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PURPOSE To investigate the safety and efficacy of cultured human corneal endothelial cell (hCEC)-injection therapy with mature differentiated (mature) cell subpopulations (SPs) for corneal endothelial failure (CEF). DESIGN Comparative, interventional case series. METHODS This study involved 18 eyes with CEF that underwent cultured hCEC-injection therapy, categorized into two groups: 1) 11 eyes administered a relatively lower proportion (0.1 to 76.3%) of mature cell SPs [Group 1 (Gr1)], and 2) 7 eyes administered a relatively higher proportion (>90%) of mature cell SPs [Group 2 (Gr2)]. From 1-week to 3-years postoperative, corneal endothelial cell (CEC) density (CECD), central corneal thickness (CCT), and best-corrected visual acuity (BCVA) were recorded, and the CEC parameter's 'spring constant' was calculated. The proportion of mature SPs was evaluated by fluorescence-activated cell sorting analysis based on cell-surface markers. RESULTS At 3-years postoperative, corneal restoration with improved BCVA was attained in 10 of the 11 Gr1 eyes and all Gr2 eyes, the median CECD in Gr2 (3,083 cells/mm2; range, 2,182-4,417 cells/mm2) was higher than that in Gr1 (1,349 cells/mm2; range, 746-2,104 cells/mm2) (P < 0.001), and the spring constant verified the superiority of the mature cultured hCECs. From 24-weeks through 3-years postoperative, the median percentage of CECD decrease was 3.2% in Gr2 and 23.6% in Gr1 (P < 0.005). CCT recovery was prompt and constant in Gr2, while diverse in Gr1. No adverse events were observed. CONCLUSION Our findings showed that mature cell SPs for hCEC-injection therapy provide rapid recovery of CCT, better CECD, and low CECD attrition over 3 years post surgery.

Cell therapies are emerging as a unique class of clinical therapeutics in medicine. In 2015, Holoclar (ex vivo expanded autologous human corneal epithelial cells containing stem cells) gained the regulatory approval for treating limbal stem cell deficiency after chemical eye burn. This has set a precedent in ophthalmology and in medicine, reinforcing the therapeutic promise of cell therapy. However, to generalize and commercialize cell therapies on a global scale, stringent translational and regulatory requirements need to be fulfilled at both local and international levels. Over the past decade, the Singapore group has taken significant steps in developing human corneal endothelial cell (HCEnC) therapy for treating corneal endothelial diseases, which are currently the leading indication for corneal transplantation in many countries. Successful development of HCEnC therapy may serve as a novel solution to the current global shortage of donor corneas. Based on the experience in Singapore, this review aims to provide a global perspective on the translational and regulatory challenges for bench-to-bedside translation of cell therapy. Specifically, we discussed about the characterization of the critical quality attributes (CQA), the challenges that can affect the CQA, and the variations in the regulatory framework embedded within different regions, including Singapore, Europe, and the United States. Impact statement Functional corneal endothelium is critical to normal vision. Corneal endothelial disease-secondary to trauma, surgery, or pathology-represents an important cause of visual impairment and blindness in both developed and developing countries. Currently, corneal transplantation serves as the current gold standard for treating visually significant corneal endothelial diseases, although limited by the shortage of donor corneas. Over the past decade, human corneal endothelial cell therapy has emerged as a promising treatment option for treating corneal endothelial diseases. To allow widespread application of this therapy, significant regulatory challenges will need to be systematically overcome.

PURPOSE To investigate the corneal endothelium damage in Graves ophthalmopathy (GO) and its role as a promising quantitative index to evaluate GO activity. DESIGN Cross-sectional study. METHODS This study included 128 eyes of 64 patients with GO. All subjects underwent ophthalmologic examinations, including proptosis, tear break-up time (BUT), corneal fluorescein staining, and Schirmer test. Corneal endothelium was measured by noncontact specular microscope and ocular biometric parameters were measured by IOLMaster 700. Each eye was assigned a specific clinical activity score (CAS), then grouped as active (CAS ≥3 points) or inactive (CAS

Background: Mitomycin C is an antimetabolite and affects corneal endothelial cells as measured by noncontact specular microscopy after trabeculectomy with mitomycin-C (MMC). Objective: To evaluate the corneal endothelial cells changes after trabeculectomy with MMC. Patients and methods: Patients were categorized into 2 groups, group A(25 eyes) were managed by trabeculectomy with mitomycin-C injection, group B (25 eyes) were managed by trabeculectomy with mitomycin-C sponge-applied technique which was carried out on patients attending at Ophthalmology Department of Al-Azhar University Hospitals from March 2019 to February 2021. Follow-up by specular microscopy preoperatively and 1 month and 6 months postoperatively to evaluate corneal endothelial cells density and morphological changes. Results: There was a significant reduction in the endothelial cell density and percentage of hexagonal cells and increased variation in cell size in the two studied groups after 1 month and 6 months compared with preoperative values. With no differences between the two studied groups. Conclusion: Trabeculectomy with both MMC injection and sponge applied caused a significant loss of the corneal endothelial cells intraoperatively or at the early postoperative period. Progressive cell losses due to MMC were not a major concern.

AIM: To investigate the safety and efficacy of using a one-step viscoelastic agent technique for posterior chamber phakic implantable collamer lens with a central hole (ICL V4c) implantation for myopia correction. METHODS: The one-step viscoelastic agent technique for ICL V4c implantation was used in 100 eyes of 52 patients. Refractive outcomes, intraocular pressure (IOP), corneal endothelial cell, and corneal densitometry values were evaluated at 1d, 1wk, 1 and 3mo postoperatively. RESULTS: All the surgeries were uneventful. No corrected distance visual acuity was lost after 3mo. IOP was 16.12±3.18 mm Hg before surgery, and 14.74±3.08 mm Hg at 1d and 14.50±2.56 mm Hg at 3mo after surgery (P0.05). The corneal densitometry values of the central 2 mm and 2 to 6 mm areas showed similar regularities. After surgery, the values significantly increased at 1d, then decreased to the preoperative values at 1wk, and then continued to decrease at 3mo (P

AIM:To evaluate the effect of the vault on corneal endothelial cells after implantation of central hole implantable lens(ICL)V4c without viscoelastic microincision.METHODS: Prospective non-randomized controlled study. A total of 70 patients(137 eyes)with myopia who underwent ICL V4c implantation in our hospital from November 2017 to February 2018 were divided into low vault group(100μm

Purpose: To investigate the effects of horizontal and oblique strabismus surgery on the corneal endothelial cell layer. Methods: Eighty-three eyes of 56 patients were prospectively evaluated. Corneal endothelial cell layer analysis was performed with a specular microscopy device (EM-3000; Tomey Corporation) preoperatively and 1 day, 2 weeks, and 2 months postoperatively. Endothelial cell density, coefficient of variation, average cell area, standard deviation (SD) of the endothelial cell area, hexagonality, and central corneal thickness (CCT) were evaluated. Results: Endothelial cell density, average cell area, and SD of the endothelial cell area did not show a statistically significant change postoperatively. In the one and two horizontal muscle surgery groups, the hexagonality measurements 2 weeks postoperatively were significantly lower compared to preoperative values. In the one horizontal muscle surgery group and when all patients were examined, CCT 1 day postoperatively was significantly higher than 2 weeks postoperatively. No significant change was observed postoperatively in any of the endothelial parameters in the oblique surgery group. Spherical equivalent was positively correlated with endothelial cell density and CCT, and it was negatively correlated with the average cell area and age. Age was positively correlated with the average cell area and the SD of the endothelial cell area, negatively correlated with endothelial cell density and hexagonality, and was not correlated with the coefficient of variation or CCT. Conclusions: There is a temporary effect of horizontal strabismus surgery on hexagonality and corneal thickness. A definite decrease in cellular hexagonality occurs as the number of endothelial cells decrease and cell areas increase with age. [ J Pediatr Ophthalmol Strabimus . 2021;58(4):254–260.]

