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1.
Int Ophthalmol ; 44(1): 169, 2024 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-38587565

RESUMEN

PURPOSE: To evaluate long-term postoperative corneal changes after phacoemulsification cataract surgery. METHODS: Twenty patients who participated in a previous study regarding corneal endothelial changes after phacoemulsification cataract surgery were examined after 7 years. The patients were divided in three groups based on their initial increase in central corneal thickness day one after the surgery: < 5% increase, 6-20% increase and ≥ 20% increase. The primary outcome measures were corneal endothelial cell loss (ECL), endothelial cell count (ECC) and endothelial morphology. RESULTS: After 7 years, a difference in cell loss between the groups was observed, except for groups 1 and 2. Endothelial cell count (ECC) differed significantly between groups 1 and 3 at 3 months. At 7 years, there was no difference in ECC between the three groups. Cell loss was found exclusively in group 1 between 3 months and 7 years. Endothelial cell morphology showed a converging pattern between 3 months and 7 years. CONCLUSION: After phacoemulsification cataract surgery, long-term ECC and morphology appear to converge towards a comparable steady state regardless of initial corneal swelling and endothelial cell loss.


Asunto(s)
Extracción de Catarata , Catarata , Facoemulsificación , Humanos , Facoemulsificación/efectos adversos , Endotelio Corneal , Córnea
2.
Cutan Ocul Toxicol ; 40(4): 332-337, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34342246

RESUMEN

PURPOSE: In the present clinical study, it was aimed to investigate the possible effects of Trypan blue (TB) use on the corneal endothelium during cataract surgery in eyes with pseudoexfoliation syndrome (PEX) during a three-month follow-up period using the contralateral eye control design. METHODS: This prospective, randomised controlled, individual cohort study included 92 eyes of 46 patients with bilateral PEX and cataracts. While 1% TB was applied to one eye of the patients before capsulorhexis (study group), it was not applied to the other eye (control group). Both groups were compared preoperatively and postoperatively in terms of endothelial cell density (ECD), endothelial cell loss (%), pleomorphism, polymegathism and central corneal thickness (CCT) using specular microscopy. RESULTS: Preoperative corneal ECD was measured as 2362.56 ± 253.27 in the study group, 2380.84 ± 220.54 in the control group, and 2145.58 ± 221.71 in the study group and 2184.97 ± 200.94 cells/mm2 in the control group in the postoperative 3rd-month follow-up (p = 0.71 and = 0.37, respectively). In addition, there were no significant differences between the two groups in terms of the percentage of hexagonal cells, coefficient of variation (CV), and CCT both preoperatively and postoperatively 3 months later (p = 0.78, =0.39, =0.95 preoperatively and p = 0.31, =0.26, =0.83 postoperatively, respectively). CONCLUSION: This study demonstrated that the injection of 1% TB into the anterior chamber for staining the anterior capsule during cataract surgery did not cause significant corneal endothelial changes at postoperative 3rd months, despite the increased fragility of corneal endothelial cells in patients with PEX.


Asunto(s)
Extracción de Catarata/efectos adversos , Catarata/patología , Endotelio Corneal/efectos de los fármacos , Síndrome de Exfoliación/cirugía , Azul de Tripano/efectos adversos , Adulto , Catarata/etiología , Extracción de Catarata/métodos , Endotelio Corneal/patología , Síndrome de Exfoliación/complicaciones , Síndrome de Exfoliación/patología , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraoculares , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Azul de Tripano/administración & dosificación
3.
Zhonghua Yan Ke Za Zhi ; 56(2): 126-130, 2020 Feb 11.
Artículo en Zh | MEDLINE | ID: mdl-32074823

