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Objective: A single layer of tightly spaced cells, known as the endothelium, rests on the posterior side of the cornea. This endothelium regulates the stroma's relative dehydration, which is essential for corneal clarity. Cell therapy is an innovative method being used to repair various corneal abnormalities. Mesenchymal stem cells (MSCs) are now one of the most significant types of stem cells scientists have studied. This study aimed to evaluate the role of MSCs for corneal endothelial regeneration. Methods: A systematic review was performed by searching for articles from reputable databases with many study-type references, including PubMed, Cochrane Library, Science Direct, and Google Scholar, up to January 2024. The resulting data were displayed using the 2020 PRISMA flowchart and evaluated using the PRISMA 2020 checklist. Most of the included studies were in vivo and used topical application and anterior chamber injection as the administration routes. Results: Based on the findings of this review, MSCs increased corneal endothelial cell density, improved the defect area and corneal transparency, facilitated endothelial cell regeneration and wound healing, and decreased neovascularization and corneal pro-inflammatory cytokines as compared to controls. Conclusion: Administration of MSCs into the anterior chamber could increase regeneration and proliferation of corneal endothelial tissue. [ABSTRACT FROM AUTHOR]

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

Purpose: In the conventional technique, viscoelastic agents are typically rinsed away with balanced salt solution (BSS), but it may lead to a series of complications such as viscoelastic residue, anterior chamber instability and intraoperative TICL rotation. The utilization of irrigation and aspiration (I/A) has been shown to be effective in maintaining anterior chamber stability, reducing the incidence of postoperative high intraocular pressure, and minimizing postoperative fundus complications. However, there is a lack of previous studies investigating the impact of I/A on corneal endothelial cells during ICL implantation. The objective of this study was to examine the effect of I/A on corneal endothelial cells in patients undergoing myopia correction through implantation of Implantable Collamer Lens with a central hole (V4c ICL). Methods: A retrospective selection was made of 344 eyes from 172 patients who underwent V4c ICL implantation and I/A to remove viscoelastic agent from the anterior chamber between 2021 and 2022. The intraocular pressure (IOP) was measured at 1 h, 2 h and 3 h after surgery. Corneal endothelial cell density (ECD), coefficient of variation in cell size (CV), standard deviation of cell area (SD), and percentage of hexagonal cells (HEX) were evaluated at 1 week postoperatively to assess corneal endothelial cells. The first two represent polymegethism or morphological variation, while the third parameter represents the degree of polymorphism of the corneal endothelial cells. Electronic medical records were utilized for data collection purpose. Results: All surgeries proceeded without complications. The IOP was 16.50 ± 3.42 mmHg (range: 11.5–22.3 mmHg) prior to surgery and increased to 21.25 ± 5.61 mmHg (range: 9.5–34.8 mmHg), 19.85 ± 5.18 mmHg (range: 11.4–36.2 mmHg) and finally settled at an average of 18.81 ± 4.57 mmHg (range: 10.1–38.8 mmHg) at the respective time points of 1 h, 2 h and 3 h after surgery. The preoperative ECD was recorded as being approximately 3004 ± 295 cell/mm2, which exhibited a marginal decreased of 1.17% postoperatively, resulting in an average ECD value of 2969 ± 303 cell/mm2 one week after surgery (P = 0.12). Similarly, the preoperative CV was determined as 31.10 ± 3.78%, and it experienced a slight reduction with an average CV value of 30.74 ± 3.77% at week after surgery (P = 0.21). And, the preoperative SD was reported as 104.76 ± 17.26, and it remained virtually unchanged with an average SD value of 104.85 ± 18.75 at one week after surgery (P = 0.95). The preoperative HEX was calculated as 55.38 ± 8.94%, and it remained its stability with an average HEX value of 55.45 ± 8.73% one week after surgery (P = 0.92). Conclusion: The utilization of I/A led to a slight decrease in postoperative ECD when compared to conventional surgical techniques. Nevertheless, the reduction in ECD remained within acceptable limits, taking into accout the avervantaged it offered, such as stabilization of the anterior chamber and decreased occurrence of viscoelastic residue after surgery. It is challenging to anticipate the long-term safety of corneal endothelial cells based on current short-term studies. However, this study provides a valuable reference indicating that neither anterior chamber irrigation nor I/A aspiration have an adverse impact on the safety of corneal endothelial cells in the short term. Further research is imperative to enhance our understanding of their effects over an extended period. [ABSTRACT FROM AUTHOR]

Purpose: To analyze and report the long-term outcomes in terms of efficacy and safety of eyes implanted with the spherical version of a foldable iris-fixated phakic intraocular lens (pIOL) for the correction of myopia. Methods: Retrospective analysis of the results of 56 eyes of 32 patients (age, 19–45 years) who underwent implantation of the spherical model of the Artiflex pIOL (Ophtec B.V., Groningen, The Netherlands) for the correction of myopia. Visual, refractive, biometric, intraocular pressure (IOP) and corneal endothelial changes were evaluated during a long-term follow-up: 2, 7, 10 and 12 years for more than 50, 30, 20 and 10 eyes, respectively. Results: At 4 weeks postoperatively, a significant reduction of manifest sphere and spherical equivalent (SE), with a significant improvement of uncorrected distance visual acuity were found (all p < 0.001). No significant changes were found during the rest of follow-up in sphere (p ≥ 0.072). The percentage of eyes with SE within ± 1.00 D was over 83% during the whole follow-up. A non-significant trend to IOP increase was observed at 4 weeks postoperatively (p = 0.530), with a significant reduction at 1 year after (p = 0.039) and no significant changes during the rest of follow-up (p = 0.180). There was a significant reduction of anterior chamber depth at 4 weeks after surgery (p < 0.001), with no significant changes during the following 9 years of follow-up (p = 0.118). However, an additional significant decrease of this parameter was observed between 10 and 13 years after surgery (p = 0.027). Mean endothelial cell loss changed from 2.01 ± 4.49% at 4 weeks after surgery to 9.11 ± 2.24% at the end of the follow-up. No complications were reported during the follow-up. Conclusions: Myopia correction with the Artiflex pIOL is an effective and safe procedure in the long term. [ABSTRACT FROM AUTHOR]

