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Objective: To observe the effectiveness and safety of long-term wearing of orthokeratology lens in adolescent myopia patients. Methods: From June 2019 to April 2023, 30 myopic adolescents (60 eyes) who had been fitted with orthokeratology lens in the ophthalmology department of Xuanwu hospital and had worn them for a long time (≥ 3 years) were reviewed. They were reexamined 1 day, 7 days, 1 month and 3 month after wearing the glasses. The changes of the axial length and the parameters of corneal endothelioscopy were compared before and after wearing the glasses for 6 months, 1 year, 2 years and 3 years. Result: A total of 30 cases (60 eyes) were observed in this study, including 13 males and 17 females, aged 7-14 years old, with an average age of 9.77 ± 1.89 years old. The equivalent spherical scope was -5.00-0.75D, with an average of -1.98± 0.97 D. Among them, 5 cases (8 eyes, 13.3%) developed grade 1 corneal staining, but no grade 2-3 staining was observed. 2 cases (4 eyes, 6.7%) developed allergic conjunctivitis, which was cured after stopping wearing and receiving corresponding treatment. The axial lengths of 6 mon, 1 a, 2 a, and 3 a before and after wearing glasses were 24.57± 0.74 mm, 24.67± 0.85 mm, 24.78± 0.96 mm, 24.91± 0.97 mm, and 25.06± 0.85 mm, respectively, showing an overall increasing trend (F=21.904, P<0.001). There were statistically significant differences in axial lengths between pre and post wearing glasses at various time points, with P values of 0.027, 0.001, 0.000, and 0.000, respectively. There was a statistically significant difference between 6 mon after wearing glasses and 1 a, 2 a, and 3 a after wearing glasses. The P-values were 0.005, 0.000, and 0.008, respectively. There was a statistically significant difference (P<0.001) between 1 year after wearing the mirror and 2 years after wearing the mirror, while there was no statistically significant difference (P>0.05) between other time points. The coefficient of variation of cell area at 6 mon, 1 a, 2 a, and 3 a before and after wearing glasses were 25± 2.9%, 26± 3.7%, 27± 4.1%, 27± 4.6%, and 27± 4.1%, respectively. Overall, F=5.490, P=0.001. Comparing the two groups, it was found that there was a statistically significant difference between the two groups, with P values of 0.012 and 0.008, respectively (P<0.05). The difference between the two groups was statistically significant (P=0. 007), There was no statistically significant difference between other time points (P>0.05). There was no statistically significant difference in corneal thickness, endothelial cell density, average area, and hexagonal cell ratio at each time point (P>0.05).Conclusion: Adolescent myopia patients can effectively control the rapid growth of their eye axis by wearing corneal reshaping lenses for a long time. However, comprehensive examination and evaluation must be conducted, qualified and appropriately sized lenses must be worn, standardized operations must be carried out, and follow-up visits must be made on time. If allergies or corneal injuries occur, timely cessation of wearing and corresponding treatment can ensure the safety of long-term wearing. Morphological examination of corneal cells revealed that long-term wearing of glasses showed an increasing trend in the variation of corneal endothelial cell area. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the corneal endothelial cell morphology in children with autosomal recessive Alport syndrome (ARAS). Methods: This is a longitudinal, prospective cohort study that evaluated pediatric patients with genetically diagnosed ARAS. Fifty-eight eyes of 29 pediatric patients (12 patients, 17 controls) underwent a full ophthalmic examination. Corneal endothelial cell density (ECD) (cells/mm²), coefficient variation (CV) of cell area (polymegathism), the percentage of hexagonal cells (HEX) (pleomorphism), and central corneal thickness (CCT) were analyzed automatically using a noncontact specular microscopy. Results: The mean ECD was 2904 ± 355.48 cell/mm² in the ARAS group and 3263.20 ± 261.71 cell/mm² in the control group (p = 0.004). In the ARAS group, the mean CV was 46.53 ± 10.43, which was significantly higher than that in controls (p = 0.026). The mean HEX was 48.86 ± 14.71 in the ARAS group and 59.06 ± 10.64 in the control group (p = 0.038). The mean CCT was 565.26 ± 39.77 µm in the ARAS group and 579.66 ± 31.65 µm in the control group (p = 0.282). The comparison of endothelial cell characteristic of the ARAS group with 1-year follow-up is as follows: The mean ECD decreased from 2904 ± 355.48 cell/mm² to 2735 ± 241.58 cell/mm² (p = 0.003). The mean CV increased from 46.53 ± 10.43 to 47.93 ± 10.50 (p = 0.471). The mean HEX decreased from 48.86 ± 14.71 to 48.50 ± 10.06 (p = 0.916). The mean CCT decreased from 565.26 ± 39.77 µm to 542.86 ± 40.39 µm (p = 0.000). Conclusion: Measurement of ECD and percentage of hexagonality can also be used as an indicator of the health of the corneal endothelium. In this study, the mean ECD and HEX were significantly lower in ARAS group than in age-matched pediatric controls. Polymegathism, which reflects cellular stress, was statistically significantly higher in ARAS group. The mean ECD and CCT decreased significantly at 1-year follow-up. This study may demostrated that endothelial damages and stress in ARAS patients appear in childhood and show a rapid increase with age. [ABSTRACT FROM AUTHOR]

Abstract Purpose Measurement of corneal endothelial cells is critical for postoperative evaluation of phakic intraocular lens (pIOL) surgery. However, inter-instrument differences in corneal endothelial cell density (ECD) after pIOL implantation have not yet been reported. This study aimed to compare automated corneal endothelial cell analysis between CellChek-20 (Konan Medical, Hyogo, Japan) and EM-4000 (Tomey, Nagoya, Japan) in healthy and postoperative eyes with pIOL. Methods We retrospectively analyzed 154 healthy and 236 postoperative eyes after pIOL surgery. Endothelial cell measurements were performed using CellChek-20 and EM-4000 with autofocusing and automated image analysis. ECD, percentage of hexagonal cells (HEX), coefficient of variation in cell size (CoV), and central corneal thickness (CCT) were compared between the two devices. Results The ECDs of the two devices were highly correlated in both healthy (Spearman’s correlation coefficient [r] = 0.805; p