RESUMEN

Objective: To discuss the efficacy and security of double-incision extracapsular cataract extraction (ECCE) in the treatment of hard-nucleus cataract with low corneal endothelial cell density. Methods: This was a retrospective case series study. Forty-six patients (47 eyes) with hard-nucleus cataract and low corneal endothelial cell density were enrolled at Shandong Eye Hospital from June 2009 to December 2018, including 22 males and 24 females, aged 50 to 74 (63.8±6.3) years. Preoperative corneal endothelial cell density was less than 1 000 cells/mm(2), and the cataract nuclear hardness was equal to or greater than grade IV. According to the surgical methods, the patients were divided into the single-incision ECCE group (24 eyes) and the double-incision ECCE group (23 eyes). The surgical procedures for the double-incision group were as follows. First, a superior scleral pre-incision was made. Then the conventional capsulorhexis was conducted through a 2.6 mm transparent corneal tunnel incision at the temporal or the nasal side, after which the hydro-dissection was performed. Next, the surgeon cut the pre-incision at the sclera, delivered the lens nucleus, sutured the scleral incision and removed the residual cortical materials from the corneal incision. Finally, a foldable intraocular lens was implanted, and the viscoelastic substance was removed. The intraoperative anterior chamber condition and the postoperative corneal edema condition were monitored. During the 6 month follow-up after surgeries, the endothelium cell density, visual acuity and astigmatism in the two groups were compared. The χ(2) test was used to compare the counting data, and the t test was used to compare the measurement data. Results: There was no statistically significant difference (t=1.12, P=0.28) in the preoperative corneal endothelial cell density between the double-incision and single-incision ECCE groups, which was (827±164) cells/mm(2) and (802±121) cells/mm(2), respectively. At 6 months after operation, in the double-incision and single-incision groups, the endothelial cell density was (793±147) cells/mm(2) and (706±101) cells/mm(2), respectively, and the difference was statistically significant (t=4.37, P<0.01). The percentage of corneal endothelial cell loss was 4.16%±3.12% and 11.69%±2.96%, respectively, and the difference was also statistically significant (t=9.52, P<0.01). The hexagon loss rate of corneal endothelial cells was 9.67%±6.11% and 28.33%±8.39%, respectively, and the difference was statistically significant (t=5.52, P<0.05). In the follow-up of 6 months, none of the eyes in the double-incision ECCE group suffered corneal endothelial decompensation compared with 3 eyes in the single-incision ECCE group. There were no statistically significant differences in postoperative astigmatism and surgically induced astigmatism between the two groups (t=-0.71, 0.15; P>0.05). Conclusions: The double-incision ECCE, in which the lens nucleus is delivered through a scleral incision and other procedures are conducted through a corneal tunnel incision, is safe and effective for cataract patients with hard nucleus and low corneal endothelial cell density. (Chin J Ophthalmol, 2020, 56: 126-130).


Asunto(s)
Astigmatismo , Extracción de Catarata , Catarata , Células Endoteliales , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
4.
Graefes Arch Clin Exp Ophthalmol ; 257(12): 2775-2787, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31659458

RESUMEN

PURPOSE: To evaluate the endothelial cell loss in patients with iris-claw phakic lenses (Artisan®) in a long-term follow-up. METHODS: We analyzed the medical records of patients who had undergone iris-claw phakic lens implantation and who had at least 5 years of follow-up. RESULTS: We included 67 eyes with myopic errors (follow-up 9.6 ± 3.0 years) and 10 eyes with mixed astigmatism or hyperopic errors (follow-up 8.8 ± 2.5 years). The mean total endothelial density loss at the last follow-up visit was 18.5% ± 17.0% and 10.5% ± 12.3%, respectively. 29.9% of the eyes in the myopic group and 20% in the hyperopic group lost more than 25% of the preoperative endothelial cell density. During the postoperative follow-up period, 60.8% of the eyes in the myopic group and 40% of the eyes in the hyperopic group lost a higher percentage than the expected physiological loss. Two eyes in the myopic group (3.0%) had a final cell density of less than 1200 cells/mm2. None of the variables studied had a statistically significant association with the percentage of annual endothelial loss in the postoperative period. Three phakic lenses were explanted: two by cataract and one by cataract and severe decrease of the endothelial density (862 cells/mm2). CONCLUSIONS: There is a significant endothelial cell loss in a low percentage of the eyes with Artisan® lenses in the long term, and it can decrease to critical levels. Periodic endothelial density evaluations are required for these patients. The selection criteria of surgical candidates could be reevaluated.


Asunto(s)
Pérdida de Celulas Endoteliales de la Córnea/etiología , Endotelio Corneal/patología , Iris/cirugía , Implantación de Lentes Intraoculares/efectos adversos , Miopía/cirugía , Lentes Intraoculares Fáquicas/efectos adversos , Refracción Ocular/fisiología , Adulto , Recuento de Células , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Miopía/fisiopatología , Complicaciones Posoperatorias , Diseño de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Agudeza Visual , Adulto Joven
5.
Exp Eye Res ; 175: 73-82, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29883637

