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Purpose: It was aimed to compare corneal endothelial changes during the initial 12-month period in which patients started using atorvastatin after a diagnosis of acute coronary syndrome (ACS). Methods: Forty-six participants (group 1) who underwent cardiac angioplasty and stenting for ACS and started using 80 mg atorvastatin in the early period were included in the study. In the study, a control group comprising 71 healthy adults (group 2) was included. These individuals did not use medication for any known systemic disease, had never taken statins, had no history of ocular surgery, and did not have any cornea-related eye diseases. Baseline and 12th month endothelial evaluations of group 1 and 2 participants were compared using specular microscopy. Results: There were 28 female and 18 male participants in group 1 and 48 female and 23 male participants in group 2 (P = 0.455). The mean baseline corneal endothelial cell density (CECD) was not significantly higher in group 1 compared to group 2 (2471.4 ± 200 cells/mm2 vs 2428.2 ± 539.8 cells/mm2, P = 0.230). When the change between baseline and 12th month CECD was examined, the decrease in group 2 was significantly different from that in group 1 (-15,2 ± 31,9 and -44,8 ± 49,6, P = 0,002). Although the percentage of hexagonal cells decreased significantly in group 2 participants, no significant change was observed in group 1 (respectively; P < 0.001, P = 0.073). The endothelial cell coefficient of variation did not differ significantly in group 1 participants over a 1-year period (P = 0.192), and a significant increase was observed in group 2 (P < 0.001). Conclusion: This study revealed that atorvastatin may have a positive effect on corneal endothelium cell density and morphology.

Purpose: Morphological stability and functional integrity of corneal endothelium are necessary to maintain long-term corneal transparency. When the number of endothelial cells drops below 450-800 cells/mm2, corneal edema, irreversible loss of corneal transparency, and decreased vision occur. There is concern regarding manual small-incision cataract surgery (MSICS) being more harmful to the endothelium in comparison to phacoemulsification. Our study aims to determine which technique maintains the corneal parameters closest to the normal physiological state.Methods: A prospective observational study was conducted over a period of 15 months on 100 eyes, out of which 43 patients underwent phacoemulsification surgery and 57 underwent MSICS. TOPCON SP-1P, Version 1.41, 50-60 Hz frequency, noncontact specular microscope with pachymeter was used to measure endothelial cell count (ECC) and central corneal thickness (CCT) on four occasions: 1 day prior to surgery and on day 1, 3rd week, and 6th week after surgery.Results: In total, 100 eyes of 100 subjects were studied with no dropout during the study period. The age range was 40-70 years. There was no statistically significant difference between the preoperative mean ECC and mean CCT in phacoemulsification and SICS groups. A statistically significant difference was observed in the postoperative mean ECC (P < 0.01) and mean CCT (P < 0.001) on day 1 and 3rd week between the phacoemulsification and SICS groups, respectively. The mean endothelial cell loss at 6 weeks was less with SICS but comparable with phacoemulsification.Conclusion: SICS is significantly faster, less expensive, less technology dependent, can deal with all types of cataracts, is relatively safe, and is more appropriate for advanced cataracts. [ABSTRACT FROM AUTHOR]

Purpose: Morphological stability and functional integrity of corneal endothelium are necessary to maintain long-term corneal transparency. When the number of endothelial cells drops below 450–800 cells/mm2, corneal edema, irreversible loss of corneal transparency, and decreased vision occur. There is concern regarding manual small-incision cataract surgery (MSICS) being more harmful to the endothelium in comparison to phacoemulsification. Our study aims to determine which technique maintains the corneal parameters closest to the normal physiological state. Methods: A prospective observational study was conducted over a period of 15 months on 100 eyes, out of which 43 patients underwent phacoemulsification surgery and 57 underwent MSICS. TOPCON SP-1P, Version 1.41, 50–60 Hz frequency, noncontact specular microscope with pachymeter was used to measure endothelial cell count (ECC) and central corneal thickness (CCT) on four occasions: 1 day prior to surgery and on day 1, 3rd week, and 6th week after surgery. Results: In total, 100 eyes of 100 subjects were studied with no dropout during the study period. The age range was 40–70 years. There was no statistically significant difference between the preoperative mean ECC and mean CCT in phacoemulsification and SICS groups. A statistically significant difference was observed in the postoperative mean ECC (P < 0.01) and mean CCT (P < 0.001) on day 1 and 3rd week between the phacoemulsification and SICS groups, respectively. The mean endothelial cell loss at 6 weeks was less with SICS but comparable with phacoemulsification. Conclusion: SICS is significantly faster, less expensive, less technology dependent, can deal with all types of cataracts, is relatively safe, and is more appropriate for advanced cataracts.