In 2013, a clinical trial was initiated to investigate cell therapy for the treatment of corneal endothelial decompensation. Cultivating human corneal endothelial cells (CECs) while maintaining their functional phenotype is challenging; therefore, establishment of a confirmed protocol is pivotal for obtaining approval from regulatory authorities for use of cellular therapy products. In this study, we evaluated organ culture (OC) as a storage method for donor corneas used as a raw material for establishing CEC cultures. OC allows storage of corneal tissue for conventional corneal transplantation at 31-37 °C for up to 5 weeks, whereas storage at 4 °C is limited to 2 weeks. We investigated 20 pairs of corneas: one cornea of each pair was stored in OC and the other in cold storage for one week before CEC culture. In 15/20 cases, the CECs assumed a hexagonal sheet-like monolayer structure and expressed endothelial function-related markers. CECs were also obtained from OC corneas that had been stored for 1 (n = 19) and 2 (n = 7) months. As a further test, CECs were cultivated from 5 OC corneas that had been transported from France to Japan. In all cases, these corneas, even after international transport, generated CECs that formed hexagonal monolayers with clinically applicable and sufficiently high cell densities. In conclusion, the CEC cultures required for endothelial cell therapy can be obtained from OC corneas without changing the standard storage operating procedures of the eye banks.

Objective: To compare the effect of Hydroxypropyl methylcellulose versus Sodium Hyaluronate on corneal endothelial cell count in patients undergoing cataract surgery by phacoemulsification. Design: It was a randomized clinical trial. Study Settings: This study was conducted at the Eye Unit III, Mayo Hospital / KEMU, Lahore over 12 months period from June 2014 to May 2015. Hypothesis: There is a significant difference in protective effect on corneal endothelial cell loss with dispersive (Hydroxypropyl methylcellulose) viscoelastic agent as compared to cohesive (sodium hyaluronate) viscoelastic agent used during phacoemulsification with intraocular lens for the treatment of cataract. Material and Methods: Total 80 patients from both the genders aged between 40-70 years with cataract undergoing phacoemulsification surgery were involved in this study. Two equal treatment groups were made by random allocation. Patients in Group-A (n=40) received Hydroxypropyl methylcellulose as viscoelastic agent while patients in Group-B (n=40) received treatment with Sodium Hyaluronate. Surgery was carried out by phacoemulsification technique and follow-up was done at first week, 1st month and 3rd month post-operatively. Data was collected in terms of endothelial cell count by noncontact specular microscope. Results: Patients age was in the range of 40 to 70 years with a mean of 57.26 ± 8.00 years. There were 31 (38.75%) females and 49 (61.25%) male patients with a female to male ratio of 1.6:1. Both the groups had no statistically significant difference in the mean corneal cell count before surgery (2839.67±368.71 cells/mm2 vs. 2801.36 ± 332.52 cells/mm2; p-value= 06.27). Post-operative mean corneal cell count at 1 week, 1 month and 3 months was significantly higher in patients in Group-A compared to Group-B. Similarly, significant difference was noted across various subgroups of both the groups on the basis of patient’s age and gender. Conclusion: This study concluded that there is less corneal endothelial cell loss with dispersive Hydroxypropyl methylcellulose viscoelastic agent as compared to cohesive sodium hyaluronate viscoelastic agent used during phacoemulsification surgery with intraocular lens implant for the treatment of cataract. Keywords: Cataract, phacoemulsification, viscoelastic agents, corneal, endothelial cell.

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

AIM: To explore the protective effect of dexamethasone combined with hypertonic solution on corneal endothelial cells of rabbit eyes. METHODS: We made four groups of rabbits for different treatments with dexamethasone and hypertonic solution. All groups were treated with low-permeability solution for 10min to maintain anterior chamber perfusion. Group A was treated with 0.2mL dexamethasone subconjunctival injection, and hypertonic glucose eye drop immediately after surgery. Group B(control group)was subjected to 0.2mL of 0.9% saline subconjunctival injection, and balanced salt solution eye drop immediately after surgery. In group C, 0.2mL dexamethasone subconjunctival injection, and hypertonic glucose eye drop were given on the second day of surgery and in group D(control group), 0.2mL of 0.9% saline through subconjunctival injection and balanced salt solution eye drop were given on the second day of the surgery. The edema degree of cornea was observed with slit lamp before the operation and on the 1, 3, 5 and 7d after operation. The cornea were also examined by anterior segment OCT, and the corneal thickness was measured by A-scan ultrasonography.RESULTS: In group A, during the entire experimental observation period, the cornea had no edema or only mild edema, the thickness of the central cornea hardly increased, and the number of corneal endothelial cells did not change significantly. There was no significant difference compared with(control group B)before modeling(P>0.05). In groups B, C, and D, corneal edema and corneal thickness increased after the rabbit eyes were modeled. There was a significant difference compared with group A(PPCONCLUSION: Dexamethasone combined with hypertonic glucose solution has a good protective effect on rabbit corneal endothelial cells. And early application can effectively prevent rabbit corneal edema and this method can also prevent the progression of corneal endothelial decompensation.

Endothelial keratoplasty (EK) is increasingly used to treat corneal endothelial disease. However, issues remain with EK including a non-zero rejection rate, shortage of donor tissue, and technical challenges for Descemet’s membrane endothelial keratoplasty. Technologies that might solve these issues include small-molecule drugs, surgical innovations, cell therapy, tissue engineering, and gene therapy. Our purpose is to inform ophthalmologists, eye bankers, and eye health professionals of technologies that could impact practice in the near future. Recent advances are targeted at solving known issues with EK. Although none is yet routine, some are in clinical trials. Technologies that are closest to an ideal solution are those facing the highest regulatory and commercial hurdles. In the future, there will multiple options for the treatment of corneal endothelial cell failure. Which of these differing treatments will be used will depend on their efficacy as well as commercial, regulatory, and patient factors.

To summarize the recent advances of clinical and preclinical studies for corneal endothelial tissue bioengineering. The challenges facing the generation of a clinical applicable corneal endothelial graft can be broadly classified into cell source selection, culture medium optimization, scaffold establishment, and the following three- and four-dimensional (4D) corneal construction. Based on the current advances in primary human corneal endothelial cell (HCEC) culture and good manufacturing practice (GMP)–compliant medium development, the first clinical trial of bioengineered HCEC injection therapy has been conducted with encouraging results. Other significant findings include the in vivo experiments of the stem cell–derived HCEC, the development of serum-, xeno-, and additive-free media, and the construction of 4D scaffold. It can be anticipated that tissue engineering–based therapy toward corneal endothelial diseases will replace the current keratoplasty method as a promising treatment option in the near future.