RESUMEN

Corneal endothelial cell (CEC) loss occurs from tissue manipulation during anterior segment surgery and corneal transplantation as well as from contact with synthetic materials like intraocular lenses and tube shunts. While several studies have quantified CEC loss for specific surgical steps, the vulnerability of CECs to isolated, controllable and measurable mechanical forces has not been assessed previously. The purpose of this study was to develop an experimental testing platform where the susceptibility of CECs to controlled mechanical trauma could be measured. The corneal endothelial surfaces of freshly dissected porcine corneas were subjected to a range of indentation forces via a spherical stainless steel bead. A cell viability assay in combination with high-resolution fluorescence microscopy was used to visualize and quantify injured/dead CEC densities before and after mechanical loading. In specimens subjected to an indentation force of 9 mN, the mean ±â€¯SD peak contact pressure P0 was 18.64 ±â€¯3.59 kPa (139.81 ±â€¯26.93 mmHg) in the center of indentation and decreased radially outward. Injured/dead CEC densities were significantly greater (p ≤ 0.001) after mechanical indentation of 9 mN (167 ±â€¯97 cells/mm2) compared to before indentation (39 ±â€¯52 cells/mm2) and compared to the sham group (34 ±â€¯31 cells/mm2). In specimens subjected to "contact only" - defined as an applied indentation force of 0.65 mN - the peak contact pressure P0 was 7.31 ±â€¯1.5 kPa (54.83 ±â€¯11.25 mmHg). In regions where the contact pressures was below 78% of P0 (<5.7 kPa or 42.75 mmHg), injured/dead CEC densities were within the range of CEC loss observed in the sham group, suggesting negligible cell death. These findings indicate that CECs are highly susceptible to mechanical trauma via indentation, supporting the established "no-touch" policy for ophthalmological procedures. While CECs can potentially remain viable below contact pressures of 5.7 kPa (42.75 mmHg), this low threshold suggests that prevention of indentation-associated CEC loss may be challenging.


Asunto(s)
Pérdida de Celulas Endoteliales de la Córnea/etiología , Diagnóstico por Imagen de Elasticidad , Endotelio Corneal/lesiones , Endotelio Corneal/patología , Lesiones Oculares/etiología , Microscopía Fluorescente , Estrés Mecánico , Heridas no Penetrantes/etiología , Animales , Recuento de Células , Supervivencia Celular , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico por imagen , Pérdida de Celulas Endoteliales de la Córnea/fisiopatología , Endotelio Corneal/diagnóstico por imagen , Lesiones Oculares/diagnóstico por imagen , Lesiones Oculares/fisiopatología , Microesferas , Porcinos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatología
6.
Zhonghua Yan Ke Za Zhi ; 54(12): 954-960, 2018 Dec 11.
Artículo en Zh | MEDLINE | ID: mdl-30526795

RESUMEN

Endothelial keratoplasty is a surgery that selectively replaces the diseased endothelium and reserves the normal corneal epithelial and stromal layers. It is now gradually replacing penetrating keratoplasty in treating endothelial dysfunction. Although endothelial cell loss exists after endothelial keratoplasty, the number of lost cells is obviously less than that of penetrating keratoplasty. The amount and function of corneal endothelial cells are important factors for maintaining corneal transparency and indicating the survival of the graft. Thus, the changes of corneal endothelial cell density after surgery are significant in predicting the prognosis. This article elaborates on the changes of endothelial cell density after endothelial keratoplasty and related influencing factors, aiming to provide reference and basis for clinical diagnosis and treatment. (Chin J Ophthalmol, 2018, 54:954-960).


Asunto(s)
Trasplante de Córnea , Células Endoteliales , Endotelio Corneal , Queratoplastia Penetrante , Recuento de Células , Córnea , Humanos
7.
Exp Eye Res ; 115: 239-45, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23830909