Purpose: Measurement of corneal endothelial cells is critical for postoperative evaluation of phakic intraocular lens (pIOL) surgery. However, inter-instrument differences in corneal endothelial cell density (ECD) after pIOL implantation have not yet been reported. This study aimed to compare automated corneal endothelial cell analysis between CellChek-20 (Konan Medical, Hyogo, Japan) and EM-4000 (Tomey, Nagoya, Japan) in healthy and postoperative eyes with pIOL. Methods: We retrospectively analyzed 154 healthy and 236 postoperative eyes after pIOL surgery. Endothelial cell measurements were performed using CellChek-20 and EM-4000 with autofocusing and automated image analysis. ECD, percentage of hexagonal cells (HEX), coefficient of variation in cell size (CoV), and central corneal thickness (CCT) were compared between the two devices. Results: The ECDs of the two devices were highly correlated in both healthy (Spearman's correlation coefficient [r] = 0.805; p < 0.001) and postoperative (r = 0.901; p < 0.001) groups. ECD from CellChek-20 was higher than EM-4000 in both healthy (mean difference = 228.9 cells/mm2; p < 0.001) and postoperative (mean difference = 115.6 cells/mm2; p < 0.001) groups. The CCT values also showed a strong correlation in healthy eyes (r = 0.974; p < 0.001) and in postoperative eyes (r = 0.936; p < 0.001); however, significant inter-instrument differences were observed. HEX and CV showed significant differences and relatively weak correlations (r < 0.7) between the two devices in both healthy and postoperative groups. Conclusion: The ECD values between the two instruments were correlated, but that of the CellChek-20 was significantly higher than that of the EM-4000 in both healthy and postoperative eyes after pIOL surgery. Most previous studies have also shown that the Konan software overestimated the ECD compared to other products in automatic measurement mode. The possibility of measurement bias should be considered when replacing equipment used for corneal endothelial cell measurements. [ABSTRACT FROM AUTHOR]

Purpose: We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). Patients and methods: This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3 years. We measured the CED before and after (at 12, 24, and 36 months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. Results: We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3 years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3 years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. Conclusions: EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients. [ABSTRACT FROM AUTHOR]

The cornea relies on a healthy endothelium to maintain transparency, and damage to endothelial cells can result in corneal oedema and vision loss. Current treatments, which often involve the use of donor corneas, face significant limitations due to a shortage of donor tissue. Although human corneal endothelial cells (HCECs) can be cultured and transplanted, their low attachment rates limit the effectiveness of these treatments. In this review, we examined studies that explore the use of magnetic nanoparticles (MNPs) to enhance the attachment of HCECs to the cornea. We evaluated the effectiveness, cell viability, and safety of this approach. Findings indicate that MNPs facilitate the targeted delivery of HCECs under a magnetic field, resulting in improved corneal clarity and reduced oedema in animal models. Cell viability remained high, and no significant safety concerns were identified. MNPs present a promising strategy to enhance HCEC transplantation. However, further research, including ongoing clinical trials, is necessary to confirm the safety and efficacy of this approach before it can be adopted for widespread clinical use. [ABSTRACT FROM AUTHOR]

Corneal endothelial decompensation is treated by the corneal transplantation of donor corneas, but donor shortages and other problems associated with corneal transplantation have prompted investigations into tissue engineering therapies. For clinical use, cells used in tissue engineering must undergo strict quality control to ensure their safety and efficacy. In addition, efficient cell manufacturing processes are needed to make cell therapy a sustainable standard procedure with an acceptable economic burden. In this study, we obtained 3098 phase contrast images of cultured human corneal endothelial cells (HCECs). We labeled the images using semi-supervised learning and then trained a model that predicted the cell centers with a precision of 95.1%, a recall of 92.3%, and an F-value of 93.4%. The cell density calculated by the model showed a very strong correlation with the ground truth (Pearson's correlation coefficient = 0.97, p value = 8.10 × 10−52). The total cell numbers calculated by our model based on phase contrast images were close to the numbers calculated using a hemocytometer through passages 1 to 4. Our findings confirm the feasibility of using artificial intelligence-assisted quality control assessments in the field of regenerative medicine. [ABSTRACT FROM AUTHOR]

The corneal endothelium, comprising densely packed corneal endothelial cells (CECs) adhering to Descemet's membrane (DM), plays a critical role in maintaining corneal transparency by regulating water and ion movement. CECs have limited regenerative capacity within the body, and globally, there is a shortage of donor corneas to replace damaged corneal endothelia. The development of a carrier for cultured CECs may address this worldwide clinical need. In this study we successfully manufactured a gelatin nanofiber membrane (gelNF membrane) using electrospinning, followed by crosslinking with glutaraldehyde (GA). The fabricated gelNF membrane exhibited approximately 80% transparency compared with glass and maintained a thickness of 20 µm. The gelNF membrane demonstrated desirable permeability and degradability for a Descemet's membrane analog. Importantly, CECs cultured on the gelNF membrane at high densities showed no cytotoxic effects, and the expression of key CEC functional biomarkers was verified. To assess the potential of this gelNF membrane as a carrier for cultured CEC transplantation, we used it to conduct Descemet's membrane endothelial keratoplasty (DMEK) on rabbit eyes. The outcomes suggest this gelNF membrane holds promise as a suitable carrier for cultured CEC transplantation, offering advantages in terms of transparency, permeability, and sufficient mechanical properties required for successful transplantation. [ABSTRACT FROM AUTHOR]

The cornea relies on a healthy endothelium to maintain transparency, and damage to endothelial cells can result in corneal oedema and vision loss. Current treatments, which often involve the use of donor corneas, face significant limitations due to a shortage of donor tissue. Although human corneal endothelial cells (HCECs) can be cultured and transplanted, their low attachment rates limit the effectiveness of these treatments. In this review, we examined studies that explore the use of magnetic nanoparticles (MNPs) to enhance the attachment of HCECs to the cornea. We evaluated the effectiveness, cell viability, and safety of this approach. Findings indicate that MNPs facilitate the targeted delivery of HCECs under a magnetic field, resulting in improved corneal clarity and reduced oedema in animal models. Cell viability remained high, and no significant safety concerns were identified. MNPs present a promising strategy to enhance HCEC transplantation. However, further research, including ongoing clinical trials, is necessary to confirm the safety and efficacy of this approach before it can be adopted for widespread clinical use.