To evaluate the changes in the corneal endothelial cell parameters and macular thickness after intraocular application of epinephrine $$\frac{1}{{10,000}}$$ and epinephrine $$\frac{1}{{100,000}}$$ . In this study, 210 eyes from 210 patients with age-related cataracts who underwent uncomplicated surgery were included. For all patients, specular microscopy of the corneal endothelium and macular OCT were performed before surgery and 3 months after the surgery. Patients were divided randomly into three groups: without drug (control group), epinephrine $$\frac{1}{{10,000}}$$ , and epinephrine $$\frac{1}{{100,000}}$$ . Three months after the surgery, specular microscopy of the cornea and macular OCT measurements were performed. Measurements were compared between the three groups. Postoperative measurements were also compared with those measurements obtained before surgery. All the three groups showed a statistically significant decrease in the endothelial cell density after surgery; the reduction in endothelial cell density in the epinephrine $$\frac{1}{{10,000}}$$ group was significantly more than those of the other two groups (P value

AIM:To investigate the effects of 1.8mm coaxial micro-incision phacoemulsification in cataract patients with diabetic.METHODS: Totally 130 eyes in 130 patients with type 2 diabetes mellitus were underwent phacoemulsification from January 2017 to December 2018, and they were randomly divided into observation group of 63 cases(63 eyes)and control group of 67 cases(67 eyes). The best corrected visual acuity(BCVA)of the two groups were compared. Average phacoemulsification energy(AVE), effective phacoemulsification time(EPT)were recorded of two groups. Corneal endothelial cell counts, corneal astigmatism and complications of two groups were compared preoperatively and 1wk, 1mo and 3mo postoperatively.RESULTS: The BCVA in observation and control groups were improved after 7d, 1, 3mo operation(Pt=3.89, Pt=0.773, P=0.221)between them were not. The corneal endothelial cell counts between the two groups was not significantly different before surgery(t=1.21, P=0.114), while it reduced a lot postoperatively in both groups. The surgically induced corneal astigmatism of the observation group was much smaller than that of the control group, and the differences were statistically significant. The main complication was corneal edema.CONCLUSION: The 1.8mm coaxial micro-incision phacoemulsification is helpful to reduce surgically induced astigmatism and has less effect on corneal endothelial cell of patients with type 2 diabetic comparing to normal 3.0mm incision phacoemulsification.

AIM: To explore the effect of phacoemulsification and intraocular lens implantation on corneal endothelial cells(CECs)in patients with glaucoma and cataract. METHODS: The clinical data of 107 patients(113 affected eyes)with glaucoma and cataract who were treated in the hospital during the period from October 2016 to October 2018 were retrospectively analyzed. Patients treated with trabeculectomy or phacoemulsification combined with intraocular lens implantation were included in the control group(n=52, 54 affected eyes)and the study group(n=55, 59 affected eyes). The changes in visual acuity, anterior chamber depth and intraocular pressure before and after surgery, CECs related indexes and incidence of postoperative complications were compared between the two groups. RESULTS: There was no significant difference in visual acuity between the two groups before surgery(P>0.05). The visual acuity of both groups were significantly improved after surgery(PPPPP>0.05). The cell area variation coefficient, hexagonal cell ratio, average cell area and corneal center thickness in control group increased significantly, while CECs density decreased significantly after surgery(PP>0.05). After surgery, changes levels of CECs related indexes in study group were significantly lower than those in control group(PPCONCLUSION: The application of phacoemulsification and intraocular lens implantation in the treatment of glaucoma with cataract can improve the visual acuity and intraocular pressure of patients, maintain structural integrity of CECs, with safety.

PURPOSE To determine the limits of normal interocular symmetry and the repeatability of central corneal thickness (CCT) and endothelial cell morphology and density. METHODS Two hundred and seventy-eight subjects (age: 10.9-80.7 years) with healthy eyes were studied. CCT as well as endothelial cell morphology and density were measured by non-contact specular microscopy. Three measurements were obtained per eye per participant. Upper and lower tolerance limits of normal interocular symmetry were defined as the 2.5th and 97.5th percentiles of the interocular differences in CCT, endothelial cell density (CECD), coefficient of variation (CoV), hexagonality, and cell size. Repeatability was determined using the intraclass coefficient correlation (ICC), the coefficient of variation (CV), and the test-retest variability standard deviation (TRTSD). RESULTS The mean interocular differences were -1.05 ± 17.5 µm (p = .32) for CCT and 0.5 ± 90.8 cells/mm2 (p = .76) for CECD. The 2.5th and 97.5th percentiles of the interocular differences were -13.9 and 15.4 µm for CCT and -177.4 cells/mm2 to 182.0 cells/mm2 for CECD. Only interocular difference in CoV correlated weakly with age (r = -0.22, P

Objective To compare corneal endothelial cell changes after femtosecond laser-assisted cataract surgery (FLACS) in diabetic and nondiabetic patients. Methods This retrospective study included patients with cataract who underwent FLACS performed by a single surgeon between August 2018 and November 2020. Changes in corneal endothelial cell density (ECD), hexagonality, coefficient of variation in cell size (CV), and central corneal thickness (CCT) at baseline and at the 1-month and 3-month postoperative follow-ups were investigated by dividing the patients into diabetic and nondiabetic groups. Results We included 75 patients (60% men, mean age: 57.7±11.4 years, range: 27-80 years) in the analysis: 31 diabetic patients (64% men, mean age: 58.7±11.9 years, range: 27-79 years) and 44 nondiabetic patients (56% men, mean age: 57.1±11.3 years, range: 34-80 years). No differences were observed between the two groups as regards preoperative and intraoperative parameters, the mean postoperative ECD, hexagonality, and CV. At 1 month postoperatively, the CCT was significantly greater in the diabetic group (P=0.034); however, at 3 months, there was no significant difference between the two groups (P=0.927). Conclusions Changes in postoperative corneal endothelial cells were comparable between patients with and without diabetes after FLACS. Femtosecond laser-assisted cataract surgery seems to cause less damage to the corneal endothelium in diabetic patients because it uses less phacoemulsification energy.

We compared the changes in corneal endothelial cells and surgical outcomes after Ahmed glaucoma valve (AGV) implantation with the valve tip inserted either into ciliary sulcus (CS) or anterior chamber (AC). We retrospectively reviewed the medical records of patients treated with CS AGV (n = 24) and AC AGV (n = 38). We compared the preoperative and postoperative central corneal endothelial cell density (ECD), endothelial cell coefficient of variation (CV), best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications, and postoperative complications in the two groups. Both groups had similar baseline characteristics and follow-up period. At the last follow-up, the AC AGV group had significantly higher mean monthly ECD loss (17.47 ± 11.50 cells/mm2 vs. 6.40 ± 7.69 cells/mm2, p p

Corneal endothelial dysfunction is a principal cause of visual deficiency. Corneal transplantation is the most effective treatment for corneal endothelial dysfunction. However, a severe shortage of available donor corneas or human corneal endothelial cells (HCECs) remains a global challenge. Previously, we acquired corneal endothelial cell-like cells (CEC-like cells) derived from human skin-derived precursors (SKPs). CEC-like cells were injected into rabbit and monkey corneal endothelial dysfunction models and exerted excellent therapeutic effect. In this study, we prolonged the clinical observation in the monkey experiment for 2 years. Polymerase chain reaction (PCR) and DNA sequencing were carried out to confirm the existence of CEC-like cells. Histological examinations were carried out to show the corneal morphology. Further transcriptome sequencing was also carried out on HCEC, CEC-like cells before transplantation and after transplantation. We found that the monkeys cornea remained transparent and normal thickness. The total endothelial cell density decreased gradually, but tended to be stable and remained in a normal range during 2-year observation. The CEC-like cells persist during observation and could adapt to the microenvironment after transplantation. The gene expression pattern of CEC-like cells was similar to HCEC and changed slightly after transplantation. In conclusion, this study presented a brand-new insight into CEC-like cells and further provided a promising prospect of cell-based therapy for corneal endothelial dysfunction. The renewable cell source, novel derivation method and simple treatment strategy may be clinically applied in regenerative medicine in the future.

We performed an investigation of the temporal impact on corneal endothelial cell (CEC) shape after ophthalmic instillation of one drop of the ROCK inhibitor, ripasudil. Subjects comprised 32 healthy adult volunteers, each of whom instilled ripasudil in the right eye. CEC shape [defined as CEC density (CECD), coefficient of variation (CV), and hexagonal cell rate (6A)], central corneal thickness (CCT), intraocular pressure (IOP), and conjunctival hyperemia were evaluated before instillation (baseline) and at 15 min, 1 h, 2 h, and 4–6 h after instillation by non-contact specular microscopy and slit-lamp microscopy. The incidence of pseudo gutta was also assessed. The CECD (cells/mm2) significantly decreased after instillation as follows: 2661 cells/mm2 at baseline, 2578 cells/mm2 at 15 min, 2527 cells/mm2 at 1 h, 2575 cells/mm2 at 2 h, and 2613 cells/mm2 at 4–6 h. After instillation, CV significantly increased and 6A significantly decreased. Pseudo gutta appeared in 18 subjects (56.3%) after instillation. There was no difference in CCT before and after instillation. IOP significantly decreased after instillation. The most severe conjunctival hyperemia was observed at 15 min after instillation, but had nearly disappeared within 2 h. Pseudo gutta appeared in more than half of the subjects, and the CEC shape changed upon instillation of one drop of ripasudil; however, it recovered at 4–6 h after instillation. Therefore, these changes would not greatly impact clinical treatment. Similar to the presence of conjunctival hyperemia, changes in CEC shape occur at early stages after instillation of ripasudil.