RESUMEN

Corneal endothelial cells form a leaky barrier on the posterior surface of the cornea, allowing influx of nutrient-carrying aqueous humor through the paracellular space and efflux of excess fluid. Corneal edema arises when the density of these non-proliferative endothelial cells declines from endothelial disease or intraocular surgery. The cellular changes occurring at low densities are ill-defined. We therefore investigated the paracellular pathway of corneal endothelial cell monolayers of varying density to determine alterations occurring in paracellular permeability and monolayer morphology. Primary cultures of bovine corneal endothelial cells (BCECs) were passaged onto permeable supports under varying culture conditions to obtain confluent monolayers of <1000, 1000-1999 and >2000 cells/mm(2). Culture growth was monitored by transendothelial electrical resistance measurements. Diffusional permeability to sodium fluorescein, FITC-dextran MW 4000 or FITC-dextran MW 20,000 was measured. Confluent cultures were also analyzed by immunofluorescence localization of the tight junction protein ZO-1 and by transmission electron microscopy. For comparison, we evaluated ZO-1 for low and high density human corneal endothelium. Our results showed that all BCEC cultures grew to the same final transendothelial electrical resistance regardless of final density. In the diffusional permeability assay, permeability increased significantly only for the smallest tracer molecule (sodium fluorescein) in the lowest density monolayers (<1000 cells/mm(2)). ZO-1 immunofluorescence distinctly localized to intercellular junctions in high density BCEC cultures but had more diffuse localization at lower densities. Transmission electron microscopy imaging revealed cells with thinner cross-sectional profiles and longer overlapping intercellular processes at low density relative to high density cultures. Low density human corneal endothelium lacked the diffuse ZO-1 distribution seen in BCECs. Our data supports the hypothesis that barrier integrity is the primary function disrupted in low density corneal endothelial monolayers and contradicts the idea of a linear decline in barrier function with decreasing cell density.


Asunto(s)
Endotelio Corneal/citología , Uniones Intercelulares/fisiología , Animales , Bovinos , Recuento de Células , Permeabilidad de la Membrana Celular , Células Cultivadas , Dextranos/metabolismo , Impedancia Eléctrica , Endotelio Corneal/metabolismo , Fluoresceína/metabolismo , Fluoresceína-5-Isotiocianato/análogos & derivados , Fluoresceína-5-Isotiocianato/metabolismo , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Microscopía Electrónica de Transmisión , Peso Molecular , Uniones Estrechas/fisiología , Proteína de la Zonula Occludens-1/metabolismo
8.
Ocul Immunol Inflamm ; : 1-9, 2023 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-37093974

RESUMEN

PURPOSE: We assess long-term surgical outcomes after an initial trabeculectomy for cytomegalovirus-associated anterior uveitis with secondary glaucoma (CMV-SG). METHODS: We retrospectively reviewed the medical records of 16 eyes of 15 patients with CMV-SG and 157 eyes of 157 patients with primary open-angle glaucoma. The average follow-up period was approximately 3 years. Surgical success was defined as intraocular pressure (IOP) below 18 mmHg and at least 20% lower than baseline. RESULTS: Kaplan-Meier survival analysis revealed that bleb survival rates were not significantly different in the CMV-SG and POAG groups (P = 0.75). Bullous keratopathy occurred in 2 of 16 eyes with CMV-SG postoperatively but did not occur in the POAG group. The corneal endothelial cell density decreased by 34.2 ± 22.7% in the CMV-SG group during an average follow-up period of 2.7 ± 2.0 years. CONCLUSION: Trabeculectomy effectively controlled IOP in CMV-SG, but attention must be paid to corneal endothelial cell loss.

9.
Acta Ophthalmol ; 100(2): 212-217, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33629525

RESUMEN

PURPOSE: To determine whether the postoperative corneal endothelial cell density (ECD) differs between glaucoma patients who underwent Baerveldt implant (BGI) surgery and patients who underwent a trabeculectomy (TE) over 5 years ago. METHODS: Cross-sectional, observational study including 34 patients who underwent TE and 36 patients who underwent BGI surgery 5-11 years ago, as part of a randomized clinical trial. None of the patients had a history of intraocular surgery prior to their glaucoma surgery. Central and peripheral ECD was measured by using a non-contact specular microscope. RESULTS: Central and peripheral ECD in the TE group was 2285 ± 371 cells/mm2 (mean ± SD) and 2463 ± 476 cells/mm2 , respectively. Central and peripheral ECD in the BGI group was 1813 ± 745 cells/mm2 and 1876 ± 764 cells/mm2 , respectively. The central and peripheral ECD was statistically significantly higher in the TE group than in the BGI group (p = 0.001 for both). Additional intraocular surgical interventions were more prevalent in the BGI group (23) than in the TE group (5) (p < 0.001). In a subanalysis, without eyes that had undergone additional surgical interventions, only the peripheral ECD was statistically significantly higher in the TE group compared with the BGI group (p = 0.011). For the BGI group, a longer postoperative period resulted in a lower central ECD (r = -0.614, p = 0.004). CONCLUSION: Long-term ECD in eyes that underwent a BGI was considerably lower compared with eyes that underwent a TE, mainly in the peripheral cornea. This suggests that BGI causes a larger decrease of ECD than TE. Additionally, the decrease after BGI appears to continue for a longer period than after TE.