BACKGROUND: The traditional surgical treatment for stromal corneal dystrophy is penetrating keratoplasty. In recent years, more and more doctors are considering using deep lamellar keratoplasty to treat stromal corneal dystrophy. Few studies comparing penetrating keratoplasty and deep lamellar keratoplasty for stromal corneal dystrophy have been reported in China. OBJECTIVE: To compare the clinical efficacy of deep lamellar keratoplasty and penetrating keratoplasty in the treatment of stromal corneal dystrophy. METHODS: Fifty-seven patients (57 eyes) diagnosed with stromal corneal dystrophy and admitted at the General Hospital of Northern Theater Command from January 2000 to January 2018 were selected, including 18 males and 39 females, aged (52.9±20.0) years. They were divided into two groups based on the surgical procedure: 21 cases (21 eyes) in the deep lamellar keratoplasty group and 36 cases (36 eyes) in the penetrating keratoplasty group. A 12-month followup was conducted to observe the best-corrected visual acuity, corneal endothelial cell density, corneal graft transparency, intraoperative and postoperative complications, and recurrence of the original disease. RESULTS AND CONCLUSION: Visual acuity at 1, 3, 6, and 12 months postoperatively was higher than preoperatively in both groups (P < 0.05). The postoperative best-corrected visual acuity between the two groups showed no significant difference (P > 0.05). With the prolongation of postoperative time, the corneal endothelial cell density gradually decreased in the two groups, and the annual loss rate of corneal endothelial cell density in the penetrating keratoplasty group was higher than that of the deep lamellar keratoplasty group at 6 and 12 months postoperatively (P < 0.05), while there was no significant difference in corneal graft transparency between the two groups at 12 months postoperatively (P > 0.05). There were six cases of complications in the deep lamellar keratoplasty group and 14 cases of complications in the penetrating keratoplasty group. There was no recurrence in 57 cases within 12 months after surgery, and the difference in recurrence rates between the two groups at 5 years after surgery was not significant (P > 0.05). The graft survival rates at 5 years after surgery in the penetrating keratoplasty group and the deep lamellar keratoplasty group were 83% and 86%, respectively, and there was no significant difference between the two groups (P > 0.05). To conclude, deep lamellar keratoplasty could be considered as an alternative to penetrating keratoplasty in the treatment of stromal corneal dystrophy. [ABSTRACT FROM AUTHOR]

BackgroundDuring cataract phacoemulsification surgery, the Alcon Centurion with Active Sentry can achieve a more stable anterior chamber, which allows a lower intraocular pressure (IOP) setting than the gravity fluidics system. In this randomized controlled trial, we compared these two systems’ damage to the cornea under different IOP settings.MethodsSeventy-eight eyes of 53 patients with corneal endothelial cell density (ECD) of 500∼1500/mm2 were enrolled and randomly divided into the active fluidics system (AFS) group using an Active Sentry handpiece with 30 mmHg IOP setting (40 eyes) and the gravity fluidics system (GFS) group using an Ozil handpiece with 80 cmH2O IOP setting (38 eyes). Intraoperative parameters, visual acuity, corneal edema ratio, central corneal thickness (CCT) changes as well as loss rate of ECD were analyzed.ResultsWe observed no significant differences in best corrected visual acuity (BCVA), cumulative dissipated energy (CDE), total case time, estimated fluidics usage (EFU) and ophthalmic viscoelastic devices (OVDs) usage between the two groups. The enrolled eyes were further divided into soft nucleus (27 eyes) and hard nucleus (51 eyes) subgroups. And we found less pain complaint during surgeries, lower corneal edema ratio at 1-day and 1-week visit, smaller CCT changes at 1-day visit and lower ECD loss rate at 1-month visit (p < 0.05) in both subgroups of the AFS group than in the GFS group, implying higher intraoperative comfort levels and less corneal damage of the AFS group with a low IOP setting.ConclusionOwing to a lower IOP setting, Centurion® Vision System with Active Sentry handpiece causes less corneal damage and pain perception during phacoemulsification for patients with low pre-operative ECD.Clinical Trial Registrationhttps://www.chictr.org.cn, identifier ChiCTR2300077865.