Abstract Background To observe the safety and effect of phacoemulsification combined with intraocular lens (IOL) implantation in patients with low corneal endothelial cell density (CD) under the low perfusion pattern with low negative pressure. Methods In this retrospective case series study, a total of 16 patients (17 eyes) were studied. They had all been diagnosed with low corneal endothelial (CD) and cataracts in the First Affiliated Hospital of Fujian Medical University from December 2019 to October 2021. They underwent phacoemulsification combined with IOL implantation under the low perfusion pattern with low negative pressure. The variations of corneal endothelial( CD), coefficient of variation (CV) of the cell area, central corneal thickness (CCT), visual acuity, and intraocular pressure before and after the operation were observed and assessed. Then a paired t-test, repeated measures analysis of variance, and Pearson correlation analysis were adopted for data analysis. Results The mean intraocular pressure of the 17 eyes was 16.88 ± 6.47 mmHg before the operation and 14.41 ± 3.10 mmHg after the operation, showing a statistically significant difference of t = 2.222, and p = 0.041. Before the operation, the mean visual acuity was 0.16 ± 0.09, and after the operation, it was 0.45 ± 0.16, displaying a statistically significant difference of t = -9.917, p

AIM:To compare the curative effect of different surgical methods combined with Toric intraocular lens(IOL)implantation on age-related hard nuclear cataract.METHODS:According to retrospective study, 104 patients(104 eyes)with age-related hard nuclear cataract confirmed in the hospital between January 2020 and December 2021 were enrolled. They were divided into phacoemulsification group(52 eyes, phacoemulsification combined with Toric IOL implantation)and small-incision group(52 eyes, small-incision split nuclear technique in horizontal space combined with Toric IOL implantation)according to different surgical methods. The best corrected distance visual acuity(BCDVA), corneal astigmatism, number of corneal endothelial cells, proportion of normal hexagonal cells, tear film function and complications were compared between the two groups.RESULTS:There was no significant difference in BCDVA(LogMAR)between the two groups before and at 3mo after surgery(all P>0.05), while BCDVA(LogMAR)was better in small-incision group than phacoemulsification group at 1wk after surgery(0.15±0.04 vs. 0.20±0.05, P0.05). At 1wk and 3mo after surgery, number of corneal endothelial cells in small-incision group was more than that in phacoemulsification group(1wk after surgery: 2363.8±315.3 vs. 2231.4±326.4 cells/mm2, P0.05). At 3mo after surgery, proportion of normal hexagonal cells in small-incision group was higher than that in phacoemulsification group(21.77%±1.91% vs. 20.59%±1.65%, P0.05). At 1wk after surgery, BUT in small-incision group was longer than that in phacoemulsification group(6.8±0.8 vs. 5.9±1.0s, P

AIM: To investigate the clinical efficacy of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the treatment of acute angle-closure glaucoma complicated with cataract.METHODS: A total of 53 patients(60 eyes)with primary acute angle closure glaucoma complicated with cataract admitted to our hospital from April 2020 to February 2021 were selected. They were divided into two groups according to the surgical method, with 28 cases(30 eyes)who were treated with femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in group A, and 25 cases(30 eyes)who were treated with traditional cataract phacoemulsification combined with goniosynechialysis in group B. The effective phacoemulsification time(EPT)and cumulative dissipated energy(CDE)during surgery in two groups were recorded. Patients were followed up to 3mo after surgery, and the intraocular pressure, anterior chamber depth(ACD), best corrected visual acuity, corneal endothelial cell loss rate(ECL)and surgical complications were observed in both groups.RESULTS: The postoperative intraocular pressure was significantly decreased and ACD was significantly increased(all P0.05). The postoperative best corrected visual acuity of the two groups was significantly better than that before surgery(P

Introduction: Multidrug regimens for glaucoma treatment often result in adherence issues due to inconvenience; these issues may be improved with fixed-dose combination drugs. The ophthalmic solution of ripasudil–brimonidine fixed-dose combination (RBFC; K-232) is the first treatment combining a Rho kinase inhibitor and an α2-adrenoceptor agonist, and has demonstrated ability to lower intraocular pressure (IOP) and have various effects on conjunctival hyperemia and corneal endothelial cell morphology. This study evaluates the pharmacologic effects of RBFC treatment versus its separate components—ripasudil or brimonidine. Methods: This single-center, prospective, randomized, open-label, blinded endpoint study with 3 × 3 crossover design randomly assigned healthy adult men to three groups (1:1:1) to undergo consecutive 8-day administration phases (with drug-free intervals of at least 5 days). Subjects received twice-daily instillation of RBFC → ripasudil → brimonidine (group A), ripasudil → brimonidine → RBFC (group B), or brimonidine → RBFC → ripasudil (group C). Endpoints included change in IOP, severity of conjunctival hyperemia, corneal endothelial cell morphology, pupil diameter, and pharmacokinetics. Results: Eighteen subjects were assigned in total (six to each group). RBFC significantly reduced IOP from baseline at 1 h post-instillation on days 1 and 8 (12.7 vs. 9.1 and 9.0 mmHg, respectively; both P < 0.001), and provided significantly greater IOP reductions than ripasudil or brimonidine at several time points. The most common adverse drug reaction with all three treatments was mild conjunctival hyperemia, which transiently increased in severity with RBFC or ripasudil, peaking at 15 min post-instillation. In post hoc analyses, conjunctival hyperemia scores were lower with RBFC than with ripasudil at several time points. Transient morphologic changes in corneal endothelial cells occurred for up to several hours with RBFC or ripasudil, but not with brimonidine. Pupil diameter did not change with RBFC. Conclusion: RBFC significantly reduced IOP compared with each agent alone. A combination of each agent's pharmacologic profile was observed in that of RBFC. Trial Registration: Japan Registry of Clinical Trials; Registration No. jRCT2080225220. [ABSTRACT FROM AUTHOR]