Background: Mitomycin-C was suggested for application during surface ablation procedures to reduce post-operative haze formation. It can effectively reduce haze formation and hence, improve the predictability of visual outcomes following refractive surgery. Despite these advantages, MMC can po-tentially damage all three main corneal cell types including epithelial (differentiated epithelium and limbal cells), stromal (keratocytes), and endothelial cells.Aim of Study: To investigate the croneal endothelial cell changes after Photorefractive Keratectomy (PRK) with and without Mitomycin-C 0.02% for low to moderate myopia.Patient and Methods: This prospective, randomized, comparative study included 60 eyes of 30 patients who were chosen from Ophthalmology Clinic at Tanta University Hos-pital and Shorouk Laser Vision Correction Centre for 6 month from December 2017 to May 2018 and scheduled for Photo-refractive Keratectomy (PRK) using193nm wavelength exci-mer laser system Allegretto EX500, (Wave Light Technologie., USA). These patients were randomly divided into two groups. Group (A) were scheduled for (PRK) with adjunctive mito-mycin-C 0.02% and patients of Group (B) were scheduled for (PRK) without mitomycin-C. Informed consents were obtained from all study participants.Results: In Group A the mean Endothelial Cell Density (ECD) was 2891.61±272.41 and at three months after surgery was 28 13.04±276.55cells/mm2 (p=0.289), pre-operative mean of Coefficient of Variation (CV) was 34.87±4.37 and post-operatively was 34.70±4.06 (p=0.877), the pre-operative mean of Central Corneal Thickness (CCT) was 523.00±26.14 m and 467.36±40.61 m post-operatively (p=0.001), the mean of hexagonality pre-operatively was 64.26±8.64% and 59.96± 8.15% post-operatively (p=0.059) which was statistically insignificant. In Group B the mean Endothelial Cell Density was (ECD) 2874.50±314.48 and at three months after surgery was 2777.23±302.44cells/mm2 (p=0.227), pre-operative mean of Coefficient of Variation (CV) was 33.49±4.98 and post-operatively 33.55±4.10 (p=0.962), pre-operative mean of central corneal thickness was 538.03±26.03 and 484.50±20.55 post-operatively (p=0.001), the mean of hexagonality pre-operatively was 63.00±7.74 and 61.43±7.29% post-operatively (p=0.423).Conclusions: There's no significant effect on endothelium in patients underwent to PRK in low to moderate myopia with or without mitomycin-C. We can't judge the same results for patients with high myopia because the ablation depth will be more and theoretically the diffusion of mitomycin-C to en-dothelium would affect its function or count.

AIM:To compare the effects of manual small incision cataract surgery and phacoemulsification combined with intraocular lens implantation on corneal endothelial cells in diabetic patients with age-related cataract.METHODS: Totally 128 eyes of 128 diabetic patients with age-related cataract treated in our hospital from July 2015 to December 2017 were divided into manual small incision group and ultrasound group according to different surgical methods. The visual acuity, astigmatism, morphology and function of corneal endothelial cells were observed before and 1 and 6wk after operation.RESULTS: The preoperative LogMAR visual acuity of manual small-incision group and ultrasound group were 0.75±0.30 and 0.80±0.29, which decreased to 0.14±0.05 and 0.15±0.04 at 6wk after surgery(P2, 2894.17±365.21/mm2, decreasing to 2714.15±431.01/mm2, 2689.22±333.45/mm2 at 6wk after surgery. The proportions of hexagonal cells were 52.16±10.11% and 49.51±11.07% before surgery, decreasing to 37.48±11.24% and 39.31±10.47% at 6wk after surgery. The preoperative corneal variation coefficients were 38.45±5.64 and 40.17±5.69, increasing to 43.27±4.85 and 44.01±4.91. There were significant differences in corneal thickness, endothelial cell density, hexagonal cell ratio and corneal variation coefficient at differences time points in the same groups(PP>0.05).CONCLUSION: Manual small incision cataract and phacoemulsification combined with intraocular lens implantation can improve the visual acuity of diabetes mellitus patients with age-related cataract. There is no significant difference in visual acuity recovery and corneal endothelial cell injury after operation. The efficacy and safety are comparable.

The prospective case series aimed to examine the agreement between the use of a slit-scanning contact specular microscope and a noncontact specular microscope in corneal endothelial cell (CEC) analysis and to evaluate the differences between the central and peripheral regions in normal corneas.After confirming normal corneal endothelium with slit-lamp microscopy, CEC images of 56 eyes of 56 cataractous patients were analyzed in the central and 4 peripheral regions using a slit-scanning contact specular microscope. A noncontact specular microscope was used for the analysis in the central region. The endothelial cell density (ECD), the percentage of hexagonal shape cells (HEX), and the coefficient of variation (CV) in the central region were compared. Differences between central and peripheral CECs were also evaluated.The mean ECD was 2778 cell/mm and was not different from the results using the noncontact specular microscope (2736 cell/mm, P = 0.051). There was a significant correlation (P0.001, R = 0.72). The analysis of HEX resulted in larger values with the slit-scanning contact microscope (53.13% vs. 48.89%, P0.001), whereas there was no difference in the CV (38.48 vs. 38.04, P = 0.56). On comparing the central and peripheral regions, there was no significant difference in the ECD, whereas significant differences were found in the superior region in the HEX and CV (P0.001) and in the nasal region in CV (P = 0.023).The analysis of ECD with the use of the slit-scanning contact specular microscope did not differ from the noncontact specular microscope, and the results demonstrated no difference between the central and peripheral ECD.

Purpose: To evaluate the effect of intravitreal anti-VEGF on corneal endothelial cell count and central corneal thickness as well as to compare these in phakic and pseudophakic eyes. Material and Methods: The study was conducted in 102 eyes selected, as per selection criteria, over a time period of 18 months. At first patient visit, examination included: 1. Fundus examination. 2. Specular microscopy was done to look for endothelial cell count and Central corneal thickness. At second visit, Injection 0.5 mg/0.05 ml of ranibizumab was administered. Visits at day 1, day 7 and 1 month were done for Endothelial cell density and central corneal thickness was measured by specular microscope Results: The mean CCT value in pseudophakic group was 502.08 ± 19.91, 501.9 ± 20.31, and 501.72 ± 21.55 on day 1, 7 and 30, respectively. The mean CCT value in phakic group was 506.53 ± 22.61, 505.96 ± 20.12, 505.92 ± 20.3 and 505.69 ± 21.47. The mean value of ECD in pseudophakic eyes on day 1, 7, and 30 were 2284.24 ± 299.86, 2281.39 ± 289.46 and 2284.06 ± 312.65 cells/mm2, respectively. The mean value of ECD in phakic eyes on day 1, 7, and 30 were 2314.51 ± 212.08, 2313.92 ± 212.7 and 2313.63 ± 216.86 cells/mm2, respectively. Conclusion: There is no significant change in endothelial cell density, central corneal thickness, coefficient of variation and intraocular pressure before and after intravitreal injection over one month of follow-up. The results are similar between phakic and pseudophakic eyes.