Asunto(s)
Pérdida de Celulas Endoteliales de la Córnea/etiología , Implantes de Drenaje de Glaucoma/efectos adversos , Trabeculectomía/efectos adversos , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trabeculectomía/métodos
10.
Indian J Ophthalmol ; 70(4): 1180-1185, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35326010

RESUMEN

Purpose: Comparison of three ultrasound (US) frequencies for phacoemulsification of hard cataracts to determine a frequency that makes phacoemulsification more efficacious and safer. Methods: A randomized controlled trial was undertaken at a medical college and hospital. In total, 207 patients with grade 5.6-6.9 (LOCS III) senile cataract were randomized into three groups. Group I underwent phacoemulsification with 28-kHz frequency, group II with 42-kHz frequency, and group III with 53-kHz frequency. The effective phacoemulsification time (EPT) and estimated fluid usage (EFU) were compared intraoperatively. The endothelial cell parameters were analyzed for 6 months. Results: The groups were matched for age (P = 0.467), gender (P = 0.497), nuclear grade (P = 0.321), and anterior chamber depth (P = 0.635). The EPT and EFU were significantly lower in group III, compared to group II and group I, with P < 0.0001 and P < 0.0001, respectively. Postoperatively, the endothelial cell density (ECD) was significantly higher in group III at 1 month (P < 0.0001), 3 months (P < 0.0001), and 6 months (P < 0.0001). The percentages of ECD loss were also significantly lower in group III; the difference was statistically significant (P < 0.0001) up to 6 months postoperatively. Conclusion: Higher frequency ultrasound was associated with a lower EPT and EFU as well as better endothelial preservation than lower frequencies in hard cataracts.


Asunto(s)
Extracción de Catarata , Catarata , Facoemulsificación , Catarata/diagnóstico , Recuento de Células , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Endotelio Corneal , Humanos , Estudios Prospectivos
11.
Front Med (Lausanne) ; 8: 757959, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34869460

RESUMEN

Background: Our study aimed to determine the correlation between the clinical staging of Fuchs' endothelial corneal dystrophy (FECD), rate of endothelial cell loss, and corneal biomechanical properties. Methods: This study combined a longitudinal retrospective/prospective analysis of corneal endothelial cell loss and a prospective cross-sectional analysis of corneal biomechanics of Fuchs' endothelial dystrophy. The trial was registered at the Thai Clinical Trials Registry as TCTR 20160927004. FECD was diagnosed by the presence of corneal guttata detected by slit lamp microscopy; the disease severity was classified into four stages using the modified Stocker's classification. In vivo confocal microscopy, Scheimpflug imaging, and Corneal Visualization Scheimpflug Technology were performed to evaluate endothelial cell count, central corneal thickness, and corneal biomechanical properties. Linear mixed modeling analyses were used to estimate the endothelial cell densities in a 4-year period. The corneal biomechanics were compared among the stages using Corvis ST parameters. Results: Eighty eyes from eighty subjects were enrolled (42, 26, 12, and none in stages 1, 2, 3, and 4, respectively). The mean endothelial cell density was 1228.35 cells/mm2. The year-by-year reduction rate was 94.3 cells/mm2 (µEMM = -94.3, 95% CI: -115.4 to -73.2, p < 0.001). Corneal endothelial cell losses in Fuchs' endothelial dystrophy were estimated to be 7.7, 7.8, and 8.4% per year for stages 1, 2, and 3, respectively. The mean corneal thicknesses of stages 1, 2, and 3 were 556 ± 32, 623 ± 33, and 648 ± 50 mm, respectively. For the corneal biomechanical parameters, the A1-length and A1-time were significantly different between stages 1 and 3 (A1-length: mean diffstage1vs.3 = 0.10, 95% CI: < 0.001-0.15, p < 0.001, A1-time: mean diffstage1vs.3 = -0.24, 95% CI: -0.41 to -0.07, respectively). Conclusions: In the advanced stage, corneas significantly changed their biomechanical viscoelastic behavior by decreasing resistance, as measured by a longer A1-length and shorter A1-time.