Purpose: Corneal endothelial cell density (ECD) gradually decreases after corneal transplantation by unknown biologic, biophysical, or immunologic mechanism. Our purpose was to assess the association between donor corneal endothelial cell (CEC) maturity in culture and postoperative endothelial cell loss (ECL) after successful corneal transplantation. Design: Prospective cohort study. Participants: This cohort study was conducted at Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. It included 68 patients with a 36-month follow-up period who had undergone successful Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty. Methods: Human CECs (HCECs) from remaining peripheral donor corneas were cultured and evaluated for maturity by surface markers (CD166+, CD44−/dull, CD24−, and CD105−) using fluorescence-activated cell sorting. Postoperative ECD was assessed according to the mature-differentiated HCEC contents: high-maturity group: > 70%, middle-maturity group: 10% to 70%, low-maturity group: < 10%. The successful rate of ECD maintained at 1500 cells/mm2 at 36 months postoperative was analyzed using the log-rank test. Main Outcome Measures: Endothelial cell density and ECL at 36 months postoperative. Results: The 68 included patients (mean [standard deviation] age 68.1 [13.6] years, 47.1% women, 52.9% DSAEK). The high, middle, and low-maturity groups included 17, 32, and 19 eyes, respectively. At 36 months postoperative, the mean (standard deviation) ECD significantly decreased to 911 (388) cells/mm2 by 66% in the low-maturity group, compared with 1604 (436) by 40% and 1424 (613) cells/mm2 by 50% in the high and middle-maturity groups (P < 0.001 and P = 0.007, respectively) and the low-maturity group significantly failed to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Additional ECD analysis for patients who underwent DSAEK alone displayed a significant failure to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Conclusions: The high content of mature-differentiated HCECs expressed in culture by the donor peripheral cornea was coincident with low ECL, suggesting that a high-maturity CEC content predicts long-term graft survival. Understanding the molecular mechanism for maintaining HCEC maturity could elucidate the mechanism of ECL after corneal transplantation and aid in developing effective interventions. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Abstract Background To describe the distribution of corneal endothelial cell density (ECD), and to explore its correlation with birth weight (BW), anthropometric parameters, and ocular biometric parameters in Chinese school children. Methods In the population-based cross-sectional Nanjing Eye Study, children were measured for anthropometric information, for ECD by the noncontact specular microscope and for ocular biometric parameters by the optic low-coherent reflectometer. Data from right eyes were analyzed to illustrate the distribution of ECD and for determining correlated factors with ECD using univariate and multiple linear regression analysis. Comparisons among three different BW groups were performed using a one-way ANOVA analysis followed by the Bonferroni correction for pairwise comparisons. Results Of 1171 children, the mean (± standard deviation) ECD was 2875.34 ± 195.00 cells/mm2. In the Multiple Linear Regression analysis, BW, gender and central corneal thickness were significantly associated with ECD. The ECD increased by 36.16 cells/mm2 with BW increasing by 1 kg (P = 0.001) and increased by 0.44 cells/mm2 for every additional 1 mm in central corneal thickness (P = 0.01). The ECD of girls was 54.41 cells/mm2 higher than boys (P

This study was performed to investigate the corneal endothelial cell density (CECD) reduction and treatment efficacy in patients with uveitic glaucoma treated by the ciliary sulcus placement of the Ahmed glaucoma valve (AGV). This retrospective study included 27 eyes of 27 patients with noninfectious uveitis who underwent the sulcus placement of the AGV. Each patient underwent a clinical assessment including a CECD measurement before surgery and at 3, 6, 9, and 12 months after surgery. The mean CECD was 2431.4 ± 367.5 cells/mm2 at preoperative baseline and 2360.5 ± 391.3 cells/mm2 at 12 months (p = 0.074), with a reduction rate of 2.73 ± 9.29%. The CECD reduction was significantly greater in patients with unilateral uveitis than that with bilateral uveitis. The rate of successful intraocular pressure control was 88% at 12 months, and the number of intraocular pressure-lowering medications was significantly reduced (p < 0.001). The current study showed that the implantation of an Ahmed tube into the ciliary sulcus provided stable intraocular pressure control in patients with glaucoma secondary to noninfectious uveitis, and CECD reduction was moderate in most patients at 12 months. [ABSTRACT FROM AUTHOR]

Purpose: There is a lack of long-term and large-scale studies on the adverse effects of soft contact lenses (SCLs) on the corneal endothelia of Asian populations. Here, we aimed to examine the effects of long-term SCL use on corneal endothelial density and morphology., Materials and Methods: This retrospective study involved consecutive patients at the Miyata Eye Hospital (Miyazaki, Japan), who had used SCLs for more than 1 year. Patients with ophthalmological disorders without refractive errors were excluded. The period of SCL use, SCL type, corneal endothelial cell density (ECD), appearance rate of hexagonal cells (HEX), and coefficient of variation of cells (CV) were analyzed., Results: In total, 17,732 eyes of 8866 patients were included in the analysis (age, 26.0 ± 8.8 years). The mean period of SCL use was 6.3 ± 5.4 years. Multivariate regression analysis revealed that ECD and HEX were significantly negatively correlated with the period of SCL use, age, and sex ( p  < 0.001 for all). The CV was significantly positively correlated with the period of use ( p  < 0.001), sex ( p  = 0.002), and age ( p  < 0.001)., Conclusions: Corneal ECD, HEX, and CV were significantly associated with the period of SCL use in long-term users. It is essential to regularly check the corneal endothelium in patients with a history of long-term SCL use.