Abstract Purpose To evaluate the effects of a novel technique using an isolated lens anterior capsule disc (LACD) to protect corneal endothelial cells in rabbit eyes during femtosecond laser-assisted cataract surgery. Methods Experimental study. 40 rabbits were divided into endothelium-protected (experimental) and control groups, with 20 rabbits in each group. In the experimental group, after femtosecond laser capsulotomy, the isolated capsule disc was lifted to the corneal endothelium by an ophthalmic viscosurgical device. The endothelium was damaged for 1 min with an ultrasonic probe. The control group underwent the same surgery, except that the disc was removed immediately after capsulorhexis. Corneal endothelioscopy was performed preoperatively and on postoperative days (PODs) 3 and 7 to observe endothelial cell counts (ECC) and endothelial cell loss rate. Central corneal thickness (CCT) was measured before and at PODs 1, 3 and 7. Results There were 3.59%±1.88% (p

AIM: To investigate the influence of the duration of orthokeratology lens cessation on patients' refractive status and corneal endothelial cells.METHODS: Adolescent myopia patients who wore orthokeratology lens from July 2019 to July 2020 and recently planned to stop wearing the lens were divided into mild group and severe group according to spherical equivalent. Refractive status, corneal morphology, corneal endothelial cells, and visual quality were measured at cessation and 1, 2 and 3mo after cessation.RESULTS: The corneal flat K values, steep K values and mean K values in the two groups were lower at cessation than those before wearing lenses. These values returned to the level before wearing lenses at 2mo after cessation(P>0.05). The corneal astigmatism, surface regularity index and surface asymmetry index in each group showed no statistically significant difference before wearing lenses and at 1, 2 and 3mo after cessation(P>0.05). There was no significant change in corneal endothelial cell density of the two groups at 1, 2 and 3mo after cessation compared with those before wearing lenses(P>0.05). The proportion of hexagonal cells in the two groups was lower at cessation than that before wearing lenses, and it returned to the level before wearing lenses at 1mo after cessation(P>0.05).CONCLUSION: Corneal morphology and corneal endothelial cells can be restored to the level before wearing orthokeratology lens at 3mo after cessation.

Background: To observe the safety and effect of phacoemulsification combined with intraocular lens (IOL) implantation in patients with low corneal endothelial cell density (CD) under the low perfusion pattern with low negative pressure. Methods: In this retrospective case series study, a total of 16 patients (17 eyes) were studied. They had all been diagnosed with low corneal endothelial (CD) and cataracts in the First Affiliated Hospital of Fujian Medical University from December 2019 to October 2021. They underwent phacoemulsification combined with IOL implantation under the low perfusion pattern with low negative pressure. The variations of corneal endothelial(CD), coefficient of variation (CV) of the cell area, central corneal thickness (CCT), visual acuity, and intraocular pressure before and after the operation were observed and assessed. Then a paired t-test, repeated measures analysis of variance, and Pearson correlation analysis were adopted for data analysis. Results: The mean intraocular pressure of the 17 eyes was 16.88 ± 6.47 mmHg before the operation and 14.41 ± 3.10 mmHg after the operation, showing a statistically significant difference of t = 2.222, and p = 0.041. Before the operation, the mean visual acuity was 0.16 ± 0.09, and after the operation, it was 0.45 ± 0.16, displaying a statistically significant difference of t = -9.917, p < 0.001. Before and after the operation, four of the 17 eyes had no detectable CD. The mean CD of the other 13 eyes at one month after the operation (644.308 ± 106.24 cells/mm2) was lower than that before the operation (709.62 ± 119.19 cells/mm2), and the differences were statistically significant (F = 20.044, p < 0.001). However, no statistically significant differences were found in the mean CV before the operation (31.23 ± 4.21), and at one month after the operation (32.62 ± 3.80; F = 2.130, p = 0.157). Moreover, the mean CCT of 14 eyes at one month after the operation (562.72 ± 27.82 μm) was larger than that before the operation (534.79 ± 24.69 μm). Conclusions: The low perfusion pattern with low negative pressure is safe and effective for corneal endothelial dysfunction patients complicated with cataracts. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of a novel technique using an isolated lens anterior capsule disc (LACD) to protect corneal endothelial cells in rabbit eyes during femtosecond laser-assisted cataract surgery. Methods: Experimental study. 40 rabbits were divided into endothelium-protected (experimental) and control groups, with 20 rabbits in each group. In the experimental group, after femtosecond laser capsulotomy, the isolated capsule disc was lifted to the corneal endothelium by an ophthalmic viscosurgical device. The endothelium was damaged for 1 min with an ultrasonic probe. The control group underwent the same surgery, except that the disc was removed immediately after capsulorhexis. Corneal endothelioscopy was performed preoperatively and on postoperative days (PODs) 3 and 7 to observe endothelial cell counts (ECC) and endothelial cell loss rate. Central corneal thickness (CCT) was measured before and at PODs 1, 3 and 7. Results: There were 3.59%±1.88% (p < 0.001) and 2.92%±2.14% (p < 0.001) loss of ECC in experimental group at POD3 and POD7, respectively, while those in the control group were 11.62%±7.43% and 10.34%±5.77%, respectively. On POD 1, the difference in central corneal thickness was significant(P = 0.019) between the two groups. At POD 3 and POD 7, CCT was not significantly different (P = 0.597;0.913) between the two groups. Conclusions: The isolated LACD technique significantly reduced damage to the endothelium caused by ultrasonic energy and protects corneal endothelial cells during phacoemulsification. [ABSTRACT FROM AUTHOR]

