty-six consecutive eyes of 41 patients with Fuchs endothelial dystrophy with or without cataract operated between November 2016 and March 2017. INTERVENTION: DMEK tissues prepared with SCUBA technique and punched to a diameter of 8.25 mm were preloaded with the endothelium tri-folded inwards in an intraocular lens (IOL) cartridge with a 2.2-mm opening filled with the same tissue culture medium contained in the vial used for shipment to the surgeon. Standardized DMEK was performed as a single procedure (n = 15) or in combination with phacoemulsification and IOL implantation (n = 31) within 48 hours from preparation using a bimanual pull-through technique. MAIN OUTCOME MEASURES: Preparation and surgical times, intraoperative and postoperative complications, best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and graft detachment rate. RESULTS: Preparation time averaged 26.2 ± 4.1 minutes (range 17-36 minutes), while the surgical time from opening of the stoppers to air fill of the anterior chamber never exceeded 9 minutes (range 3-9 minutes). Surgery was uneventful in all cases. Postoperative complications included graft detachment in 9 of 46 cases (19.6%), successfully managed in all cases by single rebubbling within 6 days from surgery, and glaucoma irresponsive to conservative treatment in 1 of 46 cases (2.1%). In all eyes without comorbidities (35 of 40 eyes) BSCVA was 20/25 (0.097 logMAR) or better as early as 3 months after surgery. Six months postoperatively, ECD was available in 24 of 25 eyes with an endothelial cell loss calculated as a percentage of the preoperative value determined at the eye bank (ranging from 2500 to 2800 cells/mm2) of 29.5% ± 14.8% (range 8.3%-52.1%). CONCLUSIONS: Delivering a preloaded DMEK tissue, tri-folded with the endothelium inwards, minimizes surgical time and costs without negatively affecting the outcomes of the procedure.

Endothelium-in Versus Endothelium-out Insertion With Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To determine whether graft orientation during insertion affects Descemet membrane endothelial keratoplasty (DMEK) outcomes. METHODS: This was a retrospective analysis of 754 consecutive DMEK cases performed by 2 experienced surgeons to treat Fuchs dystrophy. Both surgeons used an intraocular lens insertor. One surgeon always inserted the tissue scrolled endothelium outward (group 1, n = 245). The other surgeon tested 3 methods: endothelium-outward scroll configuration (group 2, n = 161), endothelium-inward trifold configuration (group 3, n = 172), and trifold configuration with concurrent use of an anterior chamber maintainer (group 4, n = 176). The main outcome measures were rebubbling rate, regrafting or failure within 6 months, and 6-month endothelial cell loss. The tissue unfolding time from graft insertion to air fill was measured in a subset of 120 cases by 1 surgeon. RESULTS: The rebubbling rates were comparable across groups (ie, 12%, 10%, 10%, and 13% for groups 1, 2, 3, and 4, respectively, P = 0.21). The 6-month graft failure/replacement rates were comparable across groups (ie, 0.8%, 1.2%, 2.3%, and 0.6%, respectively, P = 0.18). Similarly, the 6-month endothelial cell loss did not differ significantly between groups (ie, 28% ± 11%, 30% ± 13%, 28% ± 15%, and 27% ± 13%, respectively, P = 0.019). In the subset analysis, the tissue unfolding time was similar for scroll and trifold configurations (6.0 ± 3.5 vs. 5.4 ± 3.0 minutes, respectively, P = 0.43). CONCLUSIONS: The outcomes were similar for endothelium-out and endothelium-in (trifold) insertion methods with DMEK, suggesting that the choice is a matter of surgeon preference.

Morphological description of limbal epithelium: searching for stem cells crypts in the dog, cat, pig, cow, sheep and horse.