Background: To describe the distribution of corneal endothelial cell density (ECD), and to explore its correlation with birth weight (BW), anthropometric parameters, and ocular biometric parameters in Chinese school children.Methods: In the population-based cross-sectional Nanjing Eye Study, children were measured for anthropometric information, for ECD by the noncontact specular microscope and for ocular biometric parameters by the optic low-coherent reflectometer. Data from right eyes were analyzed to illustrate the distribution of ECD and for determining correlated factors with ECD using univariate and multiple linear regression analysis. Comparisons among three different BW groups were performed using a one-way ANOVA analysis followed by the Bonferroni correction for pairwise comparisons.Results: Of 1171 children, the mean (± standard deviation) ECD was 2875.34 ± 195.00 cells/mm2. In the Multiple Linear Regression analysis, BW, gender and central corneal thickness were significantly associated with ECD. The ECD increased by 36.16 cells/mm2 with BW increasing by 1 kg (P = 0.001) and increased by 0.44 cells/mm2 for every additional 1 mm in central corneal thickness (P = 0.01). The ECD of girls was 54.41 cells/mm2 higher than boys (P < 0.001). Children born with low BW presented significantly lower ECD than those born with normal BW (P < 0.05) and high BW (P < 0.05). Age and axial length were not significantly associated with ECD (P = 0.06 and P = 0.21, respectively).Conclusions: In Chinese school children aged 82 to 94 months, the ECD is positively correlated with BW and central corneal thickness, in which BW is a newly identified associated factor. It is like that gender plays an important role in ECD distribution while girls have relatively greater ECD than boys. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate corneal endothelial cell density (ECD) and morphology between normal tension glaucoma (NTG) and controls. A cross-sectional, single center study of 24 NTG and 26 age-matched healthy eyes were included. ECD, mean cell size (MCA) and coefficient of variance (CV) were analyzed, controlling for age and number and duration of concurrent glaucoma medications. NTG subjects had significantly lower ECD (2307 ± 514.7 vs. 2558 ± 278.5, p = 0.044) and larger MCA (458.3 ± 94.8 vs. 386.7 ± 57.3, p = 0.004), but no difference in CV compared to healthy subjects. NTG subjects stratified by number of glaucoma medications showed significant differences in ECD (p = 0.024) and MCA (p = 0.021), but no difference in CV. There were no significant differences in ECD, MCA or CV between subjects stratified by duration of glaucoma medication usage. After age-adjusting, there was no dose-dependent relationship between mean ECD or MCA and number of glaucoma medications. Post hoc analysis demonstrated only NTG subjects on three or more glaucoma medications had statistically significant differences in ECD (p = 0.032) and MCA (p = 0.037) compared to NTG subjects on two glaucoma medications. This study suggests that NTG is associated with lower corneal endothelial cell density and mean cell size. [ABSTRACT FROM AUTHOR]

Abstract 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

Syed Bilal Hassan Zaidi,1 Wajid Ali Khan2 1Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland; 2Pakistan Institute of Ophthalmology (PIO), Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, PakistanCorrespondence: Syed Bilal Hassan ZaidiDepartment of Ophthalmology, Mater Misericordiae University Hospital, Dublin, IrelandTel +353899568074Email syedbilalhassanzaidi@gmail.comPurpose: To determine the difference in mean corneal endothelial cell density (CECD) between the healthy and diseased eyes of the patients with unilateral pterygium with different morphology patterns by using a non-contact specular microscope (SP2000: Topcon Corporation, Japan) and to find out any relationship between severity of pterygium and daily sunlight exposure with the CECD loss.Methods: A descriptive cross-sectional prospective study was carried out at Al-Shifa Trust Eye Hospital (ASTEH), Rawalpindi, Pakistan from 21st January 2019 to 22nd January 2020. Two hundred eyes (n= 100 patients) of age range18 -68 years with unilateral pterygium were selected. Necessary demographic data and essential variables like age, smoking status, occupation, and daily direct sunlight exposure were determined. The severity of pterygium (grading) based on its morphology was determined by slit-lamp examination. CECD of each patient was carried out using a non-contact Specular Microscope. The healthy eye (without pterygium) of a patient was considered as control.Results: The age range in this study was 18– 68 years, with a mean age of 43.80 ± 24.37 years with a male to female ratio of 1.6:1 (62.00% males vs 38% females). Out of six occupations, the most common occupation was labour/construction work (n=31) followed by farming (n=27). The study reported a mean corneal endothelial cell density (CECD) of 2411.61± 143.64 vs 2751.41 ± 123.674 cells/mm2 in diseased and normal eyes, respectively (p-value = 0.0001). CECD was lower in grade 3 pterygium compared to less severe pterygium { grade 3 (Fleshy) =2261 cells/mm2 vs grade 2 (Intermediate)= 2413 cells/mm2 vs grade 1 (Atrophic)=2459 cells/mm2} although this difference between the groups was not found to be significant (p=0.065). No significant association between sunlight exposure and CECD loss was observed (p=0.065).Conclusion: This study concluded that the mean corneal endothelial cell density in patients with unilateral pterygium using a non-contact specular microscope were 2411.61± 143.64 cells/mm2.Keywords: pterygium, corneal endothelial cell density, specular microscope

Background: VEGF has an essential role in initiating wound and inflammation-related neovascularization. Several studies have demonstrated that VEGF is an important mediator of blood-- retinal-barrier breakdown, leading to fluid leakage below the macula and inducing the development of macular edema and choroidal neovascular membranes. Anti-VEGF agents interfere with its receptor binding, thus inhibiting VEGF's signal, which results in inhibition of abnormal blood vessel formation and decreasing vascular permeability. Aim of the Work: This study aimed is to report early changes in the corneal endothelial cell density (ECD) and morphology in patients undergoing intravitreal anti-VEGF injections (ranibizumab) for treatment of macular edema. Patients and Methods: This prospective study included 22 eyes of 22 DME patients indicated for IVI of Ranibizumab, with mean age 57.1±7.4 years, ranging from 42.0 years to 70.0 years. The majority of them were females (77.3%). Results: Cell density (endothelial cell count) at baseline (2601.81±220.0) didn't show statistically significant difference than that at one month (2598.91±198.1) after IVI. Coefficient variant was not significantly changed at month-1 as compared to baseline. Coefficient variant at baseline was 29.81±4.0, ranging from 22.0 to 39.0. and at one month was 31.31±5.4, ranging from 21.0 to 48.0. Hexagonal cells (HEX) were not significantly changed at one month as compared to baseline. Hexagonal cells at baseline were 68.91±3.2, ranging from 63.0 to 75.0 and after one month, it was 67.81±4.1, ranging from 60.0 to 76.0. Pachymetry was not significantly changed at one month as compared to baseline. The corneal thickness (pachymetry) at baseline was 538.81±40.1 ranging from 448.0-587.0 to 447.0-597.0. after one month of IV ranibizumab it was 536.31±42.1 0.183. Conclusion: A single IV injection of Ranibizumab in phakic and otherwise normal eyes with DME showed no change in ECD and pachymetry but a statistically non-significant increase in CV and decrease in HEX 1-month after injection. [ABSTRACT FROM AUTHOR]