The corneal endothelium, comprising densely packed corneal endothelial cells (CECs) adhering to Descemet’s membrane (DM), plays a critical role in maintaining corneal transparency by regulating water and ion movement. CECs have limited regenerative capacity within the body, and globally, there is a shortage of donor corneas to replace damaged corneal endothelia. The development of a carrier for cultured CECs may address this worldwide clinical need. In this study we successfully manufactured a gelatin nanofiber membrane (gelNF membrane) using electrospinning, followed by crosslinking with glutaraldehyde (GA). The fabricated gelNF membrane exhibited approximately 80% transparency compared with glass and maintained a thickness of 20 µm. The gelNF membrane demonstrated desirable permeability and degradability for a Descemet’s membrane analog. Importantly, CECs cultured on the gelNF membrane at high densities showed no cytotoxic effects, and the expression of key CEC functional biomarkers was verified. To assess the potential of this gelNF membrane as a carrier for cultured CEC transplantation, we used it to conduct Descemet’s membrane endothelial keratoplasty (DMEK) on rabbit eyes. The outcomes suggest this gelNF membrane holds promise as a suitable carrier for cultured CEC transplantation, offering advantages in terms of transparency, permeability, and sufficient mechanical properties required for successful transplantation.

Corneal endothelial decompensation is treated by the corneal transplantation of donor corneas, but donor shortages and other problems associated with corneal transplantation have prompted investigations into tissue engineering therapies. For clinical use, cells used in tissue engineering must undergo strict quality control to ensure their safety and efficacy. In addition, efficient cell manufacturing processes are needed to make cell therapy a sustainable standard procedure with an acceptable economic burden. In this study, we obtained 3098 phase contrast images of cultured human corneal endothelial cells (HCECs). We labeled the images using semi-supervised learning and then trained a model that predicted the cell centers with a precision of 95.1%, a recall of 92.3%, and an F-value of 93.4%. The cell density calculated by the model showed a very strong correlation with the ground truth (Pearson’s correlation coefficient = 0.97, p value = 8.10 × 10−52). The total cell numbers calculated by our model based on phase contrast images were close to the numbers calculated using a hemocytometer through passages 1 to 4. Our findings confirm the feasibility of using artificial intelligence-assisted quality control assessments in the field of regenerative medicine.

Abstract Background Corneal transplantation is the only way to treat serious corneal diseases caused by corneal endothelial dysfunction. However, the shortage of donor corneal tissues and human corneal endothelial cells (HCECs) remains a worldwide challenge. We cultivated HCECs by the use of a conditioned medium from orbital adipose-derived stem cells (OASC-CM) in vitro. Then the HCECs were used to treat animal corneal endothelial dysfunction models via cell transplantation. The purpose of this study was to conduct a long-term observation and evaluation after cell transplantation. Methods Orbital adipose-derived stem cells (OASCs) were isolated to prepare the conditioned medium (CM). HCECs were cultivated and expanded by the usage of the CM (CM-HCECs). Then, related corneal endothelial cell (CEC) markers were analyzed by immunofluorescence. The cell proliferation ability was also tested. CM-HCECs were then transplanted into monkey corneal endothelial dysfunction models by injection. We carried out a 24-month postoperative preclinical observation and verified the long-term effect by histological examination and transcriptome sequencing. Results CM-HCECs strongly expressed CEC-related markers and maintained polygonal cell morphology even after 10 passages. At 24 months after cell transplantation, there was a CEC density of more than 2400 cells per square millimeter (range, 2408–2685) in the experimental group. A corneal thickness (CT) of less than 550 μm (range, 490–510) was attained. Gene sequencing showed that the gene expression pattern of CM-HCECs was similar to that of transplanted cells and HCECs. Conclusions Transplantation of CM-HCECs into monkey corneal endothelial dysfunction models resulted in a transparent cornea after 24 months. This research provided a promising prospect of cell-based therapy for corneal endothelial diseases.

Background:The metabolic condition known as diabetes mellitus is characterized by persistently high blood sugar levels and alterations in fat and protein metabolism as well as problems in insulin secretion or action, or both. Material and Methods:Patients with diabetes mellitus referred to the KIMS Hospital, Department of General Medicine are referred to the Department of Ophthalmology for a comprehensive examination of the cornea's endothelial cell count and appearance. Descriptive and prospective cross-sectional research. Results:There is a statistically significant reduction in endothelial cell density between the diabetes population and the non-diabetic control group, with the former having a mean of 2448.145 +/- 245.77 cells per sq.mm and the latter having a mean of 2600.085 +/- 168.09 cells per sq.mm. Conclusion:The current study's findings reveal a considerable drop in endothelial cell count in diabetes compared to age-matched controls. Endothelial pleomorphism and hexagonality are observed, although polymegathism is mostly unaffected. [ABSTRACT FROM AUTHOR]

