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The effect of pseudoexfoliation syndrome (PEХ) on endothelial cells has been studied long enough. Yet the effect of phacoemulsification (PHACO) on endothelium in patients with PEХ is less explored. Purpose. To assess the impact of PHACO on corneal endothelial cell density (ECD) and on the coefficient of variation (CV) in patients with PEX. Material and methods. 30 patients (30 eyes) with PEX syndrome and 34 patients (34 eyes) with no such syndrome were examined before and after phacoemulsification. Results. In patients with PEX, the ECD after PHACO was significantly lower and CV was significantly higher (р < 0.05). Conclusion. PEX has a negative impact on endothelial cells, which leads to a pronounced cells loss after PHACO.

Objective: To compare corneal endothelial indexes in eyes with pseudoexfoliation syndrome (PEX) and without it, and identify the dependence of corneal endothelial cell density (CD) on the age and stage of glaucoma.Patients and Methods: The study included 55 people (96 eyes). There were 53 eyes with PEX and 43 eyes without it. Patients were divided into 2 age groups: 40–60 years (41 eyes) and 61–80 years (55 eyes). The groups were homogeneous with respect to the level of IOP, Central corneal thickness, anteposterior axis of the eye and the stages of glaucoma. Endothelial microscopy was performed on a SP-3000P (Topcon). Statistical processing was made with "SPSS 16.0 for Windows"(methods of variation statistics, discriminant analysis).Results: There were significant difference in eyes with PEX and without PEX in CD in ages of 40–60 years (2309,57±87,77 cells/mm2 and 2642,39±64,81 cells/mm2, p=0.005) and 61–80 years (2247,02±59,5 (cells/mm2 and 2590,18±93,39 cells/mm2, p=0.004), as well as in the average surface area of endothelial cell (434,08±17,43 µm2 and 385,17±9,57 µm2, p=0,024; 461,14±15,23 µm2 and of 395.00±13,21 µm2, p=0.002, respectively).There was age difference of CD reduction: the highest CD was at 40–50 years (2722.75±63.05 cells/mm2), and at 81–90 years if fells to 1872.67±417.29 cells/mm2 (at a given age are found only patients with PEX). Revealed that the CD is dependent on the stage of glaucoma: the density was highest in the absence of glaucoma (2603.00±162.61 cells/mm2) and at an initial stage of glaucoma (2480.65±48.88 cells/mm2), while the density was lowest at stage 3 of glaucoma (2118.73±150.51 cells/mm2). Here reducing of the CD was due to patients with PEX, while in patients without PEX the differences were not statistically significant in different stages of glaucoma.Conclusion: Our study showed that the eyes with PEX are characterized by a more pronounced damage to the corneal endothelium, than eyes without it. The condition of endothelium cells worsens in eyes with PEX, depending on the age and stage of glaucoma. Thus, the performing of endothelial microscopy can be seen as a necessary tool in the monitoring of patients with PEG for the solution of a question on tactics of treatment and timely phacoemulsification.

Purpose. To determine the long-term status of the corneal endothelium after anterior radial keratotomy. Patients and methods. The main group consisted of 69 patients (104 eyes) who underwent radial or radial-tangential keratotomy to correct myopia and myopic astigmatism an average of 23,1±2,8 years ago (range 16 to 30 years). The average age of patients was 53,8±5,7 years (range 39 to 65 years). The number of keratotomy scars ranged from 4 to 14. Repeated keratotomy was performed on 8 eyes. The control group consisted of 56 patients (110 eyes) aged from 39 to 64 years(average 54,2±4,3 years) with refractive-axial myopia from medium to high stage, whom potentially could be done anterior keratotomy in the 90th of the last century. Patients with concomitant pathology and ocular trauma that could lead to loss ofendothelial cells were excluded from both groups. Corneal endothelium cell densit y, polimegatizm, pleomorphism in addition to standard eye examination were performed to all patients with the help of contactless endothelial microscope «EM-3000» company Tomey (Japan). Results. In the control group endothelial cell densit y averaged 2734,8±121,2 cells /mm2, in the main group — 2134,2±299,1 cells/mm2 (p