To determine how the Rho kinase inhibitor, ripasudil, affects metabolic function and cell viability in donor human corneal endothelial cells (HCECs).Endothelial cell-Descemet membrane (EDM) tissues were treated with 10 μM ripasudil and assayed for mitochondrial and glycolytic activity using extracellular flux analysis and then compared to untreated controls. In addition, EDM tissues with a 24-h ripasudil treatment and control tissues were exposed to 1 μM staurosporine to induce apoptosis and then analyzed for cell viability using apoptosis and necrosis assays.Mitochondrial respiration metrics, specifically maximal respiration (P = 0.758) and spare respiratory capacity (P = 0.777), did not differ among the 1-h ripasudil treatment, 24-h treatment, and untreated tissues. Glycolytic activity assays showed an increase in glycolytic capacity at 1 h compared to the 24-h exposure group (P = 0.049) and controls (P = 0.009). Following exposure to staurosporine, the percentage of apoptotic HCECs was lower (P = 0.009) in ripasudil-treated tissues (2.473%, standard error of the mean [SEM] 0.477%) compared to untreated controls (3.349%, SEM 0.566%). In contrast, the percentage of necrotic HCECs decreased but did not differ statistically (P = 0.158) between ripasudil-treated (3.789%, SEM 0.487%) and untreated (4.567%, SEM 0.571%) tissues.Exposures to ripasudil did not result in any detectable reduction in metabolic function for HCECs in an ex vivo donor tissue model, and an increase in glycolytic activity at the 1-h time point was detected. In addition, HCECs treated with ripasudil gained a protective effect against induced apoptosis, suggesting that ripasudil may help improve the integrity of the corneal endothelium.

Purpose The purpose of this study was to evaluate the features of and relationships among corneal diameter, central corneal thickness (CCT), endothelial cell density (ECD), and corneal refractive properties in cases of microcornea (MC) with normal axial length. Methods We included 22 patients (35 eyes) with MC and cataracts and 41 patients (48 eyes) with isolated cataracts as age-matched controls. They were divided into patients with MC younger than 18 years (MC-child), patients with MC 18 years or older (MC-adult), children with congenital cataracts (CCs), and adults with senile cataracts (SCs). Corneal diameter, axial and anterior chamber length, and keratometry were measured; central corneal endothelial cell imaging was performed. Results The mean horizontal corneal diameter was 7.71 ± 1.51 and 8.78 ± 0.52 mm in MC-child and MC-adult groups, respectively, and 11.89 ± 0.59 and 11.52 ± 2.42 mm in child and adult controls, respectively. The mean CCT was 641.26 ± 63.37 (MC-child) and 617.38 ± 45.40 mm (MC-adult), and 554.92 ± 34.64 (CC) and 551.58 ± 28.47 mm (SC). The mean ECD was 2898.47 ± 443.90 (MC-child) and 2825.81 ± 484.65 cells/mm2 (MC-adult), and 3155.13 ± 372.67 (CC) and 2749.33 ± 399.63 cells/mm2 (SC). The average keratometry was 44.22 ± 3.14 D (MC-child) and 43.86 ± 2.59 D (MC-adult), and 44.19 ± 1.44 D (CC) and 43.94 ± 1.34 D (SC). Conclusions Patients with MC and normal axial length possess specific parameters, including significantly smaller corneal diameter and thicker CCT than the patients in the control groups. There were no significant differences in ECD and average keratometry. These parameters should be taken into account in the follow-up and treatment.

Purpose To determine the pachymetric and corneal endothelial cell morphometric features and their relationship to ocular and systemic factors in healthy Congolese subjects. Methods Non-contact specular microscopy was used in 278 healthy eyes (278 subjects) to measure central corneal thickness (CCT), corneal endothelial cell density (CECD) along with cell size, coefficient of variation (CV) in cell size, and hexagonality (HEX). The lower and upper reference limits and average values for each parameter were determined. Correlation and association of average values with anthropo-demographic and clinical variables were assessed. Results The mean age was 38.9 ± 17.2 years (10.9–80.7 years). Average values were 504.2 ± 30.7 μm (CCT), 2907.1 ± 290.9 cells/mm2 (CECD), 348.5 ± 38.4 μm2 (cell size), 32.9 ± 3.6% (CV), and 51.8 ± 7.2% (HEX). CCT was 504.9 ± 33.6 μm in men and 503.6 ± 28.3 μm in women (p = .73); values for CECD were 2917.1 ± 253.5 cells/mm2 and 2899.2 ± 317.8 cells/mm2 (p = 0.61), respectively. Lower and upper reference limits were 449.6 μm and 566.0 μm for CCT, and 2165.3 cells/mm2 and 3414.4 cells/mm2 for CECD, respectively. CCT correlated with body mass index (BMI), (r = − 0.12, P = 0.04). CECD decreased with age (r = − 0.49, P r = − 0.20, P = 0.001), intraocular pressure (r = − 0.13, P = 0.029) and ocular perfusion pressure (r = − 0.28, P = 0.028). CECD decayed by 8.3 cells/mm2 or 0.30% per year of age and CCT decreased by 0.72 μm per kg/m2. Conclusions Mean central cornea was thinner, CECD higher, and references limits lower than reported in other African populations. The CCT and CECD normative values reported herein will be useful for both clinical and research purposes in this population.

PRCIS We reduced the tube length through small limbal incision in eyes underwent Ahmed glaucoma valve implantation and found rate of corneal endothelial cell density was markedly reduced from -12.2%/year to -3.5%/year after this simple procedure. PURPOSE To evaluate the effect of postoperative tube tip trimming (TT) after Ahmed glaucoma valve (AGV) implantation on corneal endothelial cell (CEC) loss. METHODS In this retrospective cohort study, a total of 75 eyes from 67 patients (41 eyes in the AGV implantation only group (AGVG: mean follow up, 42.2±13.8▒mo) and 34 eyes in the TT after AGV implantation group (TAGVG: mean follow up, 64.9±18.5▒mo) were analyzed. TT was performed through a small limbal incision at a mean of 41 months after AGV implantation. Both groups were followed up for at least 1 year and underwent at least two specular microscopic (SM) examinations after AGV implantation and/or TT. RESULTS In the AGVG, CEC density was reduced from 2247.0±527.3 to 1665.7±643.3▒cells/mm2 (P

Corneal transplantation is currently the most effective treatment to restore corneal clarity in patients with endothelial disorders. Endothelial transplantation, either by Descemet membrane endothelial keratoplasty (DMEK) or by Descemet stripping (automated) endothelial keratoplasty (DS(A)EK), is a surgical approach that replaces diseased Descemet membrane and endothelium with tissue from a healthy donor eye. Its application, however, is limited by the availability of healthy donor tissue. To increase the pool of endothelial grafts, research has focused on developing new treatment options as alternatives to conventional corneal transplantation. These treatment options can be considered as either 'surgery-based', that is tissue-efficient modifications of the current techniques (e.g. Descemet stripping only (DSO)/Descemetorhexis without endothelial keratoplasty (DWEK) and Quarter-DMEK), or 'cell-based' approaches, which rely on in vitro expansion of human corneal endothelial cells (hCEC) (i.e. cultured corneal endothelial cell sheet transplantation and cell injection). In this review, we will focus on the most recent developments in the field of the 'cell-based' approaches. Starting with the description of aspects involved in the isolation of hCEC from donor tissue, we then describe the different natural and bioengineered carriers currently used in endothelial cell sheet transplantation, and finally, we discuss the current 'state of the art' in novel therapeutic approaches such as endothelial cell injection.