The cornea provides protection and transparency to the eye, allowing an optimal sharpness view. In some pathological conditions the cornea is able to regenerate thanks to the presence of a stem cells reservoir present at the level of the transition area between cornea and sclera (limbus). Corneal cell therapies in Veterinary Medicine are really limited due to the lacking of knowledge about the anatomy of the limbal area, the putative presence of stem cells and their identification in domestic species. The aim of this study was to provide an overview of the main distinctive structural features of the sclero-corneal junction and conjunctival-corneal junction areas in some species of veterinary importance, using optic microscope observations of histological sections. The resulting data were compared with cornea from humans adapting protocols already used to identify stem cells by means of a specific cellular marker. We tested the expression of ΔNp63α isoform in the cornea basal cells, trying to correlate the distribution profile with areas of highly proliferative turnover. The results obtained from this study represent a first step towards the identification of a corneal stem cells reservoir in different animals.

Lente intraocular fáquica plegable acrílica de apoyo angular para la corrección de miopía: seguimiento de 5 años / An angle-supported foldable phakic intraocular lens for correction of myopia: A five-year follow-up

OBJETIVO: Evaluar la eficacia y la seguridad de una lente intraocular (LIO) fáquica plegable de apoyo angular para la corrección de miopía de grado moderado-alto tras 5 años de seguimiento. MÉTODOS: Análisis prospectivo y retrospectivo, observacional, longitudinal, no aleatorizado de una serie casos que incluye un total de 100 ojos de 67 pacientes con miopía moderada-alta implantados con una LIO fáquica Acrysof Cachet (Alcon Laboratories Inc.) con el objetivo de minimizar el error refractivo. El rango de edad comprende de 18 a 60 años. La agudeza visual sin corrección de lejos (AVsc), la refracción manifiesta, la agudeza visual con corrección de lejos (AVcc), la densidad de células endoteliales, la posición de la LIO fáquica, la presión intraocular y las complicaciones detectadas fueron registradas antes de la operación y durante los 5 años de seguimiento. RESULTADOS: Cinco años después de la implantación la refracción manifiesta media se redujo de forma significativa de un equivalente esférico de −11,62 ± 3,35 dioptrías (D) a −0,33 ± 0,85 D. La AVsc fue de 20/20 o mejor en 5 de los 25 casos (20%) y 20/40 o mejor en 22 casos (88%). La AVcc fue de 20/20 o mejor en 17 casos (68%) y 20/32 o mejor en 23 casos (92% de los ojos). El error refractivo residual presentaba un valor entre ± 0,50 D y emetropía en 12 casos (48%) y entre ± 1,00 D en 19 casos (76%). La media de pérdida de células endoteliales en los 5 años fue del 11,8% en la región central y del 13,7% en la periferia. La distancia media entre endotelio-LIO fáquica fue de 2,11 ± 0,18 mm y la distancia media LIO fáquica-cristalino, de 0,88 ± 0,20 mm. CONCLUSIONES: Esta LIO fáquica de apoyo angular proporciona una corrección refractiva y una predictibilidad favorables, así como una seguridad aceptable en pacientes con un grado de miopía moderado-alto. A pesar de que la densidad de células endoteliales disminuyó durante los 5 años de seguimiento, los resultados están dentro del rango reportado en estudios anteriores con otras LIO fáquicas

OBJECTIVE: To evaluate the efficacy and safety of an angle-supported foldable phakic intraocular lens (pIOL) for the correction of moderate to high myopia after 5 years follow-up. METHODS: Prospective and retrospective, observational, longitudinal, non-randomised consecutive series of cases conducted on a total of 100 eyes of 67 patients with moderate to high myopia implanted with an Acrysof Cachet pIOL (Alcon Laboratories Inc.) with the aim of minimising the refractive error. The ages ranged between 18 to 60 years. Uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), endothelial cells density, pIOL position, intraocular pressure, and complications were recorded preoperatively and during the 5 year follow-up. RESULTS: Five years after implantation, the mean manifest spherical equivalent refraction reduced significantly from −11.62 ± 3.35 dioptres (D) to −0.33 ± 0.85 D. UDVA was 20/20 or better in 5 of 25 cases (20%), and 20/40 or better in 22 cases (88%). CDVA was 20/20 or better in 17 cases (68%), and 20/32 or better in 23 cases (92%) of eyes. The residual refractive error was within ± 0.50 D of emmetropia in 12 cases (48%), and within ± 1.00 D in 19 cases (76%). Mean endothelial cell loss at 5 years was 11.8% central, and 13.7% peripheral. Mean endotheliumpIOL distance was 2.11 ± 0.18 mm, and mean pIOL-crystalline distance was 0.88 ± 0.20 mm. CONCLUSIONS: This angle supported pIOL provided a favourable refractive correction and predictability, as well as acceptable safety in patients with moderate to high myopia. Although endothelial cell density decreased over 5 years, the results are within the range reported in previous studies with other pIOLs