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

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

Specular microscopy is a noninvasive diagnostic tool that allows for in vivo evaluation of corneal endothelium in health and various diseased states. Endothelial imaging helps in the diagnosis and management of several endothelial disorders. The review focuses on the principles of specular microscopy, limitations of endothelial imaging, and its interpretation in common conditions seen in the clinical practice. A thorough PubMed search was done using the keywords specular microscopy, corneal endothelium, and endothelial imaging.

Purpose: This study aimed to examine the corneal endothelial morphology and thickness in patients with Type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched nondiabetic controls. Methods: This hospital-based cross-sectional observational study was conducted in the ophthalmology department of a tertiary hospital consisting of 262 patients (131 with T2DM as cases and 131 without diabetes who served as controls). All patients underwent a comprehensive ocular examination including visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement. Central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CV), and percentage of hexagonal cells (HEX) were compared between the cases and controls. Predictors of corneal endothelial dysfunctions were analyzed. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 17.0. Chi-square test, Fisher's exact test, and Spearman's rho correlation analysis were used as appropriate. Results: Patients with T2DM showed poorer visual acuity and higher intraocular pressure. As compared to controls, patients with T2DM had thicker CCT, lesser ECD, decreased HEX, and higher CV but the differences were statistically nonsignificant. HbA1c levels showed a significant positive correlation with CCT and CV and a negative correlation with ECD. Macroalbuminuria and higher albumin creatinine ratio was associated with an increase in CV in patients with T2DM. Conclusion: Our study showed that poorly controlled patients with T2DM and those with macroalbuminuria have corneal endothelial abnormalities.

Purpose: Vascular endothelial dysfunction in autosomal dominant polycystic kidney disease (ADPKD) may affect the retinal vascular parameters due to structural similarities of kidney and retina. We aimed to evaluate the microvascular changes of retina and optic disc and also corneal endothelial cell density in patients with ADPKD. Methods: Forty-six eyes of 23 patients with ADPKD (Group 1), and 46 eyes of 23 sex- and age-matched healthy controls (Group 2) were included in this cross-sectional study. Demographic and ophthalmic findings of participants were collected. Corneal endothelial cell density (CECD) measurements were obtained by noncontact specular microscopy. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic nerve head were analyzed by optical coherence tomography angiography. Results: The mean ages were 41 ± 11 years for Group 1 and 39 ± 10 years for Group 2 (P = 0.313). CECD values were significantly lower in group 1 when compared to group 2 (2653 ± 306 cells/mm2 and 2864 ± 244 cells/mm2, respectively, P < 0.001). The foveal retinal thickness and RNFL thickness were similar, but superior quadrant thickness of RNFL was significantly lower in Group 1 than Group 2 (126 ± 14 μm vs. 135 ± 15 μm, P = 0.003). In Group 1, whole image of optic disc radial peripapillary capillary densities were significantly lower compared to Group 2 (49.4 ± 2.04%, and 50.0 ± 2.2%, respectively, P = 0.043). There was no significant difference regarding superficial, deep retinal vessel densities, foveal avascular zone and flow areas between the groups (P > 0.05 for all). Conclusion: Lower CECD values and decreased superior quadrant RNFL thickness, and microvascular densities of optic disc were revealed in patients with ADPKD. Evaluation of CECD and retinal microvasculature may be helpful in the management of these patients.