Syril Dorairaj,1 Goundappa K Balasubramani2 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USACorrespondence: Syril DorairajMayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USATel +1 201-704-7896Email syrildorairaj@gmail.comPurpose: To characterize changes in endothelial cell density and morphology following phacoemulsification combined with either excisional goniotomy with the Kahook Dual Blade (KDB-phaco) or first-generation iStent trabecular microbypass implantation (iStent-phaco).Setting: A single clinical practice.Methods: Twenty-one adult subjects from one center with visually significant cataract and mild-moderate open-angle glaucoma underwent KDB-phaco or iStent-phaco in one eye and the alternate procedure in the fellow eye as part of a prospective, multicenter, randomized trial. Specular microscopy and pachymetry were performed before and 6– 29 months after surgery. Parameters analyzed included change from baseline of endothelial cell density (ECD), the coefficient of variation (CV), the percent of hexagonal cells (%HEX), and central corneal thickness (CCT).Results: Baseline ECD, CV, %HEX, and CCT were similar between groups. A mean (standard deviation) of 18.2 (5.8) months postoperatively (range 12.5– 28.7 months), the change from baseline in ECD was − 90 ± 226 cells/mm2 (− 3.4%) in KDB-phaco eyes (p=0.083) and − 239 ± 247 cells/mm2 (− 9.0%) in iStent-phaco eyes (p< 0.001); the change in iStent-phaco eyes was significantly greater than in KDB-phaco eyes (p=0.013). The magnitude of Endothelial Cell Loss (ECL) was not correlated with length of postoperative follow-up time in either group. No significant differences in change from baseline in CV, %HEX, or CCT were noted with the exception of a decrease in %HEX in iStent-phaco eyes (p=0.017). No eyes manifested corneal edema, decompensation, or other cornea-related complications.Conclusion: Both KDB-phaco and iStent-phaco are associated with postoperative ECL, with iStent-phaco producing significantly greater ECL than KDB-phaco. The clinical significance of these findings is unclear, and future studies are warranted to more robustly characterize long-term effects of glaucoma surgical procedures—with and without permanent implants—on ECD and corneal health and to develop evidence-based guidelines for the pre- and post-operative evaluation of corneal health in eyes undergoing glaucoma surgery.Keywords: glaucoma, excisional goniotomy, Kahook Dual Blade, iStent trabecular microbypass stent, endothelial cell loss

To compare the benefit of femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification (PE) and 2 fragmentation patterns in managing dense cataracts.Randomized controlled trial.Patients with nuclear opacity (NO) grade5 (Lens Opacities Classification System III) were enrolled at the Singapore National Eye Centre. Patients who were unsuitable for FLACS, whose corneal endothelial cell count (ECC) was1,500 cells/mmNinety-three patients were randomized to PE (48), FLACSg (22), and FLACS16 (23). Majority were Chinese (87; 93.5%). Mean age was 74.3 ± 8.8 years of age. Cataracts were mostly graded as NO 5-6 (49; 61.3%). EPT among treatment arms was not different (P = .097, one-way ANOVA) but was significantly higher for NO6 than NO6 (P.001, general linear model). ECC loss was significantly less in FLACSg than in PE (P = .018, Bonferroni correction). Mean 1-month postoperative LogMAR BCVA (0.23 ± 0.20) was significantly better than preoperative BCVA (1.02 ± 0.85; P.001, paired t test) but not different between PE and FLACS.FLACSg but not FLACS16 significantly lowered the mean ECC loss during phacoemulsification in dense cataracts.

Funded by the NIHR Health Technology Assessment Panel (project reference number HTA 13/04/46) and sponsored by University College London (UCL). Supported by the NIHR Biomedical Research Centre (A. C. Day) based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. Partly supported by the NIHR Biomedical Research Centre, (C. Bunce) based at Guy's and St Thomas' NHS Foundation Trust and King's College London. Purpose : To report the 1-year outcomes of a randomized trial comparing femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification cataract surgery (PCS). Setting : Moorfields Eye Hospital, New Cross Hospital, and Sussex Eye Hospital, United Kingdom. Design : Multicenter, randomized controlled noninferiority trial. Methods : Patients undergoing cataract surgery were randomized to FLACS or PCS. Postoperative assessments were masked. Outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), complications, corneal endothelial cell count, and patient-reported outcomes measures. Results : The study enrolled 785 participants. A total of 311 of 392 (79%) participants were allocated to FLACS and 292 of 393 (74%) participants were allocated to PCS attended follow-up at 1 year. Mean UDVA was 0.14 (SD = 0.22) for FLACS and 0.17 (0.25) for PCS with difference of -0.03 logarithm of the minimum angle of resolution (logMAR) (95%, -0.06 to 0.01, P = .17). Mean CDVA was 0.003 (0.18) for FLACS and 0.03 (0.23) for PCS with difference of -0.03 logMAR (95% CI, -0.06 to 0.01, P = .11); 75% of both FLACS (230/307) and PCS (218/290) cases were within +/- 0.5 diopters (D) refractive target, and 292 (95%) of 307 eyes of FLACS and 279 (96%) of 290 eyes of PCS groups were within +/- 1.0 D. There were no significant differences between arms for all other outcomes with the exception of binocular CDVA mean difference -0.02 (-0.05 to 0.002) logMAR (P = .036) favoring FLACS. Mean cost difference was £167.62 per patient greater for FLACS (95% iterations between -£14.12 and £341.67). Conclusions : PCS is not inferior to FLACS regarding vision, patient-reported health, and safety outcomes after 1-year follow-up. A difference was found for binocular CDVA, which, although statistically significant, was not clinically important. FLACS was not cost-effective. Publisher PDF

Aim To compare whether aphakic contact lenses or secondary iris-claw intraocular lenses are superior in the refractive management post-pars plana vitreolensectomy in a pedigree with an FBN1 mutation causing non-syndromic ectopia lentis (NSEL) with retinal detachment (RD). Methods Eight affected individuals had pars plana vitreolensectomy for bilateral ectopia lentis (EL). Twelve eyes of 6 patients had secondary iris-claw intraocular lenses inserted and 4 eyes of 2 patients were managed with contact lenses. Rhegmatogenous retinal detachment (RRD) was treated when necessary. Pre- and post-operative assessment included visual acuity, endothelial cell count and dilated fundal examination. Results Macula-on RRD was present in all individuals >18y, 64% (7/11 eyes) presenting post-vitreolensectomy with 57% having bilateral non-synchronous RRD. Surgical aphakia was managed with iris-fixated intraocular lenses (IOL group, n=6), or contact lenses (CL group, n=2). Visual acuity ≥0.3 logMAR (driving standard) was achieved in 75% of IOL group eyes and 25% of the CL group eyes. Mean loss of corneal endothelial cell count in the IOL group was 4% at 2y post-operative. Conclusion In this cohort, refractive management with iris-claw IOLs provided superior outcomes to contact lenses and the authors recommend this as the optimal refractive correction in EL patients.

Purpose We sought to assess the correlation of corneal endothelial cell (CEC) density to alterations of collagen composition of Descemet membrane (DM) in advanced Fuchs endothelial corneal dystrophy (FECD) and to image such changes by slit-lamp biomicroscopy in vivo. Design Prospective, observational consecutive case series. Methods Fifty eyes (50 subjects) with advanced FECD were enrolled. After slit-lamp biomicroscopy and corneal Scheimpflug imaging, the Descemet endothelium complex (DEC) was retrieved during DM endothelial keratoplasty (DMEK) surgery. The expression of collagens I, III, and IV (COL I, COL III, and COL IV) and corresponding CEC density were analyzed by immunofluorescence flat mount-staining. Presence, diameter and surface area of collagen expression, and CEC density served as the main outcome measures. Results Immunofluorescence staining revealed central coherent collagen positive areas (mean surface area = 10 mm2 ± 6 mm2) corresponding to a fibrillar layer burying the guttae of DM in 84% (42/50) of DECs. CEC density overlying the fibrillar layer compared with the periphery was significantly reduced (−54.8%, P Conclusion A fibrillar layer with a clear geographic pattern marks areas of pronounced loss of CEC density in advanced FECD eyes and may be imaged by slit-lamp biomicroscopy in vivo.