Measurements of central corneal thickness and endothelial parameters with three different non-contact specular microscopy devices.

We aimed to compare the measurements of central corneal thickness (CCT) and endothelial parameters with three different non-contact specular microscopy (SM) devices. Fifteen eyes of 15 healthy individuals (6 males; 9 females) were enrolled in the study. Mean age was 37.93 ± 15.13 years. Endothelial parameters and CCT were measured with Nidek CEM-530, Topcon SP-3000P, and Tomey EM-3000 SM devices by the same physician. Endothelial parameters included endothelial cell count (ECC), maximum, minimum, and average endothelial cell size. and hexagonality ratio. There were no statistically significant differences in ECC, CTT, and average endothelial size (AES) between the devices (p > 0.05). The measurement of maximum endothelial size (MES) was different between Nidek SM and Topcon SM devices (p = 0.001), but there was no difference in MES between Nidek SM and Tomey SM (p = 0.058), and between Topcon SM and Tomey SM (p = 0.081). There was no difference in minimum endothelial size (MinES) between Nidek SM and Topcon SM (p = 0.794); however, there was a significant difference in MinES between Tomey SM and Nidek SM (p < 0.001), and between Tomey SM and Topcon SM (p < 0.001). Comparison of hexagonality ratio showed statistically significant difference between the devices (p < 0.001). No significant differences in the measurements of ECC, CCT, and AES were detected between different SM devices, whereas a statistically significant difference in hexagonality ratio was detected between the devices. These devices should not be used alternatively in the endothelial morphology assessment in patient's follow-up.

The effect and safety of intravitreal injection of ranibizumab and bevacizumab on the corneal endothelium in the treatment of diabetic macular edema.

OBJECTIVE: To investigate the effect and safety of intravitreal injection (IVI) of bevacizumab and ranibizumab on corneal endothelial cell count and morphology in patients with diabetic macular edema. MATERIALS AND METHODS: A total of 60 eyes from 60 consecutive patients who received 0.5 mg/0.05 ml IVIs of bevacizumab (n = 30, IVB group) or 1.25 mg/0.05 ml ranibizumab (n = 30, IVR group) for three consecutive months were investigated prospectively. Specular microscopy was performed to evaluate endothelial cell count, the percentage of hexagonal cells (pleomorphism), and the coefficient of variation of the cell size (polymegathism); optical biometry was performed to evaluate central corneal thickness. Results before injection and 1 month after the first and third injections were compared. RESULTS: The groups were matched for age (p = 0.11) and gender (p = 0.32). There was no significant difference in endothelial cell count (IVB group, p = 0.66; IVR group, p = 0.74), pleomorphism (IVB group, p = 0.44; IVR group, p = 0.88) and polymegathism (IVB group, p = 0.21; IVR group, p = 0.24) before injection or 1 month after the first and third injections. There was also no difference in central corneal thickness (IVB group, p = 0.15; IVR group, p = 0.58) before injection or 1 month after the first and third injections. CONCLUSION: Monthly 1.25 mg/0.05 ml IVIs of bevacizumab or 0.5 mg/0.05 ml of ranibizumab for three consecutive months in the treatment of diabetic macular edema does not affect corneal morphology and has no harmful effects on the endothelium.

In Vivo Measurement of Human Corneal Impedance Value.