12.
Int J Ophthalmol ; 14(5): 684-692, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34012882

RESUMEN

AIM: To compare the corneal outcome in Fuchs' endothelial dystrophy (FED) patients between femtosecond laser-assisted cataract surgery (FLACS) and conventional phaco surgery (CPS). METHODS: This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS (stop and chop technique) in FED patients. Central corneal thickness, corneal light backscatter, corneal densitometry, and central corneal endothelial cell count and hexagonality (noncontact endothelial cell microscope), and corrected distance visual acuity (CDVA) were assessed preoperatively and at day 1, 40, and 180 postoperatively. RESULTS: Totally 31 patients (16 women) were included. At day 40 postoperatively, the mean endothelial cell loss (ECL) was 23.67% by FLACS and 17.30% by CPS (P=0.53). At day 180 postoperatively, ECL was 25.58% in FLACS and 21.32% in CPS (P=0.69). Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2, 2-6, 6-10 and 10-12, total densitometry with all layers and all annuli was performed. A significant difference was found in 6-10 (posterior layer) at day 1 with -1.42 grayscale units (GSU; 95%CI: -2.66 to -0.19, P=0.02). In 10-12 (anterior layer, central layer and all layers) at day 40 were significant different with 7.7 (95%CI: 1.89 to 13.50, P=0.009), 3.97 (95%CI: 0.23 to 7.71, P=0.03), 4.73 GSU (95%CI: 0.71 to 8.75, P=0.02), respectively. In the remaining parameters we found no difference between the two groups (P>0.05). Three CPS eyes suffered from corneal decompensation. CONCLUSION: There is no significant difference in corneal outcome between FLACS and CPS. Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

13.
J Clin Med ; 10(19)2021 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-34640426

RESUMEN

Glaucoma is the leading cause of irreversible blindness worldwide. The only proven factor in slowing the progression of glaucomatous neuropathy is lower intraocular pressure (IOP), which can be achieved with pharmacology, laser therapy, or surgery. However, these treatments are associated with various adverse effects, including corneal endothelial cell loss (CECL). In recent years, several novel surgeries for reducing the IOP, collectively referred to as minimally invasive glaucoma surgery (MIGS), have been developed, one of which is the iStent. However, the long-term effects of such surgeries remain unknown. We compared a group of patients with open-angle glaucoma and cataract who underwent phacoemulsification alone with a group of patients with similar demographic and clinical characteristics who underwent simultaneous phacoemulsification and iStent implantation. Overall, 26 eyes of 22 subjects who underwent a combined phacoemulsification-iStent procedure and 26 eyes of 24 subjects who underwent cataract surgery were included. Before surgery, endothelial cells accounted to 2228.65 ± 474.99 in iStent group and 2253.96 ± 404.76 in the control group (p = 0.836). After surgery, their number declined to 1389.77 ± 433.26 and 1475.31 ± 556.45, respectively (p = 0.509). There was no statistically significant difference in CECL between the two groups 18-24 months after surgery, despite increased manipulation in the anterior chamber and the presence of an implant in the trabecular meshwork in those with an iStent implant. Thus, iStent bypass implantation is a safe treatment in terms of CECL for mild-to-moderate open-angle glaucoma.

14.
Korean J Ophthalmol ; 34(6): 432-438, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33307602

RESUMEN

PURPOSE: To evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs). METHODS: The medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared. RESULTS: The study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05). CONCLUSIONS: Phacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.


Asunto(s)
Catarata , Facoemulsificación , Catarata/complicaciones , Recuento de Células , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Pérdida de Celulas Endoteliales de la Córnea/etiología , Endotelio Corneal , Humanos , Implantación de Lentes Intraoculares , Facoemulsificación/efectos adversos , Estudios Retrospectivos
15.
Korean J Ophthalmol ; 34(6): 446-453, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33307604

RESUMEN

PURPOSE: To investigate the effect of head tilt on the tube position of the Ahmed glaucoma valve (AGV) implanted in patients with glaucoma and to assess how the head tilt-induced alterations of tube parameters and the level of tube entry influence corneal endothelial cell density (ECD). METHODS: A total of 29 eyes of 26 patients with AGV implantation were included. Tube-cornea distance, tube-cornea angle, and intracameral tube length were measured using anterior segment optical coherence tomography in three different head positions (neutral, 30° temporalward tilt, and 30° nasalward tilt). The tube entry was assessed using static gonioscopy. ECD was measured using specular microscopy before and after surgery. RESULTS: The mean tube-cornea distance, tube-cornea angle, and intracameral tube length (neutral: 0.87 ± 0.39 mm, 30.56 ± 5.89˚, and 3.10 ± 0.82 mm, respectively) decreased with head tilts (temporalward: 0.82 ± 0.39 mm, 29.27 ± 5.82˚, and 3.04 ± 0.82 mm, respectively; nasalward: 0.83 ± 0.40 mm, 29.61 ± 6.04˚, and 3.05 ± 0.81 mm, respectively; all p < 0.01). The multivariate analyses found age and the tube insertion level to be associated with postoperative changes in the central ECD (p = 0.039 and 0.013, respectively), and the postoperative follow-up period and tube insertion level to be associated with the difference between the inferonasal and superotemporal ECDs (p = 0.034 and 0.007, respectively). CONCLUSIONS: Mild alterations of head positions induced changes in the intracameral tube positions of AGV implants; nevertheless, it did not significantly affect ECD loss. However, the eyes with tubes inserted anteriorly to Schwalbe's line may be more susceptible to corneal ECD loss.