Objective: The aim of the present study was to assess the anterior segment parameters of patients with chronic obstructive pulmonary disease (COPD) by corneal specular microscopy and biometry and to compare the results with healthy controls. Materials and Methods: Our prospective study consisted of 122 eyes of 61 patients with COPD and 110 eyes of 55 patients without any systemic diseases. A comprehensive medical history was obtained, and corrected visual acuity, bio microscopic and fundus examination, intraocular pressure (IOP) measurement with applanation tonometry, and non-contact specular microscopy were performed in all participants. Results: The endothelial cell density was lower in the COPD group than in the control group (p

Purpose. To study the efficacy of a modified four-point fixation technique for the repositioning of a dislocated intraocular lens (IOL) with four eyelets in the absence of capsule support. Methods. Four patients with dislocated four-eyelet hydrophilic acrylic IOLs (Akreos AO60) were enrolled. The modified technique combined four-point fixation with intrascleral sutures and suture burying. The technique minimized the limbus incision to 1 mm with no externalization of the IOL or its haptics. Follow-ups included routine ophthalmic examinations, corneal endothelial cell counts, and measurement of IOL tilt and decentration (measured using Pentacam® HR images). Results. The IOLs were successfully repositioned in all cases. After a mean follow-up period of 19.75 ± 7.85 months (range: 8 to 24 months), the patients’ best-corrected vision acuity (BCVA (LogMAR), before: 0.63 ± 0.36, after: 0.58 ± 0.43, P = 0.604 ) and intraocular pressure (pre 13.35 ± 0.85 mmHg, post 14.80 ± 2.03 mmHg, P = 0.150 ) remained unchanged. Corneal endothelium density decreased about 6.84 ± 2.97%. In all cases, the IOL was well positioned during the follow-up. At the final visit, the average IOL tilt was 1.36 ± 0.35° horizontally and 1.31 ± 0.14° vertically. The average IOL decentration was 0.23 ± 0.12 mm horizontally and 0.18 ± 0.13 mm vertically. Conclusions. With this modified technique, dislocated IOLs with four-eyelets could be treated safely with favorable outcomes.

Panpan Li,1,2 Yujian Zhang,1 Lihua Kang,1 Yu Guan,1 Jian Wu,1 Huaijin Guan1 1Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, China; 2Department of Ophthalmology, The First People’s Hospital of Nantong, Nantong, China Purpose: To compare corneal variations in patients undergoing one-handed and two-handed coaxial phacoemulsification. Setting: Eye Institute, Affiliated Hospital of Nantong University, Nantong, China. Design: Prospective consecutive nonrandomized comparative cohort study. Methods: Patients with cataracts were subject to one-handed (one-handed group) or two-handed coaxial phacoemulsification (two-handed group). Intraoperative phaco parameters and postoperative outcomes, such as visual acuity, surgically induced astigmatism (SIA), corneal volume, central corneal thickness, and corneal endothelial cell counts/size were compared. Results: No significant differences in the intraoperative phaco parameters were noted between the 2 groups. At postoperative week 1, visual outcomes were significantly improved in the one-handed compared with the two-handed group (all P

AIM: To explore the clinical effect of femtosecond laser combined with cataract phacoemulsification(PHACO)in the treatment of senile patients with cataract. METHODS: The clinical data of 78(78 eyes)patients with cataract were retrospectively analyzed. Patients with femtosecond laser combined with PHACO were included in observation group(40 cases in 40 eyes), and patients with PHACO alone were included in control group(38 cases in 38 eyes). The changes of intraocular pressure(IOP), best corrected visual acuity(BCVA)\〖logarithmic visual acuity chart(LogMAR)\〗, central corneal thickness(CCT), corneal endothelial cells(CEC)count and tear oxidative stress indexes \〖prostaglandin E2(PGE2), glutathione peroxidase(GSH-Px)\〗 were compared before operation, at 1d,1wk and 1mo after operation, and phacoemulsification time and the occurrence of complications within 1mo after operation were analyzed in the two groups. RESULTS: At 1d, 1wk and 1mo after operation, the values of IOP and BCVA in two groups were decreased significantly compared with those before operation, and the values showed significantly decreasing trend with the prolongation of postoperative observation time, and the values in the observation group were significantly lower than those in the control group after treatment(P2 in two groups were significantly increased compared with those before operation, and the levels showed significantly decreasing trend with the prolonged observation time, and the levels in the observation group were significantly lower than those in the control group(PPPCONCLUSION: Femtosecond laser combined with PHACO can effectively improve the levels of IOP, CCT and CEC count in elderly patients with cataract, and reduce the occurrence risk of postoperative complications, and it is beneficial to prognosis and recovery.

Panpan Li,1,2 Yujian Zhang,1 Lihua Kang,1 Yu Guan,1 Jian Wu,1 Huaijin Guan1 1Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, China; 2Department of Ophthalmology, The First People’s Hospital of Nantong, Nantong, China Purpose: To compare corneal variations in patients undergoing one-handed and two-handed coaxial phacoemulsification. Setting: Eye Institute, Affiliated Hospital of Nantong University, Nantong, China. Design: Prospective consecutive nonrandomized comparative cohort study. Methods: Patients with cataracts were subject to one-handed (one-handed group) or two-handed coaxial phacoemulsification (two-handed group). Intraoperative phaco parameters and postoperative outcomes, such as visual acuity, surgically induced astigmatism (SIA), corneal volume, central corneal thickness, and corneal endothelial cell counts/size were compared. Results: No significant differences in the intraoperative phaco parameters were noted between the 2 groups. At postoperative week 1, visual outcomes were significantly improved in the one-handed compared with the two-handed group (all P

Purpose: The aim of this study was to analyze and compare corneal endothelial cell morphology and characteristics in bilateral keratoconus (KCN) patients with unilateral Vogt's striae. Methods: Fifty patients aged 20–38 years were recruited in this cross-sectional contralateral eye study. In this study, corneal endothelial cell parameters were evaluated in patients with bilateral KCN and unilateral Vogt's striae using the Topcon SP2000P specular microscope (Topcon, Tokyo, Japan). Results: In the current study, there were no significant differences in corneal endothelial cell parameters including endothelial cell density (ECD), hexagonal cell ratio (HEX), and coefficient of variance of cell size (CV) between the KCN groups with and without Vogt's striae, [(2968.34 ± 276.65 vs. 2980.05 ± 253.30, P = 0.618), (51.88 ± 13.57 vs. 53.24 ± 9.31, P = 0.658), and (32.50 ± 5.40 vs. 32.97 ± 4.07, P = 0.467), respectively]. Also, among study groups with and without Vogt's striae, ECD did not correlate with anterior chamber depth (ACD) [(P = 0.564, r = 0.09), (P = 0.219, r = −0.18), respectively], maximum keratometry (Kmax) [(P = 0.215, r = 0.18), (P = 0.898, r = 0.02), respectively], and central corneal thickness (CCT) [(P = 0.989, r = −0.02), (P = 0.643, r = −0.07), respectively].Our results showed significant differences in corrected and uncorrected distance visual acuity (UDVA), cycloplegic refractive error components (calculated by vectorial analysis), CCT, and Kmax between two study groups (all P

Background: The corneal complications of a successful vitreoretinal surgery are not the main interest of the surgeon operating on a difficult retinal detachment. However, the surgeon should pay attention to avoid corneal decompensation. Aim: To evaluate corneal endothelial cell changes in patients undergoing pars plana vitrectomy with and without silicon oil (SO) injection.Subjects and Methods: This prospective observational study includes 54 eyes divided into two equal groups: silicone-filled group (group one) and saline-filled group (group two). Endothelial cell densities (ECD), coefficient of variation (CV), central corneal thickness (CCT), and percentage of hexagonal cells at the corneal center were measured preoperatively and at the first week, the first month, and the third month postoperatively and compared between the two groups. All data were collected and statistically analyzed using SPSS program. Results: Three months after PPV, mean ECD in group one and in group two was highly significant (p

Background Complete nuclear disassembly of superhard cataracts cannot always be achieved by phaco chop, which is considered one of the best techniques for dealing with hard cataracts. We present a phaco chop-progressive cracking technique to divide superhard cataracts completely. Case presentation We presented a case of cataract with over Grade V nucleus sclerosis and very low density of corneal endothelial cell (812 cells/mm2). By performing the cataract surgery with our phaco chop-progressive cracking technique, the corneal endothelial cells were well protected and the patient’s visual acuity was markedly improved from finger counting at 40 cm to 20/200 the day after surgery without obvious corneal edema. Conclusions Although an initial learning curve was needed, this phaco chop-progressive cracking technique could be of particular benefit to the superhard cataract, especially in patients with low density of corneal endothelial cells.