Background: Corneal endothelial cells are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients due to stressful events. Present study was aimed to evaluate corneal endothelial density, hexagonality and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at early postoperative period and 1 month after phacoemulsification. Material And Methods: Specular microscopy examinations prior to phacoemulsification and at early postoperative period and 1 months after phacoemulsification were performed on diabetic and non-diabetic groups in grade 2 and grade 3 nuclear sclerosis. Later the changes in endothelial density, the percentage of hexagonality, and Central corneal thickness were evaluated. Result: Mean age of 120 study sample was 58.45 years (standard deviation – 8.498 years), with the highest 74 years and lowest 43 years. There were 53 (44%) females and 67 (56%) males in the study. 42 (35%) samples were from 51-60 years age group followed by 37 (30.83%) subjects in 61-70 years age group. Mean corneal endothelial cell density decreases after cataract surgery in comparison with pre-operative density among study samples. Mean pre-operative corneal endothelial cell density was lower in diabetics in comparison with non-diabetics, and the difference was statistically significant. Cell density count decreases after cataract surgery in both groups with significant difference between two groups. Mean corneal endothelial cell morphology (hexagonal cell percentage) decreases after cataract surgery in comparison with pre-operative density among study samples. Central corneal thickness increases in early postoperative period followed by normalisation at day 30. Conclusion: Diabetic group showed greater hexagonality decrease compared to non-diabetic group at 1 month after phacoemulsification. It is suggested that diabetic corneal endothelium requires additional care and protective measures during cataract surgery to minimize surgical trauma. There were no statistically significant differences in the endothelial loss and Central corneal thickness changes between the diabetic and non-diabetic group at 1 month follow up after phacoemulsification. [ABSTRACT FROM AUTHOR]

Purpose: To determine between-method differences in corneal endothelial cell parameters using center and automated methods of non-contact specular microscopy (CellCheck software of Konan, Inc.) in glaucomatous eyes. Methods: We analyzed the central corneal endothelial cell density (ECD) of 245 glaucomatous eyes using center (ECD-Ce) and automated methods (ECD-Au). Based on the ECD-Ce, we allocated subjects to Groups 1 to 10 (at 250 cells/mm2 intervals) and evaluated the ECD, coefficient of variation in cell area (CV), and percentage of hexagonal cells (HEX). Results: There was a close correlation (r = 0.91) between the ECD values measured using both methods. However, ECD-Au were significantly higher than those measured by the center method when ECD-Ce was less than 2500 (in Groups 1 to 8; P < 0.001 to P = 0.006). The regression equation of (ECD-Au—ECD-Ce) = 1028–0.397*ECD-Ce shows greater deviation in eyes with lower ECD, and this difference became 0 when ECD -Ce was 2593 cells/mm2. None of the 44 subjects with an ECD-Ce of < 1000 cells/mm2 recorded an ECD-Au < 1000 cells/mm2. Compared with the center method, the automated method had higher and lower median CV and HEX values, respectively (P < 0.001). The between-method differences in both CV and HEX were negatively correlated with ECD-Ce (r = −0.49, P < 0.001 and r = −0.25, P < 0.001, respectively). Conclusion: The automated method of the CellCheck software overestimates ECD in eyes with lower ECD values and may overlook risk of corneal decompensation. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate fluorescein effect on the corneal endothelium by endothelial specular microscopy in diabetic retinopathy patients undergone fundus fluoresecein anjiography (FFA). Methods: One hundred thirthy four diabetic retinopathy patients undergone FFA aged between 42 and 74 years were included study. We checked the corneal endothelial cell density (ECD), coefficient of variation of cell area (CV/polymegethism) and percentage of hexagonal cells (6A/pleomorphysm) before FFA and 1 hour, 1 day, 1 week after the procedure. Results: The mean baseline ECD was 2223±216 cells/mm2. The mean ECD before and 1 hour (2234±224 cells/mm2), 1 day (2237±231 cells/mm2), 1 week (2226±219 cells/mm2) after the procedure weren't significantly different (p=0.243; repeated measure ANOVA). The mean of the coefficient variations of the endothelial cell size before and 1 hour, 1 day, 1 week after the procedure were 0.327±0.07, 0.319±0.06, 0.322±0.06, 0.325±0.07 respectively (p=0.281; repeated measure ANOVA). The mean of the baseline percent of hexagonal cells (pleomorphism) in the endothelium was 61.7±5.2, and the postoperative 1 hour, 1 day, 1 week percent were 62.3±5.7, 61.9±6.1, 61.3±5.9, respectively (p= 0.317; repeated measure ANOVA). Conclusion: The results of this study demonstrated that fluorescein has no toxic effect on corneal endothelium. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to determine the influence of age on central corneal thickness and corneal endothelial morphology as well as to identify the relationship between them in normal Thai eyes. Methods Non-contact specular microscopy was performed in volunteers stratified into seven age groups ranging from 11 to 88 years. The corneal endothelial parameters studied included central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in cell size (CV), cell area (CA) and percentage of regular hexagonal cells. Results In a total of 501 subjects (1002 eyes), the mean age was 43.12 ± 18.80 years and 347(69.3%) were females. The mean CCT, ECD, CV, CA, and hexagonality was 533.80 ± 33.00 μm, 2732 ± 258 cell/mm2, 37.61 ± 6.76%, 369.04 ± 37.90 μm, and 49.03 ± 7.53%, respectively. There was a significant inverse correlation between age and CCT (r = − 0.215, P