Asunto(s)
Células Endoteliales , Implantes de Drenaje de Glaucoma , Cámara Anterior/diagnóstico por imagen , Estudios Transversales , Humanos , Presión Intraocular
16.
BMJ Open Ophthalmol ; 4(1): e000233, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30997403

RESUMEN

OBJECTIVE: Femtosecond laser-assisted cataract surgery (FLACS) decreases the use of energy and provides a more precise capsulorhexis compared with conventional phaco surgery (CPS). The purpose of this study was to examine if the lower energy use in FLACS caused less endothelial cell loss compared with CPS and if there was a difference in refractive predictability between CPS and FLACS. METHODS AND ANALYSIS: This was a randomised controlled study of 96 patients with a 6-month follow-up comparing one eye surgery by FLACS and the contralateral eye operated by CPS (divide and conquer technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality (non-contact endothelial cell microscope) were assessed preoperatively at 40 and at 180 days postoperatively. RESULTS: The mean phaco energies were 6.55 (95% CI 5.43 to 7.66) and 9.77 (95% CI 8.55 to 10.95) U/S (p<0.0001) by FLACS and CPS, respectively. At day 40, the mean endothelial cell loss (ECL) was 344 cells/mm2 (95% CI 245 to 443) by FLACS (12.89%) and 497 cells/mm2 (95% CI 380 to 614) by CPS (18.19%) (p=0.027). At day 180, ECL was 362 cells/mm2 (95% CI 275 to 450) in FLACS (13.56%) and 465 cells/mm2 (95% CI 377 to 554) in CPS (17.03%) (p=0.036).The mean absolute difference from the attempted refraction was 0.43 (95% CI 0.36 to 0.51) dioptres (D) at day 40 and 0.46 D (95% CI 0.39 to 0.53) at day 180 by FLACS compared with 0.43 D (95% CI 0.36 to 0.51) at day 40 (p=0.95) and 0.46 D (95% CI 0.37 to 0.52) at day 180 (p=0.91) with CPS. CONCLUSION: ECL was significantly lower in FLACS compared with CPS at both day 40 and day 180. ECL was correlated to the energy used. We found no difference in refractive predictability or CDVA between the groups.

17.
Saudi J Ophthalmol ; 33(1): 7-11, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30930656

RESUMEN

AIM: To study the five-year endothelial cell loss in patients having undergone penetrating keratoplasty (PKP) and who received corneal donor tissue from international eye banks. METHODS: This retrospective clinical study reviewed outcomes in 41 patients who underwent PKP at a tertiary eye center from February 2008 to July 2011. Standard PKP surgical technique was used for all patients, and graft tissue was supplied in all cases by eye banks in the United States of America. At five years after surgery, measurements were taken of endothelial cell density (ECD), coefficient of variation, hexagonality, donor's age, recipient's age, Death-to-preservation (DP), and preservation time (PT). RESULTS: The recipients and donors median age was 30.0 years (24.0-35.5 years) and 59.0 years (53.0-61.0 years) respectively; the median DP and PT were 8.0hours.(6.0-10.0hours) and 10.0 days (9.0-11.5 days) respectively. At baseline, the ECD was 2398(2325-2525). At five years after surgery, all of the grafts were found to have survived; the median ECD was 1035 cell/mm2 (693-1346 cell/mm2); the mean coefficient of variation was 35.2 ±â€¯9.8%; and the mean hexagonality was 63.7 ±â€¯24.3%. The overall ECD loss was 56% (95% CI: 50-62%); the ECD loss was 51.3% and 61.2% in corneas from donors younger and older than 60 years respectively (p = 0.056); likewise, the ECD loss was 52.6% and 61.0% in corneas with PT shorter and longer than 10 days respectively (p = 0.289). Although the difference in both cases was not statistically significant, it was clinically important (about 10%). CONCLUSION: The ECD after five years in patients undergoing internationally-transported corneal tissue grafts incurred 56% loss; the donor's age and the PT were positively associated with ECD loss.