PURPOSE: To examine the validity of in vivo electrical corneal resistance (CR) measurements taken by a corneal resistance device (CRD). METHODS: Eighty-two eyes (mean age ± SD, 50.1 ± 23.3; range, 22-87 years: 50 eyes of 33 males and 32 eyes of 17 females) of patients who had undergone cataract surgery and volunteers at the Kanazawa Medical University Hospital were enrolled. The CR was compared among gender; age; side, that is, left versus right eye; healthy (fluorescein-negative) versus epithelium-injured eyes (fluorescein-positive), corneal radius of curvature; corneal endothelial cell count; and corneal thickness. RESULTS: The mean ± SD of the CR in the 82 eyes was 273.2 ± 78.2 Ω. By age group, the mean ± SD CR was 283.3 ± 87.4 Ω (30 eyes) in the 20s, 275.0 ± 50.0 Ω (4 eyes) in the 30s, 266.7 ± 70.7 Ω (9 eyes) in the 40s, 257.1 ± 53.5 Ω (7 eyes) in the 50s, 242.9 ± 78.7 Ω (7 eyes) in the 60s, 266.7 ± 84.0 Ω (18 eyes) in the 70s, and 300.0 ± 81.6 Ω (7 eyes) in the 80s, with no significant difference among the groups. By gender, the mean ± SD CR was 270.0 ± 83.0 Ω (50 eyes) in males and 278.0 ± 71.0 Ω (32 eyes) in females. By side, the CR values were 282.9 ± 83.4 Ω (44 eyes) in the right eye, 265.9 ± 71.3 Ω (41 eyes) in the left eye, with no significant difference among the groups. By status, the values were 280.0 ± 70.0 Ω (44 eyes) in healthy eyes and 200.0 ± 144.2 Ω (13 eyes) in injured eyes, with a significant between-group difference (P = 0.009). The mean ± SD corneal thickness (0.56 ± 0.03 mm) in 46 healthy eyes was slightly correlated with the CR. CONCLUSIONS: The CRD quantitatively measured the CR in healthy eyes. The CR did not differ significantly by age, gender, or left versus right eye. The significant difference in CR between the healthy and injured eyes showed that the measurements have validity.

Two cases of ultrathin Descemet stripping automated endothelial keratoplasty utilizing a graft that had undergone radial keratotomy.

This is a report of two cases in which tissue that had undergone radial keratotomy (RK) was utilized for double-pass ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). Postoperative slit-lamp examination, visual acuity, anterior segment optical coherence tomography, and specular microscopy were available 30 months after surgery. Both corneas from a donor, who had undergone RK several years before his demise, and were otherwise suitable for endothelial keratoplasty were prepared for UT-DSAEK using double-pass dissection using first a 300 mm microkeratome head and then a 130µm microkeratome head (ALTK system, Moria, Antony, France). After the second cut, the tissue was punched to 9.0 mm and transplanted in two eyes with endothelial decompensation according to standard technique. As early as 3 months after surgery, both patients had 20/25 best-corrected visual acuity, which remained stable for the following 27 months. Postoperative endothelial cell loss was 34% and 57% at 2.5 years. In conclusion, post-RK donor tissue can be used for UT-DSAEK.

Evaluation of Total Corneal Thickness and Corneal Layers With Spectral-Domain Optical Coherence Tomography.

PURPOSE: To evaluate total corneal thickness and corneal layers in healthy young adults using spectral-domain optical coherence tomography and to describe its repeatability and reproducibility. METHODS: Eighty-six eyes from 86 healthy volunteers were prospectively and consecutively enrolled. Manual measurements of central corneal thickness (CCT) and central thickness of epithelium, Bowman's layer, stroma, and the Descemet-endothelium complex were performed using Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). To assess the reliability of the repeated measurements, intraclass correlation coefficients and coefficients of variation were used. RESULTS: Mean CCT, epithelium, Bowman's layer, stroma, and Descemet-endothelium values were 555.50 ± 29.64, 54.60 ± 4.25, 16.70 ± 1.73, 467.51 ± 28.91, and 16.74 ± 1.66 µm, respectively. The intraclass correlation coefficients ranged from 0.746 (Bowman's layer) to 0.999 (CCT and stroma) and from 0.483 (Bowman's layer) to 0.995 (CCT) and 0.998 (stroma) for intraobserver repeatability and interobserver reproducibility, respectively. The measurements showed coefficients of variation lower than 11% in all cases. CONCLUSIONS: This study establishes a normal database for corneal thickness and all its layers in healthy young adults with spectral-domain optical coherence tomography. This device exhibited a high degree of intraobserver repeatability and interobserver reproducibility for all regions except Bowman's layer.