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

Corneal endothelial cell (CEC) dysfunction causes corneal edema and severe visual impairment that require transplantation to restore vision. To address the unmet need of organ shortage, descemetorhexis without endothelial keratoplasty has been specifically employed to treat early stage Fuchs endothelial corneal dystrophy, which is pathophysiologically related to oxidative stress and exhibits centrally located corneal guttae. After stripping off central Descemet's membrane, rho‐associated protein kinase (ROCK) inhibitor has been found to facilitate CEC migration, an energy‐demanding task, thereby achieving wound closure. However, the correlation between ROCK inhibition and the change in bioenergetic status of CECs remained to be elucidated. Through transcriptomic profiling, we found that the inhibition of ROCK activity by the selective inhibitor, ripasudil or Y27632, promoted enrichment of oxidative phosphorylation (OXPHOS) gene set in bovine CECs (BCECs). Functional analysis revealed that ripasudil, a clinically approved anti‐glaucoma agent, enhanced mitochondrial respiration, increased spare respiratory capacity, and induced overexpression of electron transport chain components through upregulation of AMP‐activated protein kinase (AMPK) pathway. Accelerated BCEC migration and in vitro wound healing by ripasudil were diminished by OXPHOS and AMPK inhibition, but not by glycolysis inhibition. Correspondingly, lamellipodial protrusion and actin assembly that were augmented by ripasudil became reduced with additional OXPHOS or AMPK inhibition. These results indicate that ROCK inhibition induces metabolic reprogramming toward OXPHOS to support migration of CECs. [ABSTRACT FROM AUTHOR]

Background: Corneal transplantation is the only way to treat serious corneal diseases caused by corneal endothelial dysfunction. However, the shortage of donor corneal tissues and human corneal endothelial cells (HCECs) remains a worldwide challenge. We cultivated HCECs by the use of a conditioned medium from orbital adipose-derived stem cells (OASC-CM) in vitro. Then the HCECs were used to treat animal corneal endothelial dysfunction models via cell transplantation. The purpose of this study was to conduct a long-term observation and evaluation after cell transplantation. Methods: Orbital adipose-derived stem cells (OASCs) were isolated to prepare the conditioned medium (CM). HCECs were cultivated and expanded by the usage of the CM (CM-HCECs). Then, related corneal endothelial cell (CEC) markers were analyzed by immunofluorescence. The cell proliferation ability was also tested. CM-HCECs were then transplanted into monkey corneal endothelial dysfunction models by injection. We carried out a 24-month postoperative preclinical observation and verified the long-term effect by histological examination and transcriptome sequencing. Results: CM-HCECs strongly expressed CEC-related markers and maintained polygonal cell morphology even after 10 passages. At 24 months after cell transplantation, there was a CEC density of more than 2400 cells per square millimeter (range, 2408–2685) in the experimental group. A corneal thickness (CT) of less than 550 μm (range, 490–510) was attained. Gene sequencing showed that the gene expression pattern of CM-HCECs was similar to that of transplanted cells and HCECs. Conclusions: Transplantation of CM-HCECs into monkey corneal endothelial dysfunction models resulted in a transparent cornea after 24 months. This research provided a promising prospect of cell-based therapy for corneal endothelial diseases. [ABSTRACT FROM AUTHOR]

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

Corneal endothelial cells (CEnCs) cannot be regenerated once damaged, so restoring corneal function can only be achieved through tissue engineering. In this study, biocompatible films were prepared from silk fibroin (SF) and taurine (Ta) as a carrier for the regeneration of CEnCs. Ta/SF films were prepared by mixing Ta at various concentrations (0, 0.25, 0.5, 1, and 2 mM) in a 7% SF solution to determine the effects of Ta concentrations on cornea endothelial proliferation. We observed that the 0.25 mM Ta/SF film produced the highest number of viable cells and cellular proliferation. Ta/SF film was also found to maintain cell morphology and cell functionality. Current research on graft materials for corneal regeneration focuses on maintaining transparency, adhesion, and proliferation of corneal endothelial cells. In addition to the above-mentioned advantages, the Ta/SF film in this study creates an environment similar to the native CEnCs environment by using Ta, an amino acid abundantly present in the eye tissue. Therefore, Ta/SF film may be useful as a new treatment modality and a carrier for CEnCs in cornea tissue regeneration. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series. Methods: We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy. Results: The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0–23.5), 7.4 (IQR 1.0–-22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7–14.1) and 6.4 (IQR 2.6–-12.1) in age controlled normal eyes (P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group (P = 0.001). Nanophthalmic eyes with ACD 2.5 mm were significantly better postcataract surgery (P = 0.02 and P = 0.002, respectively). Conclusion: The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth

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.

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: Corneal endothelial cells (CECs) serve as a barrier and foothold for the corneal stroma to maintain the function and transparency of the cornea. Loss of CECs during aging or disease states leads to blindness, and cell replacement therapy using either donated or artificially differentiated CECs remains the only curative approach.Methods: Human induced pluripotent stem cells (hiPSCs) that were cultured in chemically defined medium were induced with dual-SMAD inhibition to differentiate into neural crest cells (NCCs). A small-molecule library was screened to differentiate the NCCs into corneal endothelial-like cells. The characteristics of these cells were identified with real-time PCR and immunofluorescence. Western blotting was applied to detect the signaling pathways and key factors regulated by the small molecules.Results: We developed an effective protocol to differentiate hiPSCs into CECs with defined small molecules. The hiPSC-CECs were characterized by ZO-1, AQP1, Vimentin and Na+/K+-ATPase. Based on our small-molecule screen, we identified a small-molecule combination, A769662 and AT13148, that enabled the most efficient production of CECs. The combination of A769662 and AT13148 upregulated the PKA/AKT signaling pathway, FOXO1 and PITX2 to promote the conversion of NCCs to CECs.Conclusion: We established an efficient small molecule-based method to differentiate hiPSCs into corneal endothelial-like cells, which might facilitate drug discovery and the development of cell-based therapies for corneal diseases.