Objectives:To investigate corneal endothelial cell density (ECD), morphology, and central corneal thickness (CCT) in patients with gout compared with healthy subjects.Materials and Methods:Fifty eyes of 50 gout patients and 50 eyes of 50 healthy subjects without gout or any other systemic disease were included in this study. After detailed ophthalmologic examination, specular microscopy (Tomey EM-4000; Tomey Corp) measurement was performed for all participants. ECD, average cell area (ACA), coefficient of variation (CV), hexagonality ratio, and CCT values were recorded.Results:Mean ECD and hexagonality ratio were lower (p=0.004 and p=0.002) and CV, ACA, and CCT values were higher (p=0.001, p=0.007, and p=0.001) in patients with gout when compared to healthy subjects. There were significant correlations between gout disease duration and CD and hexagonality ratio (p=0.019 and p=0.043) and also between uric acid value and hexagonality ratio and CCT (p=0.044 and p=0.003).Conclusion:Altered corneal endothelial function was found in patients with gout when compared to healthy subjects and the alteration increased as gout duration and uric acid value increased.

Purpose: To evaluate corneal endothelial cell density (ECD) in the eyes with different grades of late spontaneous in-the-bag intraocular lens (IOL) dislocation. Methods: A prospective study included seventy-eight patients who applied for IOL dislocation. Overall 80 eyes were divided into four grades based on the in-the-bag IOL dislocation classification. All eyes underwent a complete ophthalmological examination. ECD was evaluated using in vivo corneal confocal microscopy. Results: Median corneal ECD was 1929 (1022–2958) cells/mm2 of all the patients. The lowest number of ECD was in grade 2 (grade 1 median ECD 1990.33 (1182–2425.33) cells/mm2, grade 2—1577.0 (1022–2958) cells/mm2, grade 3—2205.84 (1259–2807.67) cells/mm2 and grade 4—2072.17 (1045–2581.0) cells/mm2). A statistically significant difference was observed between the median of ECD of grade 2nd and 3rd (p = 0.023). By grouping cases into those with and without glaucoma, we found that corneal ECD was significantly lower in eyes with glaucoma compared with eyes without glaucoma in grades 3 and 4 (p < 0.05), while in other grades, the difference did not reach the significance level. We divided the corneal ECD of all eyes into two categories ≤ 1500 cells/mm2 and > 1500 cells/mm2. Logistic regression demonstrated that the odds of having corneal ECD less than 1500 cells/mm2 increased by 3.5-fold if patients with IOL dislocation had been diagnosed with glaucoma previously. Conclusion: Late spontaneous in-the-bag IOL dislocation reduced corneal ECD. Previously diagnosed glaucoma was the most common comorbidity. This condition has a significant impact on corneal ECD for patients with IOL dislocation. [ABSTRACT FROM AUTHOR]

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 < 0.001), BMI (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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate reproducibility of endothelial cell density (ECD) measurements using the Konan Cell Check D in donor corneas by two different ophthalmologists and to compare the two automated cell count methods (center and flex-center) available in the software of this specular microscope., Methods: ECD values were quantified in 54 donor corneas by two independent investigators using the Cell Check D (Konan Medical USA Inc) with both automated cell count methods. In the center method, at least 30 contiguous cells are marked. For the flex-center method, an area is delineated and only the cells within the designated area are counted., Results: The mean ECD was 2473.81±378.22 cells/mm 2 . Good ECD intergrader reproducibility for the center (ICC=0.821) and the flex-center method (ICC=0.784) were noted. Poor reliability was observed for coefficient of variation and hexagonality (ICC≤0.265). When both methods for ECD analysis were compared, a moderate correlation for the two independent graders using the two manual (center and flex-center) methods was detected (correlation coefficient of 0.678 and 0.745 for each of the investigators). Comparison between methods yielded significantly higher ECD with the flex-center method (P=0.013). When corneas were divided by ECD, those under 2200 cells/mm 2 and those between 2200 and 2700 cells/mm 2 also had significantly higher ECD with the flex-center method (P<0.022)., Conclusions: ECD values are reproducible with both methods, although the flex-center method ECDs tend to be higher, particularly in cases of low ECD. Eye banks and surgeons should exercise caution in making decisions based only on small differences in ECD., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Abstract Background To compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD). Methods This study prospectively evaluated changes in the CECD in 60 eyes of 60 patients who underwent trabeculectomy and 50 eyes of 45 patients who underwent EX-PRESS device implantation. Baseline patient data recorded included age at surgery, sex, type of glaucoma medications, and lens status. Using a noncontact specular microscope, corneal specular microscopy was performed preoperatively at the central cornea and then at 6, 12, 18 and 24 months after surgery. CECD before and after surgery was compared using a paired t-test. Results There was a significant decrease in the IOP and number of antiglaucoma medications in both groups after the surgery. The mean CECD in the trabeculectomy group was 2505 ± 280 cells/mm2 at baseline, while it was 2398 ± 274 cells/mm2 (P