Effects of age and breed on corneal thickness, density, and morphology of corneal endothelial cells in enucleated sheep eyes.

OBJECTIVE: The purpose of the study was to determine corneal thickness (CT), endothelial cell density (ECD), morphology, and morphometry in ovine eyes, and to report the effects of age and breed on these parameters. ANIMALS STUDIED AND PROCEDURES: Forty-eight healthy ovine eyes were classified into six groups (eight eyes per group) according to animals' age (lambs and adults) and breed (Manchega, Ripollesa, and Rasa Aragonesa). Endothelial cell density (cells/mm(2) ) and CT (µm) were calculated in the central cornea and four peripheral quadrants by means of specular microscopy. Mean cell area (MCA (µm(2) )), pleomorphism (% hexagonal cells), and polymegethism (CV) were evaluated in the central cornea. Statistics consisted of an ANOVA model and a LSD test for the post hoc analysis. RESULTS: Results in lambs were as follows: ECD = 3532 ± 259, CT = 699 ± 56, MCA = 283 ± 22, % hexagonal cells = 75.64 ± 3.09, and CV = 18 ± 8.4; and in adults: ECD = 2204 ± 261, CT = 804 ± 87, MCA = 473 ± 53, % hexagonal cells = 69.9 ± 3.42, and CV = 18.1 ± 5.2. There were differences (P < 0.001) in all parameters studied between both groups except for the CV (P = 0.962). Regarding the breed, Rasa Aragonesa presented a higher CT (P = 0.001) and CV (P = 0.04) compared to other breeds. Mean values of all groups together showed that central and dorsal areas of the cornea were the thickest, whereas temporal quadrant was the thinnest (P < 0.001). CONCLUSIONS: This study demonstrates that age and breed influence corneal and endothelial parameters in sheep.

Changes in Central Corneal Thickness and Endothelial Cell Count Following Pediatric Cataract Surgery.

OBJECTIVE: To evaluate the mean changes in Central Corneal Thickness (CCT) and Endothelial Cell Count (ECC) in eyes after pediatric cataract surgery with foldable intraocular lens using scleral tunnel incision micro-surgical technique. STUDY DESIGN: Qausi experimental study. PLACE AND DURATION OF STUDY: Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, from May 2011 to March 2012. METHODOLOGY: Fifty-two eyes of 37 children with pediatric cataract were included in the study. Extracapsular Cataract Extraction (ECE) with foldable Intra Ocular Lens (IOL) implantation using sclera tunnel incision was performed in all children. Endothelial Cell Count (ECC) and Central Corneal Thickness (CCT) were recorded before surgery and 1 month, 3 months and 6 months after surgery and the effect of currently practiced surgical technique on ECC and CCT was evaluated. RESULTS: The mean age at the time of surgery was 8.8 ±2.7 years (range: 4 to 15 years). The postoperative ECC and CCT were significantly different from the pre-operative values. Mean pre-operative ECC was 3175.3 ±218.4 cell/mm2 and in first postoperative month the mean ECC was 3113.4 ±210.8 cell/mm2(p<0.0001). In the 3rd and 6th month postoperative means ECC were 3052 ±202.5 cell/mm2(p<0.0001) and 3015 ±190.6 cell/mm2(p<0.0001), respectively. The mean cell loss at first postoperative month was 1.95% and at 3rd and 6th postoperative month were 3.9% and 5.05%, respectively. Mean pre-operative CCT was 514 ±49.9 µm and first postoperative mean CCT after 1 month was 524.1 ±25 µm (p = 0.084). After the 3rd and 6th months postoperative, mean CCT were 527.3 ±24.6 µm, and 530 ±24.5 µm, respectively. Third and 6th months postoperative means were significantly higher than baseline CCT, p = 0.024 and 0.007, respectively. CONCLUSION: Endothelial cell loss with closed chamber micro-surgical technique using scleral tunnel incision is within acceptable limits and within the range of normal ECC in children.