Objetivo: determinar el comportamiento del endotelio corneal en pacientes sometidos a cirugías simultáneas de vítreo y catarata. Métodos: se realizó un estudio observacional, descriptivo y prospectivo. El universo lo constituyó 15 pacientes (15 ojos) sometidos a cirugías de catarata y vítreo de forma simultánea. El estudio se efectúo en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" de enero a noviembre de 2010. Resultados: la mayoría de los pacientes fueron hombres entre 53 y 67 años de edad. Las principales causas de indicación quirúrgica de vitrectomía pars plana fueron el desprendimiento de retina y la hemorragia vítrea. La densidad celular promedio antes de la cirugía y después de esta mostró una pérdida de 634 células (26,8 %). La ausencia de polimegatismo y sus formas leves predominaron en el preoperatorio, hubo un incremento hacia formas moderadas y severas en el posoperatorio. El pleomorfismo se comportó de forma similar al polimegatismo. Las complicaciones posquirúrgicas fueron hipertensión ocular, síndrome tóxico del segmento anterior y uveítis anterior. Conclusiones: valorar el estado del endotelio antes de la cirugía permite trazar una estrategia quirúrgica encaminada a proteger esta importante capa corneal y establecer un pronóstico visual del paciente. De esta forma permite evaluar su comportamiento en el posoperatorio.Objective: to determine the corneal endothelium behavior in the cataract surgery and vitrectomy performed simultaneously. Methods: a prospective, descriptive and observational research was carried out in “Ramón Pando Ferrer” Cuban Institute of Ophthalmology from January to November 2010. The sample was made up of 15 eyes from 15 patients, who had undergone cataract surgery and vitrectomy simultaneously. Results: most of the patients were men aged 53 to 67 years. The main causes to indicate the pars plana vitrectomy were retinal detachment and vitreous hemorrhage. Before and after surgery, the average cellular density showed loss of 634 cells (26,8%). Mild polymegatism forms were not detected before surgery but moderate as well as severe forms were observed after surgery. Pleomorphism behaved similarly to polymegatism. Three complications were observed after surgery: ocular hypertension, toxic syndrome of the anterior segment and the anterior uveitis. Conclusions: the evaluation of the state of the corneal endothelium behavior before surgery helps drawing up a surgical strategy to protect this important corneal layer and to establish a visual prognosis of the patient as well as to evaluate the postsurgical progress.

OBJETIVO: Determinar el estado del endotelio corneal mediante la microscopia óptica convencional, antes y después de la extracción extracapsular del cristalino o facoemulsificación. MÉTODOS: Se realizó un estudio descriptivo, prospectivo y transversal a 100 pacientes diagnosticados de catarata a los que se les realizó técnica de Blumenthal y facomeulsificación, en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre septiembre- noviembre 2006. RESULTADOS: Predominaron pacientes masculinos, en los grupos de edades 40 a 59 y 60 a 79 años. La técnica de Blumenthal modificó la densidad celular y la hexagonalidad, pero no modificó el coeficiente de variabilidad. La técnica de facoemulsificación modificó todos los parámetros morfométricos. En la técnica de facoemulsificación, donde el tiempo de ultrasonido fue mayor, los pacientes tuvieron mayor pérdida endotelial. CONCLUSIONES: La microscopia especular debe ser incluida como un examen de rutina prequirúrgico y posquirúrgico en la cirugía de catarata para demostrar el efecto de la misma sobre el endotelio corneal.OBJECTIVE: To determine the state of the corneal endothelium by means of the conventional optic microscopy, before and after the extracapsular extraction of the crystalline lens or phacoemulsification. METHOD: Prospective, descriptive and cross-sectional study was performed in 100 patients diagnosed with cataract, who underwent surgery with the Blumenthal technique or Phacomeulsification procedure at "Ramón Pando Ferrer" Cuban Institute of Ophthalmology from September - November 2006. RESULTS: Males prevailed in the age groups of 40-59 and 60-79 years. The Blumenthal technique changed the cellular density and hexagonality, except for the variability coefficient. The phacooemulsificación method modified all the morphometric parameters and the longer application of ultrasound meant greater endothelial loss in patients subjected to this technique. CONCLUSIONS: The specular microscopy should be included as a routine test before and after every cataract surgery to demonstrate the effect of the surgical procedure on the corneal endothelium.