Objective: To compare the corneal endothelial cell density in patients of Pseudoexfoliation syndrome (PXS) with normal healthy controls. Study Design: Cross sectional comparative. Place and Duration of Study: This study was carried out at Armed Forces Institute of Ophthalmology, Rawalpindi from Mar 2016 to Jan 2017. Patients and Methods:Patients of PXS and healthy subjects of both genders between ages of 40 and 50 years, with best corrected visual acuity of 6/6 on snellen visual acuity chart were included in the study. All the participants including controls and PXS patients were subjected to ophthalmic clinical examination including corrected distance visual acuity, slit lamp examination by the single trainee researcher to exclude bias. Participants in both groups were evaluated for corneal endothelial cell density (ECD) by using non-contact, TOPCON SP 3000P Specular microscope. Sampling bias was eliminated by analyzing 100 cells in the center of each specular microscope photograph and mean of three readings was analyzed. Results: Both the groups were similar with respect to gender and age. In our study sample there were 29 (58%) males in PXS group and 24 (48%) males in control group with no statistical significant (p-value > 0.05) difference between gender distributions of both groups. The mean age of the PXS group was 46.34 ± 2.932 years, and in control group was 45.54 ± 2.887 years (p-value >0.05). The mean value of ECD was found to be 2021.548 ± 528.142 cells/mm2 in PXS patients and the mean value of ECD in healthy subjects was noted to be 2772.692 ± 383.395 cells/mm2, showing significantly lower ECD in PXS cases. Similarly, significantly higher number of cases 22 (44%) had CED

Background: Age-related cataract is a leading cause of visual impairment, considered a global health burden, it is responsible for over 47% of blindness worldwide. Surgical intervention is usually the treatment of choice and phacoemulsification cataract surgery with implantation of an intraocular lens is the most common procedure, which may have several complications. Objectives: To determine the effects of phacoemulsification surgery on corneal endothelial cell density and corneal thickness in patients undergoing cataract surgery. Methods: The present study was conducted on patients diagnosed with immature senile cataract requiring surgical intervention from November 2013 to 2014 in Khatam al Anbia Hospital (a tertiary ophthalmology center). Physical examination included best-corrected visual acuity using the Snellen chart, refraction, slit-lamp bio-microscopy for anterior chamber evaluation, keratometry, Goldman tonometry, gonioscopy, and dilated indirect ophthalmoscopy, pachymetry, specular microscopy and biometry. Surgery was performed by similar method and technique in all patients. The change in the corneal endothelial cell count or density and central corneal thickness (CCT) number were compared preoperatively and one day, one week, one month, and three months post–operatively. Results: A total of 92 eyes of 85 patients (43 females and 42 males with mean age of 62.1±12.2 years) were studied. Patients’ visual acuity improved (log MAR: 1±0.5 preoperatively to 0.45±0.34 post-operatively) (p=0.001). There was 11.4% endothelial cell loss (ECL) and significant decrease in ECC (from 2,791.15±99.86 to 2,472.87±472.14) (p=0.04). The central corneal thickness increased significantly (from 530.47±2.60 to 540.91±36.07). Diabetic patients (12.9%) had a statistically significant higher ECL rate after phacoemulsification (14.6% versus 8.7% respectively, p=0.002). Conclusion: Phacoemulsification resulted in significant corneal endothelial damage, which is particularly important in patients with a borderline reservoir of endothelial cell, such as diabetic patients, which highlights the necessity of refining the current surgical methods and instruments to minimize the endothelial damage. Trial registration: The trial was registered in the Thai clinical trial registry (http://www.clinicaltrials.in.th) with the ID: TCTR20171122001. Funding: The study was supported by a research grant of Mashhad University of Medical Sciences

Background: To investigate corneal endothelial cell density in eyes with primary pterygium.Methods: A retrospective study was conducted to compare endothelial cell density between 1,565 patients with primary pterygium and 3,448 patients without pterygium. Then a prospective study was designed to confirm the findings of the retrospective study in 95 patients with unilateral primary pterygium.Results: In the retrospective study, the mean endothelial cell density in eyes with primary pterygium was significantly lower (2,454 ± 303 cells/mm2 ) than those in eyes without pterygium (2,525 ± 312 cells/mm2 , p < 0.0001). However, the difference was not as high as previously reported (71 cells/mm2 , 2.9 per cent). In the prospective study, there was no significant difference in mean endothelial cell density in eyes with unilateral primary pterygium (2,480 ± 263 cells/mm2 ) and the contralateral eyes with no pterygium (2,527 ± 277 cells/mm2 , p = 0.20). There was also no significant difference in hexagonality (p = 0.10) or co-efficient of variation of size (p = 0.15) of corneal endothelial cells between eyes with pterygium and the contralateral eyes with no pterygium.Conclusion: Primary pterygium may not be associated with a decrease in endothelial cell density in our study population of rural Chinese patients. [ABSTRACT FROM AUTHOR]