Objective: To establish a primary cell culture and clarify the characteristics of canine corneal endothelial cells in vitro. Procedures: The eyes were enucleated from dogs that were euthanized for reasons unrelated to this study. Enucleated canine eyes were dissected, and the intact corneas were isolated from the globes. Using enzymes, the corneal endothelial cells were dispersed from the cornea. The obtained canine corneal endothelial cells were cultured in a cell culture dish. Cultured corneal endothelial cells were morphologically evaluated using phase‐contrast microscopy. Immunohistochemical analysis of the cultured cells, particularly of the corneal endothelial cell marker, zonula occludens‐1 (ZO‐1), Na+/K+‐ATPase, and vimentin, was performed to clarify whether the cultured cells were actually corneal endothelial cells. Furthermore, the post‐passage morphology of cultured cells was evaluated. Results: Canine primary cultured corneal endothelial cells showed morphologically small, cobblestone‐like structures. The isolated cells had proliferative ability in vitro and demonstrated positive expression of the corneal endothelial cell markers, ZO‐1, Na+/K+‐ATPase, and vimentin. However, repeated passages resulted in larger cell sizes as assessed by phase‐contrast microscopy. Repeated passages also resulted in lower cell density. Conclusions: This study demonstrated the successful culture of canine corneal endothelial cells. This might enhance the understanding of corneal endothelial cell characteristics in dogs. [ABSTRACT FROM AUTHOR]

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.

Purpose: To present a novel technique that using capsulorhexis flap to protect corneal endothelial cells during femtosecond laser-assisted cataract surgery. Methods: During the procedure, an isolated capsulorhexis flap was used to lift it up carefully by using OVD until the flap attached to the corneal inner layer. It kept steady during the phaco phase, and been removed by I/A tip after intraocular lens implantation. Results: In our pilot study, the damage to the corneal endothelial cells from the phacoemulsification procedure were no more than the traditional phaco procedure, even femtosecond laser assisted cataract surgery. Conclusion: Isolated capsulorhexis flap technique initiate a new approach to protect the endothelial cell. It is a simple technique with a short learning curve, but still need a further investigation to prove the protection of corneal endothelial cells.

Rabbit corneal endothelial cells are frequently used in pharmacological experiments and are useful for corneal transplant experiments. We performed the present study to analyze the effect of conditioned medium (CM) derived from human umbilical cord mesenchymal stem cells (HUMSCs) on the growth of rabbit corneal endothelial cells (RCECs) and to establish a program for expansion of RCECs in vitro. RCECs were cultured using a CM derived from HUMSCs (HUMSCs‐CM) in vitro. The proliferation ability of RCECs cultured in the presence of HUMSCs‐CM was evaluated by conducting 3‐(4,5‐dimethyl‐2‐thiazolyl)‐2,5‐diphenyl‐2‐H‐tetrazolium bromide, colony formation, and scratch migration assays. The proliferation ability of RCECs maintained in HUMSCs‐CM was significantly enhanced as compared to RCECs cultivated in the control group. Immunofluorescence indicated that zonula occludens‐1 (ZO‐1) and N‐cadherin were located at intercellular junctions. Real‐time PCR and western blot analyses demonstrated that the CEC‐relative functional markers were expressed in RCECs maintained in HUMSCs‐CM. Flow cytometry analyses demonstrated that HUMSCs‐CM promoted the G0/G1 entrance to the S phase in RCECs. Our results demonstrated that HUMSCs‐CM induced the proliferation of RCECs in vitro and maintained the necessary characteristic phenotypes. The expanded RCECs may provide a promising cell source for experimental research and clinical therapy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series.Methods: We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy.Results: The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0-23.5), 7.4 (IQR 1.0--22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7-14.1) and 6.4 (IQR 2.6--12.1) in age controlled normal eyes (P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group (P = 0.001). Nanophthalmic eyes with ACD <2.5 mm had a significantly greater reduction in ECD at 3 months postcataract surgery compared to baseline (P = 0.039). Visual outcomes and IOP reduction in the study group with ACD >2.5 mm were significantly better postcataract surgery (P = 0.02 and P = 0.002, respectively).Conclusion: The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth <2.5 mm, the percentage cell loss was significantly higher warranting the need for extensive intraoperative care. Increasing age was found to be the only significant risk factor influencing the ECD in short eyes. [ABSTRACT FROM AUTHOR]

We aimed to compare the local effects of intracameral cefuroxime diluted in normal saline (SF groups) against those of cefuroxime in balanced salt solution (BSS group) on the cornea of rabbits. Fourteen New Zealand albino rabbits were randomised into two groups. The right eyes of the rabbits in the SF group I were injected intracamerally with 1 mg cefuroxime diluted with 0.1 mL normal saline (n = 7), whereas the right eyes of the BSS group II were injected with 1 mg intracameral cefuroxime diluted with 0.1 mL with balance salt solution, and the left eyes of all rabbits received no treatment group III (control group). Corneal thickness was measured with pachymetry before and 1 week after the injection. Corneal samples were evaluated with light, specular and electron microscopy. Mean endothelial cell count was lower in the SF than in the BSS and control groups. Although an increase in corneal thickness was found in both treatment groups, this was not the case for the control group. The corneal endothelium preserved its hexagonal structure in all groups. Although both treatment groups showed a loss of endothelial microvilli, this was more prevalent in the SF group. However, microvilli were preserved in the control group. Dissolution of tight junctions in corneal endothelium was observed in the SF group only. Mitochondrial swelling, coarsening of endoplasmic reticulum, cytoplasmic vacuolisation, and increased endothelial cell sizes were the same in both treatment groups but was not observed in the control group. Thicker and more oedematous corneal stroma were observed in the SF group compared with the BSS and control groups. Dilution of intracameral cefuroxime in BSS yielded superior results compared with dilution in normal saline owing to toxicity to the endothelial cells and decline in the endothelial cell number, resulting in intracellular and intercellular morphological changes. BSS or any other solution with proven safety should be used in clinical studies. [ABSTRACT FROM AUTHOR]

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.