Assessment of the Accuracy and Cut-Failure Rates of Eye Bank-Cut Corneas for Use in Endothelial Keratoplasty: A Comparison of Outcomes Between 2010 and 2013.

PURPOSE: To evaluate the accuracy of eye bank-prepared precut donor corneas over time by comparing cut-failure rates and corneal thickness measurements in 2010 and 2013. METHODS: A total of 2511 human corneas cut by a technician-operated mechanical microkeratome intended for endothelial keratoplasty were evaluated prospectively at one large eye bank facility in 2010 and in 2013. The endothelium was evaluated by slit lamp, and specular microscopy both before and after cutting was performed. Graft thickness as measured by pachymetry and/or optical coherence tomography was collected to assess the accuracy of the cut tissue. Cut-failure rates were compared between normal donor tissue and tissue with significant preexisting scarring. RESULTS: The combined cut-failure rate in 2010 and 2013 was 2.3% (23/1000) and 1.6% (24/1511), respectively (P = 0.23). The cut-failure rate among normal tissue in 2010 and 2013 was 2.0% (19/927) and 1.4% (19/1400), respectively (P = 0.24). The cut-failure rate among previously scarred tissue in 2010 and 2013 was 5.5% (4/73) and 4.5% (5/111), respectively (P = 0.74). The mean surgeon-requested graft thickness was 144.7 µm (range 100-150, SD 13.6) and 127.2 µm (range 75-150, SD 25.2) in 2010 and 2013, respectively (P < 0.0001). The mean deviation from target graft thickness was 21.3 µm (SD 16.3) and 13.6 µm (SD 12.5) in 2010 and 2013, respectively (P < 0.0001). CONCLUSIONS: From 2010 to 2013, the combined cut-failure rates trended toward improvement, while the accuracy of graft thickness improved. This study suggests that the accuracy and success rates of tissue preparation for endothelial keratoplasty improve with experience and volume.

Double-Ring Sign to Confirm Correct Orientation of Donor Lenticules During Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To describe a sign that can confirm the correct position of donor lenticules during Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: In this clinical and laboratory study, DSAEK was performed in 3 eyes with a diagnosis of pseudophakic bullous keratopathy. Additionally, 2 whole globes and 2 precut corneoscleral buttons were procured for the purpose of the laboratory part of the study. After removal of recipient Descemet membrane, the donor graft was inserted into the anterior chamber, unfolded, and attached to the posterior corneal stroma with an air bubble. A similar procedure was performed in the eye-bank eyes with lenticules attached in both correct and upside-down orientations. RESULTS: After the anterior chamber was completely filled with air, 2 or more concentric shiny rings were formed at the border of the donor lenticule because of total internal reflection in the graft. In the live and eye-bank eyes with a donor graft attached in the correct orientation, the innermost shiny ring, indicating the stromal side of the graft, was observed under the recipient cornea, whereas the outermost ring, indicating the endothelial side, was formed deeper. When the donor lenticule was intentionally implanted upside down in the eye-bank eyes, the reverse situation occurred, and the largest ring was observed just beneath the recipient cornea. CONCLUSIONS: The correct anterior-posterior orientation of the donor lenticule during DSAEK could be identified by the shiny rings formed at the border of the graft after the anterior chamber was completely filled with air.

Development of a nomogram to achieve ultrathin donor corneal disks for Descemet-stripping automated endothelial keratoplasty.