Purpose: To compare central corneal thickness measurements obtained by Pentacam with those obtained by IOL Master 700, Cirrus Anterior segment optical coherence tomography and Tomey Specular microscopy in normal healthy eyes. Methods: Two hundred and six eyes of healthy subjects were included in the study. Each subject was assessed by four different methods of measuring central corneal thickness using Pentacam, IOL Master 700, Cirrus AS-OCT and Tomey Specular microscopy by a single examiner. Results: The mean CCT [± standard deviation (SD)] for Pentacam, IOL Master 700, Cirrus AS-OCT and Tomey Specular microscopy were Pentacam (Oculus), AS-OCT (Cirrus), IOL Master 700 and Specular microscopy (Tomey) were 523.75 (±27.75), 525.29 (±28.81),517.13 (±28.43) and 512.82 (±27.60) μm, respectively. All the means were significantly different from one another (P < 0.000). The differences between pairs of mean central corneal thickness (CCT) for Pentacam and IOL Master, Pentacam and anterior segment- optical coherence tomography (AS-OCT), and Pentacam and Specular microscopy are statistically significant. Bland–Altman plots showed that pentacam and IOL Master 700 have the closest agreement, followed by AS-OCT. Specular microscopy was found to have the poorest agreement with Pentacam. Conclusion: We found that CCT measurements of Pentacam did not correlate with measurements of IOL Master, or AS-OCT or Specular microscopy. In clinical practice, the devices analyzed should not be used interchangeably due to low agreement regarding CCT values.

Purpose: Vascular endothelial dysfunction in autosomal dominant polycystic kidney disease (ADPKD) may affect the retinal vascular parameters due to structural similarities of kidney and retina. We aimed to evaluate the microvascular changes of retina and optic disc and also corneal endothelial cell density in patients with ADPKD.Methods: Forty-six eyes of 23 patients with ADPKD (Group 1), and 46 eyes of 23 sex- and age-matched healthy controls (Group 2) were included in this cross-sectional study. Demographic and ophthalmic findings of participants were collected. Corneal endothelial cell density (CECD) measurements were obtained by noncontact specular microscopy. Foveal retinal thickness, peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina and optic nerve head were analyzed by optical coherence tomography angiography.Results: The mean ages were 41 ± 11 years for Group 1 and 39 ± 10 years for Group 2 (P = 0.313). CECD values were significantly lower in group 1 when compared to group 2 (2653 ± 306 cells/mm2 and 2864 ± 244 cells/mm2, respectively, P < 0.001). The foveal retinal thickness and RNFL thickness were similar, but superior quadrant thickness of RNFL was significantly lower in Group 1 than Group 2 (126 ± 14 μm vs. 135 ± 15 μm, P = 0.003). In Group 1, whole image of optic disc radial peripapillary capillary densities were significantly lower compared to Group 2 (49.4 ± 2.04%, and 50.0 ± 2.2%, respectively, P = 0.043). There was no significant difference regarding superficial, deep retinal vessel densities, foveal avascular zone and flow areas between the groups (P > 0.05 for all).Conclusion: Lower CECD values and decreased superior quadrant RNFL thickness, and microvascular densities of optic disc were revealed in patients with ADPKD. Evaluation of CECD and retinal microvasculature may be helpful in the management of these patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare central corneal thickness measurements obtained by Pentacam with those obtained by IOL Master 700, Cirrus Anterior segment optical coherence tomography and Tomey Specular microscopy in normal healthy eyes.Methods: Two hundred and six eyes of healthy subjects were included in the study. Each subject was assessed by four different methods of measuring central corneal thickness using Pentacam, IOL Master 700, Cirrus AS-OCT and Tomey Specular microscopy by a single examiner.Results: The mean CCT [± standard deviation (SD)] for Pentacam, IOL Master 700, Cirrus AS-OCT and Tomey Specular microscopy were Pentacam (Oculus), AS-OCT (Cirrus), IOL Master 700 and Specular microscopy (Tomey) were 523.75 (±27.75), 525.29 (±28.81),517.13 (±28.43) and 512.82 (±27.60) μm, respectively. All the means were significantly different from one another (P < 0.000). The differences between pairs of mean central corneal thickness (CCT) for Pentacam and IOL Master, Pentacam and anterior segment- optical coherence tomography (AS-OCT), and Pentacam and Specular microscopy are statistically significant. Bland-Altman plots showed that pentacam and IOL Master 700 have the closest agreement, followed by AS-OCT. Specular microscopy was found to have the poorest agreement with Pentacam.Conclusion: We found that CCT measurements of Pentacam did not correlate with measurements of IOL Master, or AS-OCT or Specular microscopy. In clinical practice, the devices analyzed should not be used interchangeably due to low agreement regarding CCT values. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine the corneal endothelial morphology and thickness in patients with Type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched nondiabetic controls.Methods: This hospital-based cross-sectional observational study was conducted in the ophthalmology department of a tertiary hospital consisting of 262 patients (131 with T2DM as cases and 131 without diabetes who served as controls). All patients underwent a comprehensive ocular examination including visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement. Central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CV), and percentage of hexagonal cells (HEX) were compared between the cases and controls. Predictors of corneal endothelial dysfunctions were analyzed. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 17.0. Chi-square test, Fisher's exact test, and Spearman's rho correlation analysis were used as appropriate.Results: Patients with T2DM showed poorer visual acuity and higher intraocular pressure. As compared to controls, patients with T2DM had thicker CCT, lesser ECD, decreased HEX, and higher CV but the differences were statistically nonsignificant. HbA1c levels showed a significant positive correlation with CCT and CV and a negative correlation with ECD. Macroalbuminuria and higher albumin creatinine ratio was associated with an increase in CV in patients with T2DM.Conclusion: Our study showed that poorly controlled patients with T2DM and those with macroalbuminuria have corneal endothelial abnormalities. [ABSTRACT FROM AUTHOR]