The main treatment available for restoration of the corneal endothelium is keratoplasty and DMEK provides faster visual recovery and better postoperative visual acuity when compared to DSAEK. However, the technical challenges related to this technique and the steep technical learning curve seem to prevent the overcoming of DSAEK in favor of DMEK. Furthermore, the outcome of lamellar keratoplasty techniques is influenced by problems related to corneal grafting tissue availability, management, and quality. On the other hand, improvements in the field of cell engineering have opened the way for the use of stem cells-derived corneal endothelial cells with regenerative intent. In this overview, latest findings in endothelial cell engineering are reported, and perspectives of clinical application of mesenchymal stem cells for corneal endothelial replacement and regeneration are evaluated.

Corneal endothelial cell (CEC) disorders, such as Fuchs's endothelial corneal dystrophy, induce abnormal corneal hydration and result in corneal haziness and vision loss known as bullous keratopathy. We investigated whether injection of cultured human CECs supplemented with a rho-associated protein kinase (ROCK) inhibitor into the anterior chamber could increase CEC density.We performed an uncontrolled, single-group study involving 11 persons who had received a diagnosis of bullous keratopathy and had no detectable CECs. Human CECs were cultured from a donor cornea; a total of 1×10At 24 weeks after cell injection, we recorded a CEC density of more than 500 cells per square millimeter (range, 947 to 2833) in 11 of the 11 treated eyes (100%; 95% confidence interval [CI], 72 to 100), of which 10 had a CEC density exceeding 1000 cells per square millimeter. A corneal thickness of less than 630 μm (range, 489 to 640) was attained in 10 of the 11 treated eyes (91%; 95% CI, 59 to 100), and an improvement in best corrected visual acuity of two lines or more was recorded in 9 of the 11 treated eyes (82%; 95% CI, 48 to 98).Injection of human CECs supplemented with a ROCK inhibitor was followed by an increase in CEC density after 24 weeks in 11 persons with bullous keratopathy. (Funded by the Japan Agency for Medical Research and Development and others; UMIN number, UMIN000012534 .).

Phacoemulsification is a commonly used surgical method in cataract surgery. This paper observes and compares the surgical efficacy of three incisions of different length for phacoemulsification to identify the optimal method for cataract surgery. Ninety patients were enrolled in the present study and divided into three groups. The 1.8-mm group received Bausch & Lomb MI60 foldable intraocular lens (IOL) implantation (n=30), 3.2-mm group received Bausch & Lomb Akreos AO foldable lens implantation (n=30), and 5.5-mm group received Alcon TYPE 05 rigid IOL implantation (n=30). Visual acuity, Oculyzer-based anterior segment analysis, and corneal endothelial cell count before surgery, and 3, 7, 30, and 90d after surgery were recorded and compared. Pseudophakic accommodation three days, one week, one month, and three months after surgery was determined. Intraoperative ultrasound time and ultrasonic energy were recorded. It was finally concluded that for phacoemulsification with the same phaco tip, a 1.8-mm microincision can lead to quicker recovery of visual acuity, more stable astigmatism, and higher pseudophakic accommodation than conventional incision.

AIM: To Evaluate the effects of different capsulotomy diameters during phacoemulsification on corneal and blood aqueous barrier. METHODS: Totally 78 cases(100 eyes)with cataract were treated by femtosecond laser assisted phacoemulsification. The patients were randomly divided into two groups. There were 36 cases(50 eyes)in experimental group, in which the capsulotomy diameter was 4.7mm, and 42 cases(50 eyes)in the control group, in which the capsulotomy diameter was 6.0mm. Phacoemulsification power and time were recorded for each procedure. Follow-up exams were performed on 1d, 1wk and 2mo after surgery. Preoperative and postoperative best corrected visual acuity, central corneal thickness, aqueous flare, corneal endothelial cell count were assessed for the two groups. RESULTS: No significant difference was found on preoperative best corrected visual acuity(BCVA), hardness of the lens nucleus, centrel corneal thickness(CCT)and the effective phaco time and the average phaco power of the two groups(P>0.05). There was also no statistically significant difference on BCVA between the two groups after surgery(P>0.05). The change of central corneal thickness and the aqueous flare cells in the experimental group were less than those in the control group at 1d and 1wk postoperatively(PP>0.05). The rate of lost corneal endothelial cell was significantly lower in the experimental group than the control group at 2mo postoperatively(P>0.05). CONCLUSION: The phacoemulsification with small capsulotomy diameters decreases the injury to the corneal and blood aqueous barrier. The patients recovered more quickly.

This study investigates the possible role of the filtration bleb in the continuous decrease in corneal endothelial cell (CEC) density observed following trabeculectomy. This study involved 51 eyes of 37 glaucoma patients who underwent trabeculectomy. The CEC density was determined by contact specular microscopy in three areas: (1) the cornea center, (2) near the trabeculectomy filtration bleb, and (3) the opposite side of the bleb. The eyes were grouped according to post-surgical follow-up years: 0–1 (Group 1), 1–2 (Group 2), 2–3 (Group 3), 3–4, (Group 4), and 4+ years (Group 5). The mean CEC densities at the opposite side of the bleb, in the cornea center, and near the bleb were 2210 ± 487, 1930 ± 528, and 1519 ± 507 cells/mm2, respectively, in all eyes. The CEC density was significantly lower near the bleb than at the other two sites. The coefficient of variation was significantly higher near the bleb than at the other two sites. The CEC densities at the cornea center and at the opposite side of the bleb showed no significant differences. However, the CEC densities near the bleb showed time-dependent decreases to 1790, 1601, 1407, 1339, and 1224 cells/mm2 for Groups 1, 2, 3, 4, and 5, respectively. CEC density following trabeculectomy decreased near the bleb, but not at the cornea center, suggesting that the involvement of the filtration bleb in CEC density loss should be further examined to elucidate the pathology of CEC loss following trabeculectomy.

Objective: To determine the protective effects of intraocular lens implantation without viscoelastic agents on corneal endothelial cells. Methods: Patients with age-related cataract were randomly divided into two groups: Group A (24 patients, 30 eyes) underwent phacoemulsification and intraocular lens implantation without viscoelastic agents, and group B (21 patients, 30 eyes) underwent phacoemulsification and intraocular lens implantation with viscoelastic agents. The corneal endothelial cell counts, percentages of hexagonal cells, and central corneal thicknesses were evaluated at 1 week, 1 month, and 6 months after surgery. Results: There was no significant difference in preoperative basic characteristics between the two groups (p > 0.05). The postoperative corneal endothelial cell count and percentage of hexagonal cells in both groups decreased compared with preoperative values at 1 week, 1 month, and 6 months after surgery, and the decrease of group A was significantly lower than that of group B at all time points (p 0.05). Conclusions: Compared with regular intraocular lens implantation, intraocular lens implantation without viscoelastic agents is less damaging to corneal endothelial cells, resulting in greater corneal safety.