El cambio de una técnica quirúrgica a otra mucho más compleja, no deja de constituir un verdadero reto, más cuando esta técnica requiere de un difícil mecanismo de adaptación a nuevos criterios clínicos y tecnológicos, así como una curva de aprendizaje extensa y difícil, así se comporta el caso de la transición de la extracción extracapsular del cristalino (EECC) a la facoemulsificación en el manejo quirúrgico de la catarata. Nuestro estudio tuvo como objetivo comparar resultados anatómicos y funcionales del manejo quirúrgico de la catarata utilizando esas dos diferentes modalidades (extracción extracapsular del cristalino y facoemulsificación), además de valorar la agudeza visual posoperatoria con cristales y sin ellos, el cilindro refractivo y/o queratométrico posquirúrgico; comparar las modificaciones morfológicas y morfométricas después de implementar estos tipos de cirugía en la población celular del endotelio corneal y enumerar las complicaciones más frecuentes. Realizamos un estudio prospectivo, comparativo y descriptivo a 100 ojos portadores de catarata que fueron intervenidos (desde enero de 2005 a enero de 2006), mediante extracción extracapsular del cristalino (50 ojos), y facoemulsificación (50 ojos) como técnicas quirúrgicas, los cuales conformaron los grupos de estudio, atendiendo a los criterios de inclusión adoptados. A todos se les realizó seguimiento posoperatorio durante tres meses en el Centro de Microcirugía Ocular de nuestro Instituto Cubano de Oftalmología “Ramón Pando Ferrer”. Las variables analizadas fueron: edad, agudeza visual con cristales, astigmatismo inducido, conteo celular endotelial y complicaciones transoperatoria. La agudeza visual corregida o sin corrección fue superior en los ojos intervenidos mediante facoemulsificación. La recuperación visual fue mucho más precoz en los pacientes sometidos a facoemulsificación, se indujo menos astigmatismo en los pacientes del grupo de facoemulsificación, con un menor cilindro refractivo y queratométrico final. Los pacientes operados con la técnica de facoemulsificación presentaron menor deterioro del endotelio corneal, el grupo de facoemulsificación presentó un mayor número de complicaciones transoperatorias y posoperatorias, aunque escasas.The shift of a simpler surgical technique to a more complex procedure is a real challenge, even more if this technique requires a difficult mechanism of adapting to new clinical and technological criteria and the learning curve is also extensive and difficult. This is the case of the transition of extracapsular extraction of the crystalline to phacoemulsification in the surgical management of the cataract. Our study was intended to compare anatomic and functional results of two cataract surgical management modalities, that is, extracapsular extraction of the crystalline ECEC and phacoemulsification, in addition to assess postoperative visual acuity with/without spectacles and the refractive and /or keratometric cylinder after surgery; also to compare the morphological and morphometric changes after implementing these types of surgery in the cell population of the corneal endothelium, and to list the commonest complications. A prospective, comparative and descriptive study was performed in 100 eyes affected by cataract and operated on by ECEC (50 eyes) and by phacoemulsification (50 eyes) from January 2005 to January 2006, which were included in two study groups according to the approved inclusion criteria and followed up postoperatively for three months at the Center of Eye Microsurgery of “Ramon Pando Ferrer” Cuban Ophthalmologic Institute. The analyzed variables were age, visual acuity with the spectacles, induced astigmatism, endothelial cell count and transoperative complications. Corrected and non-corrected visual acuity was higher in phacoemulsification-treated eyes. Visual recovery occurred much earlier, induced astigmatism was lower and final refractive and keratometric cylinder was also lower in phacoemulsification-operated eyes. The patients who underwent phacoemulsification surgical technique exhibited less corneal endothelium deterioration although the number of transoperative and postoperative complications was higher.

Objetivo: determinar el comportamiento del endotelio corneal en pacientes sometidos a cirugías secuenciales de vítreo y catarata. Métodos: estudio observacional descriptivo, prospectivo en una muestra conformada por 15 ojos de 15 pacientes sometidos a cirugías múltiples del vítreo y del cristalino, entre enero y noviembre de 2010. Resultados: la mayoría de los pacientes fueron hombres entre 53 y 67 años. Las causas de indicación quirúrgica de vitrectomía pars plana fueron desprendimiento de retina y hemorragia vítrea. La densidad celular promedio preoperatoria y posoperatoria descendió el 17,2 %. Predominó la ausencia de polimegatismo y sus formas leves en el preoperatorio, con un incremento de formas moderadas y severas en el posoperatorio. El pleomorfismo se comportó de una forma similar al polimegatismo. Las complicaciones posquirúrgicas fueron la hipertensión ocular, el síndrome tóxico de segmento anterior y la uveítis anterior, con 9 casos entre los dos momentos quirúrgicos. Conclusiones: el endotelio corneal sufre modificaciones, tanto anatómicas como funcionales luego de ser sometido a una vitrectomía pars plana, las que se acentúan luego de una segunda cirugía, más aún si esta es en el segmento anterior como la extracción de la catarata por facoemulsificación.