AIM: To compare the corneal endothelial cell counts pre- and post-operation, ultrastructure of anterior lens capsule and surgical completion after diathermic high-frequency capsulorhexis (DHC) and continuous curvilinear capsulorrhexis (CCC) applied in phacoemulsification (PHACO) of white cataract surgery. METHODS: Sixty-six eyes of 66 patients (33 males and 33 females) with cataract aged between 60 and 80y (mean 72.5±5.5) were recruited and undergone the surgery from June 2014 to November 2016. Anterior lens capsule, derived from two kinds of capsulorhexis, were randomly divided into two groups according to random number table. The ultrastructure of the capsule edge and its closer tissue were observed by transmission electron microscopy (TEM) and optical microscopy respectively. The surgical completion conditions and corneal endothelial cell counts were analyzed pre- and post-operation after two capsulorhexis. RESULTS: The capsule derived from CCC had smooth edge, well-organized cellular structure and the cells filling into the cutting edge under TEM and optical microscopy. The capsule derived from DHC had an approximate 60 banded area of cell degeneration and necrosis, with dentiform prominences at the edge of the capsule, and no cell structure was observed at this area. The corneal endothelial cell counts of both groups were slightly declined 1wk post-operation compared with that of pre-operation. There was no statistical difference between the two groups (t=1.63, P>0.05). CONCLUSION: DHC shows good clinical value in white mature and hypermature cataract surgery.

Yosuke Harada,1,2 Ken Fukuda,1 Asami Nakahira,1 Kentaro Tada,1 Tamaki Sumi,1 Atsuki Fukushima1 1Department of Ophthalmology and Visual Science, Kochi Medical School, Nankoku, Japan; 2Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan Background: The aim of the study was to investigate the efficacy of therapy in patients with cytomegalovirus (CMV) anterior uveitis. Patients and methods: We reviewed the records of patients with CMV anterior uveitis who attended our institution between October 2010 and December 2015 and who were confirmed to have CMV DNA in the aqueous humor by polymerase chain reaction analysis. Results: Fourteen immunocompetent patients (10 men and 4 women, total of 17 eyes) were enrolled. The mean ± SD age at the onset of antiviral therapy was 63.1 ± 11.3 years (range, 44–87 years). CMV DNA was not detected in the aqueous humor of 3 patients on initial testing, but it was detected on subsequent analysis. All patients underwent systemic antiviral therapy. Among the patients who were followed up for more than 6 months after starting systemic antiviral therapy, systemic antiviral therapy was successfully terminated in all 4 patients without corneal endothelial loss but had to be continued because of disease recurrence on its termination in 5 of 8 patients (62.5%) with corneal endothelial damage (P = 0.038). Conclusions: Patients with corneal endothelial cell loss are likely to require longer term antiviral therapy than those without endothelial damage. In addition, whereas definitive diagnosis of CMV anterior uveitis requires the detection of CMV DNA in aqueous humor by polymerase chain reaction, one-fifth of patients in the present study tested negative on initial examination. Keywords: cytomegalovirus, anterior uveitis, corneal endothelial cell, polymerase chain reaction, clinical course

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.

AIM: To compare the difference in corneal endothelial cell density and morphology after phacoemulsification using Ringer lactate(RL)and balanced salt solution(BSS)irrigating solutions.METHODS: The prospective randomized controlled trial study was conducted between February 2017 and April 2017 in Dr. YAP Eye Hospital, Yogyakarta, Indonesia. There were a total of 52 subjects(52 eyes)who were senile cataract patients further grouped into two, 26 patients undergoing the phacoemulsification procedure using RL irrigating solution and the other 26 patients with BSS irrigating solution, both conducted by one operator. On the 1, 7, and 28d post operative, an evaluation was done to measure the density and corneal endothelial cell morphology, as well as the variable of inflammation in the two groups.RESULTS: Fifty-two eyes had undergone phacoemulsification with posterior intraocular lens implantation. Both groups were evaluated for the endothelial cell reduction and corneal endothelial cell morphology change, along with post-operative inflammation. On the 28d post-operative, endothelial cell reduction in the BSS group(173.96 cell/mm2, 8.12%)was lower than the RL group(253.20 cell/mm2, 10.25%), percentage of corneal endothelial cell variation coefficient increase in the BSS group(2.92%, 8.36%)was lower compared to the RL group(3.42%, 9.96%), decrease of hexagonal cells of corneal endothelium cells presentation percentage in the BSS group(4.30%, 8.17%)was lower compared to the RL group(4.84%, 8.97%), and the percentage increase of central corneal thickness in the BSS group(4.69 μm, 0.89%)was almost equal to the RL group(4.53 μm, 0.90%). All of the results regarding difference in density and corneal cell endothelium morphology between the two groups did not reveal any statistically significant difference(P>0.05). Inflammatory variable in the two groups were even.CONCLUSION: BSS and RL were equal in their capability of maintaining endothelial cell loss and endothelial cell morphologic change in senile cataract patients after phacoemulsification.

AIM: To observe the influence of mitomycin C on corneal endothelial cell in phacoemulsification combined trabeculectomy. METHODS: Totally 58 patients with cataracts and glaucoma were selected and divided into 2 groups randomly, with 29 cases in each. All patients were treated with phacoemulsification combined trabeculectomy, and those of the control group used no anti-metabolism drugs in the surgery, while those of the observation group given 0.2mg/mL mitomycin C in the surgery. The visual acuity and intraocular pressure, filtering bleb form and complications were compared before and after treatment. Further more, central corneal thickness of patients was detected by corneal topography, and corneal endothelial cell density, hexagonal cell percentage, and variable coefficient of patients were detected with non-contact corneal endothelium. RESULTS: Before surgery, there was no significant difference in visual acuity between groups(P>0.05); after surgery, the visual acuity of both groups increased, and there was no significant difference between groups either(P>0.05). Before surgery, there was no significant difference on intraocular pressure between groups(P>0.05); after surgery, the intraocular pressure of both groups decreased, and that of the observation group was lower than the controls, the difference between groups and in-groups were both had statistical significance(PP>0.05), but the complication rate of observation group was lower than the controls(PP>0.05). CONCLUSION: Using mitomycin C in the surgery of phacoemulsification combined trabeculectomy is benefit to stabilize intraocular pressure and reduce postoperative complication rate, without the risk of injuring corneal endothelial cells.