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

Purpose: To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD). Methods: Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively. Results: Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK. Conclusion: The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.

Specular microscopy is a noninvasive diagnostic tool that allows for in vivo evaluation of corneal endothelium in health and various diseased states. Endothelial imaging helps in the diagnosis and management of several endothelial disorders. The review focuses on the principles of specular microscopy, limitations of endothelial imaging, and its interpretation in common conditions seen in the clinical practice. A thorough PubMed search was done using the keywords specular microscopy, corneal endothelium, and endothelial imaging. [ABSTRACT FROM AUTHOR]

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

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

Context: Surgical outcome of retropupillary fixation of iris claw lens. Aims: To evaluate the various indications, intra and post-operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes. Settings and Design: The study design is a retrospective study at a tertiary eye care center. Methods: Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow-up duration of at least 1 year. Statistical Analysis Used: Data analysis was performed using paired t-test and Chi-square test. Results: Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best-corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm2 preoperatively which decreased to 2200 ± 728 cells/mm2 at 1 year follow-up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%. Conclusion: Iris claw is a safe and an effective method of rehabilitating aphakic eyes.

Purpose: To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD).Methods: Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively.Results: Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028-3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380-3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK.Conclusion: The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation. [ABSTRACT FROM AUTHOR]

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

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

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

Purpose: Phacoemulsification is the surgical procedure of choice for cataract, providing excellent visual and safety outcomes. Femtosecond laser-assisted cataract surgery (FLACS) is an addition to the surgical armamentarium. The study aims to compare the outcomes of FLACS using LenSx™ (Alcon Inc., USA) to standard 2.2 mm clear corneal phacoemulsification. Prospective case-control, comparative, interventional study was conducted in a tertiary care center.Methods: In each group, 55 eyes of 55 patients underwent cataract surgery using either FLACS or conventional phacoemulsification (control group). The primary outcome variables, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), specular microscopy, pachymetry, mean absolute error (MAE), and anterior chamber depth (ACD) were compared between two groups at 4 weeks postoperatively. Intraoperative effective phaco time (EPT), postoperative circularity of the rhexis, capsular overlap over the edge of the intraocular lens (IOL), and decentration of the IOL were the secondary variables which were compared.Results: No significant difference was found between the groups for UCVA, pachymetry, MAE, and ACD at 4 weeks postoperatively. The FLACS group had better BCVA (P = 0.0294). Circularity of capsulorrhexis (P = 0), circular overlap over the edge of IOL (P = 0), and centration of IOL (P = 0.002) at 4 weeks postoperatively were better in the FLACS group. EPT was lower in FLACS for similar grade of cataract (P = 0). Endothelial cell loss in FLACS group was 4.2% more (P = 0.032).Conclusions: FLACS is superior to conventional phaco in the circularity of rhexis, capsular overlap, and centration of the IOL and uses less EPT. However, conventional phacoemulsification is equivalent to FLACS in most other parameters. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 27‑year‑old male was referred to us as a case of unilateral glaucoma with corneal haze. History revealed about painless diminution in vision and presence of hearing impairment. The article discusses the advice provide to the patient to stop the topical glaucoma medications one by one under monitoring and patient was started on topical hypertonic saline and registered for endothelial keratoplasty.