18.
Arq. bras. oftalmol ; Arq. bras. oftalmol;87(4): e2023, 2024. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1557098

RESUMEN

ABSTRACT Purpose: To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. Methods: Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed. Results: The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision. Conclusions: In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.

19.
Acta Ophthalmol ; 95(1): 91-96, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27495264

RESUMEN

PURPOSE: To investigate central and peripheral corneal endothelial cell density (ECD) in relation to Baerveldt (BV) glaucoma drainage device (GDD) tube corneal (TC) distance. METHODS: Prospective study of all patients scheduled for glaucoma tube surgery with 36 months follow-up. A BV GDD was inserted into the anterior chamber (AC). Anterior segment optical coherence tomography (AS-OCT) scans were made to determine the TC distance. Central and peripheral ECD was measured, preoperatively and at 3, 6, 12, 24 and 36 months postoperatively. RESULTS: Fifty-three eyes were included [primary open-angle glaucoma, (n = 13); secondary glaucoma, (n = 30); and primary angle-closure glaucoma, (n = 10)]. Central ECD significantly decreased during follow-up, with a mean decrease of 4.54% per year (p < 0.001), and 6.57% in the peripheral quadrant closest to the BV GDD tube (PQC, p < 0.001). In the PQC, a yearly decrease of 1.57% was shown after transiridial tube placement versus 7.43% after placement 'free' into the AC (p = 0.006). Endothelial cell (EC) loss was related to TC distance (mean 1.69 mm), with a central loss of 6.20% and 7.25% in the PQC per year with shorter TC distances, versus a central loss of 4.11% and 5.77% in the PQC per year with longer TC distances (outside mean ± 2SD, p < 0.001). A difference in EC loss by glaucoma subtype was not identified. CONCLUSION: The TC distance is of significant influence on corneal ECD, a shorter TC distance causing more severe EC loss, especially in the PQC. Transiridial placement of the BV GDD tube seems safer than placement 'free' into the AC.


Asunto(s)
Cámara Anterior/cirugía , Pérdida de Celulas Endoteliales de la Córnea/etiología , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma de Ángulo Cerrado/cirugía , Glaucoma de Ángulo Abierto/cirugía , Anciano , Cámara Anterior/diagnóstico por imagen , Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Femenino , Humanos , Presión Intraocular , Intubación/instrumentación , Intubación/métodos , Persona de Mediana Edad , Estudios Prospectivos , Implantación de Prótesis/efectos adversos , Tomografía de Coherencia Óptica
20.
Curr Eye Res ; 42(1): 32-40, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27249218

RESUMEN

PURPOSE: To develop high fidelity finite element (FE) models of the Descemet's stripping automated endothelial keratoplasty (DSAEK) allograft to estimate the stress distributions generated on the allograft during its deformed state in popular allograft insertion configurations and qualitatively correlate the stress distributions to postsurgical endothelial cell (EC) loss. MATERIALS AND METHODS: Corneal allograft simulation was performed using ANSYS (Canonsburg, PA, USA) utilizing isotropic nonlinear hyperelastic corneal material properties to evaluate the stress distributions generated on the DSAEK allograft during popular allograft insertion configurations, namely forceps, taco, and double-coil insertion configurations. The gathered FE simulation results were qualitatively compared with published clinical studies to verify the simulation results. RESULTS: The FE simulation results demonstrate that high stress regions predicted by FE model results correctly predict the areas of postsurgical EC loss as published in the studies available in open literature. The FE simulation stress magnitude results suggest that highest EC loss due to mechanical bending trauma occurs in double-coil configuration followed by forceps and then taco configuration. CONCLUSIONS: The results of the presented FE simulation study highlight that allograft regions with high stress distribution demonstrate postsurgical EC loss in clinical studies. The modeling procedures presented in this research can be utilized to develop novel surgical devices/techniques that can modulate the postsurgical EC loss due to mechanical bending trauma and facilitate allograft unfolding inside the AC, thereby improving the results of the DSAEK surgical procedure.


Asunto(s)
Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Queratoplastia Endotelial de la Lámina Limitante Posterior/métodos , Células Endoteliales/patología , Análisis de Elementos Finitos , Complicaciones Posoperatorias , Estrés Mecánico , Aloinjertos , Recuento de Células , Simulación por Computador , Pérdida de Celulas Endoteliales de la Córnea/etiología , Queratoplastia Endotelial de la Lámina Limitante Posterior/instrumentación , Distrofia Endotelial de Fuchs/cirugía , Humanos , Donantes de Tejidos
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