PURPOSE: To report the predictability of a nomogram for ultrathin donor lamella creation for Descemet-stripping automated endothelial keratoplasty (DSAEK) with an automated microkeratome. SETTING: Instituto de Oftalmología La Arruzafa, Córdoba, Spain. DESIGN: Prospective nonrandomized consecutive case series. METHODS: This study enrolled eyes of consecutive patients in which DSAEK was performed to treat Fuchs dystrophy or bullous keratopathy. Patients with macular pathology or other vision-limiting pathology were included. The same surgeon performed all surgeries using an automated keratome (Amadeus II) linked to an artificial anterior chamber. The target donor lamella thickness was from 70 to 120 µm based on a nomogram that incorporates advancement speed, blade holder size, and corneal thickness. The decimal corrected distance visual acuity (CDVA) at 3 months postoperatively, graft thickness at 1 month, and complications were recorded. RESULTS: Fifty-one patients (60 eyes) were enrolled. One month postoperatively, the mean donor lamella thickness was 99.33 µm ± 16.97 (SD) (range 67 to 130 µm). The target thickness range was achieved in 96.66% of cases (58 eyes). In 32 patients with a potential visual acuity of 20/20, the mean postoperative CDVA was 0.80 ± 0.16 (range 0.55 to 1.20). There were no complications during flap preparation, intraoperatively, or postoperatively and no events caused donor corneal tissue to be discarded. CONCLUSIONS: The use of a nomogram with an automated microkeratome for DSAEK provided good visual outcomes with a thin donor lamella (≤120 µm). The outcomes with the nomogram were similar to those reported for Descemet membrane endothelial keratoplasty. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Estudio generacional en familias con distrofia corneal endotelial de Fuchs / Generational study conducted in families with Fuchs' endotelial corneal dystrophy

Objetivos: identificar la presencia de rasgos clínicos de distrofia corneal endotelial de Fuchs en familiares de pacientes con este diagnóstico. Métodos: se realizó un estudio observacional, descriptivo y transversal de 15 familias trigeneracionales de pacientes con distrofia corneal endotelial de Fuchs, captados en consulta de córnea del Instituto cubano de Oftalmología Ramón Pando Ferrer del año 2008 al 2011. La muestra quedó constituida por un total de 78 pacientes. Se utilizaron planillas de recolección de datos para estudiar las siguientes variables de interés: gutas corneales según grados, clasificación clínica, edad, sexo y grado de parentesco según árbol genealógico familiar. Se resumieron las variables cualitativas utilizando frecuencias absolutas y relativas porcentuales. Resultados: del total de descendientes directos, el 44,1 por ciento presentó gutas en su córnea. El 34,6 por ciento de los pacientes estudiados presentaron la enfermedad y el 23,1 por ciento córnea guttata. La distrofia y la córnea guttata se constataron más en el sexo femenino, con mayor incidencia en mayores de 60 años para los primeros. Los descendientes del primer nivel evidenciaron más afectación corneal que los de segundo nivel, con el 75,9 y el 23,5 por ciento respectivamente. Todas las familias presentaron miembros afectados en su descendencia. Conclusiones: la mayor parte de las familias de pacientes con distrofia corneal endotelial de Fuchs presentan cambios endoteliales en las córneas, por lo que estas deben ser incluidas en el estudio con fines diagnósticos y preventivos(AU)

Objective: to identify clinical features of Fuchs' endothelial corneal dystrophy in relatives of patients with this diagnosis.Methods: bservational, descriptive and transversal study of 15 three- generation families of those patients with Fuchs' endothelial corneal dystrophy who went to the cornea consultation of the "Ramón Pando Ferrer", Cuban Institute of Ophthalmology from 2008 to 2011. The sample was made up of 78 patients. Data collection forms were used to study the following variables of interest: Cornea Guttata by degree, clinical classification, age, sex and degree of relationship as family tree. Qualitative variables were summarized using percentage absolute and relative frequencies. Results: of the total number of direct descendants, 44,1 % had cornea guttata; 34,6 percent of the patients presented with Fuchs' endothelial corneal dystrophy and 23,1 percent of them had cornea guttata. Dystrophy and cornea guttata were found more frequently in females, with the highest incidence of the former in patients over 60 years. First degree descendants showed more corneal involvement than the second degree ones (75,9 and 23,5 percent, respectively). All the families had offspring affected by the disease.Conclusions: most of the members of the families suffered corneal endothelial changes, so they should be included in the study for diagnostic and preventive purposes(AU)