Context: Surgical outcome of retropupillary fixation of iris claw lens.Aims: To evaluate the various indications, intra and post-operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes.Settings and Design: The study design is a retrospective study at a tertiary eye care center.Methods: Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow-up duration of at least 1 year.Statistical Analysis Used: Data analysis was performed using paired t-test and Chi-square test.Results: Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best-corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm2 preoperatively which decreased to 2200 ± 728 cells/mm2 at 1 year follow-up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%.Conclusion: Iris claw is a safe and an effective method of rehabilitating aphakic eyes. [ABSTRACT FROM AUTHOR]

Specular microscopic study on clear corneal grafts indicates that at times surprisingly low endothelial cell density can maintain the grafted cornea in a relatively dehydrated state. The critical limit of the endothelial cell count for corneal decompensation is thought to be 700 cells/mm2. This communication reports 13 cases of clear corneal graft with endothelial cell count below 700 cells/mm2.

Context: Donor tissue scarcity, Eye Bank Specular Microscopy as yet not made mandatory and tissue utilization often based on clinical judgment only. Aims: Prospectively analyze alteration in clinical grading of donor corneas and hence utilization, based on Eye Bank Specular Microscopy (EBSM) and to infer if EBSM should be mandatory in all eye banks. Materials and Methods: 200 consecutive otherwise 'suitable for surgery' donor eyes were graded clinically. On quantitative and qualitative analysis of endothelial cells by EBSM, final grading was adjusted. Impact on subsequent utilization for various surgeries was analyzed with regard to Age of Donor, Death to Enucleation Time, Death to Preservation Time and Lens Status of Donor Eye. Results: 76 eyes (38%) (P < 0.05) had significant change in grading. 12/59 (20.30%) tissues from donors <=40 years showed Cell Density (CD) between 1801-2500. 19/76 (25%) tissues from donor >60 years showed CD >= 2500. From donor >=81 years, 2/13 (15.3%) eyes showed CD between 2501-3000 and 1 (7.6%) eye showed CD > 3000. Owing to better grading after EBSM, 13/14 (92.85%) tissues with DTET >6 hours and 5/5 (100%) tissues with DTPT > 16 hours were transplanted. Out of 45 (22.5%) pseudo-phakic tissues, 21 (46.67%) tissues were used for Therapeutic/Tectonic Penetrating Keratoplasty (PKP) while 24 (53.33%) tissues were used for Optical PKP. Conclusions: EBSM significantly alters final grading of tissues and its subsequent utilization. Acquiring huge importance in areas where adequate supply of corneas is lacking, EBSM becomes an indispensable tool for optimizing availability of qualified tissues for surgery. EBSM should be made a mandatory analysis. [ABSTRACT FROM AUTHOR]

Purpose: To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus. Materials and Methods: Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter. Results: Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P<0.001). Mean ECD loss rate at four years was 47.82% in Group A and 21.62% in Group B (P<0.001). Mean annual ECD loss rate was calculated 14.12% per year in Group A and 5.78% per year in Group B. In the PK group, increase in mean CCT was 15.60% in two years and 15.03% in four years, while in the DALK group, mean CCT increased by 8.05% in two years and 9.31% in four years. Conclusions: As the majority of ectatic disorders such as keratoconus occur in young people, long-term endothelial cell survival following treatment with keratoplasty is essential for the long-term visual ability. Our finding that corneal endothelial cell loss in the DALK group occurs at a slower rate than in the PK group suggests DALK as a safer alternative to PK in these selected patients. [ABSTRACT FROM AUTHOR]

We report the case of a 16-year-old woman with microspherophakia and secondary open angle glaucoma. The patient presented with a membrane dividing the anterior chamber into two segments without edema or Descemet's membrane detachment. Slit lamp biomicroscopy, Pentacam, and specular microscopy images were obtained. Double anterior chamber is primarily found in patients with anterior chamber anomalies when there is no history of surgery or trauma. [ABSTRACT FROM AUTHOR]