Purpose: To report 6-month outcomes of visual acuity, the corneal thickness and endothelial cell density (ECD) in patients undergoing femtosecond laser-assisted Descemet's stripping endothelial keratoplasty (FS-DSEK). Methods: This prospective, consecutive, interventional series examined 25 eyes of 25 patients who underwent FS-DSEK for Fuchs endothelial dystrophy and bullous keratopathy. The pre-cut corneal endothelial graft thickness (CET) was 150 µm. Best-corrected visual acuity (BCVA), central corneal thickness (CCT), donor CET, recipient corneal stromal thickness (CST) and ECD were assessed at 1 week and 1, 2, 3 and 6 months postoperatively. Results: The mean BCVA at 6 months was 0.76 ± 0.35 logMAR units, improving from 1.54 ± 0.52 logMAR. CCT decreased significantly, from 759.8 ± 152.4 µm at 1 week to 631.7 ± 79.7 µm at 6 months (P = 0.001) postoperatively. CET recovered to 153.4 ± 33.7 µm (P = 0.076) at 6 months as pre-cut status. The CST decreased from 561.5 ± 96.3 µm at 1 week to 479.7 ± 57.9 µm at 6 months (P < 0.001). Preoperatively, the donor ECD was 2747.6 ± 255.4 cells/mm2, and the ECD decreased to 1729.1 ± 562.9 cells/mm2 at 6 months, for a peak ECD loss of 36.86%. A greater decrease in CST observed from 1 week to 6 months postoperatively correlated with a lower ECD loss (P = 0.019) and a lower preoperative ECD (P = 0.012). However, a thinner CET correlated with a higher preoperative ECD (P = 0.028). Conclusions: FS-DSEK is a safe and effective surgical alternative for corneal endothelial decompensation. The donor ECD and its changes could be used as predictive factors for the improvement of CST and CET. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the influence of age on central corneal thickness and corneal endothelial morphology as well as to identify the relationship between them in normal Thai eyes.Methods: Non-contact specular microscopy was performed in volunteers stratified into seven age groups ranging from 11 to 88 years. The corneal endothelial parameters studied included central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation in cell size (CV), cell area (CA) and percentage of regular hexagonal cells.Results: In a total of 501 subjects (1002 eyes), the mean age was 43.12 ± 18.80 years and 347(69.3%) were females. The mean CCT, ECD, CV, CA, and hexagonality was 533.80 ± 33.00 μm, 2732 ± 258 cell/mm2, 37.61 ± 6.76%, 369.04 ± 37.90 μm, and 49.03 ± 7.53%, respectively. There was a significant inverse correlation between age and CCT (r = - 0.215, P <  0.001), ECD (r = - 0.496, P <  0.001),and hexagonality (r = - 0.265, P <  0.001). The CV and CA directly correlated with age (r = 0.242, P <  0.001 and r = 0.470, P <  0.001). The estimate rate of endothelial cell loss was 0.2% per year. There was no correlation between CCT and ECD (P = 0.106).Conclusion: Normative data for corneal endothelial morphology in healthy Thai eyes showed that CCT, ECD, and hexagonality were significantly decreased, while the endothelial cell area and the variation in cell size were increased with aging. The central corneal thickness did not correlate with the endothelial cell density. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare Mydrane (combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%) and mydriatic drops (tropicamide 1% and phenylephrine 10%) used for cataract surgery in terms of efficacy in pupil dilation and impact on corneal endothelial cell density (CD) and central corneal thickness (CCT). Prospective study including 64 eyes of 64 patients that underwent phacoemulsification with intraocular lens implantation. Patients were randomized into two groups: Mydrane group received: tropicamide and phenylephrine one day preoperatively and Mydrane during the surgery. Reference group received: tropicamide and phenylephrine preoperatively. Pupil size was measured only in Mydrane group, in the same eye of the same patient one day preoperatively after mydriatic drops were given and during the surgery, after intracameral Mydrane injection. CD and CCT were evaluated one day preoperatively and one month postoperatively in all patients and compared between Mydrane and reference groups. The results show CCT and CD significantly decreased after surgery in both groups. There is no difference in this decrease between groups. In Mydrane group there was no difference in dilated pupil diameter between Mydrane and mydriatic drops. Gender, diabetes mellitus, POAG, alpha-1 blocker treatment failed to affect pupil dilation obtained with Mydrane. Cataract surgery affects CCT and CD regardless of which mydriatic protocol had been used. Pupil diameter was similar after drops instillation and after Mydrane injection in all patients from the Mydrane group. [ABSTRACT FROM AUTHOR]

AIM: To compare the effect of small incision extracapsular cataract extraction and phacoemulsification on corneal endothelial cells and explore the differences between these two most commonly used surgeries for grade Ⅱ-Ⅲ lens nucleus. METHODS: Retrospective study. We retrospectively evaluated the data of age-related cataract patients who had completed surgery in our hospital between June 2013 and December 2015. There were 84 eyes of 84 patients. The corneal endothelial cell density of all the patients were greater than 2000/mm2 and lens nucleus were grade Ⅱ-Ⅲ. The patients were divided into manual small incision cataract surgery(MSICS)group and phacoemulsification(Phaco)group. MSICS group included 42 cases(42 eyes)and Phaco group included 42 cases(42 eyes). Postoperative evaluations were performed at 1d, 1wk, 1mo and 6mo and included uncorrected visual acuity(UCVA), corneal endothelial cell density and the proportion of hexagonal cells.RESULTS: There were no statistically significant differences of the two groups in preoperative basic data, UCVA, corneal endothelial cell density and the proportion of hexagonal cells, nuclear classification. The postoperative UCVA were significantly improved in both groups(χ2=148.01, Pχ2=165.97, PF=37.74, P F=24.56, PP=0.002)after the operation and returned to baseline by 1wk(P=0.894)after surgery. There was no significant difference between the two groups in UCVA, corneal endothelial cell density and the proportion of hexagonal cells at each observation point (P>0.05). CONCLUSION: Manual small incision cataract surgery and phacoemulsification can indiscriminately improve UCVA and decrease the density of corneal endothelial cells. However, the change of hexagonal cells proportion was not obvious. These two surgeries for cataract patients with corneal endothelial cell density greater than 2000/mm2, grade Ⅱ-Ⅲ lens nucleus have similar efficacy and safety.

Purpose: To assess the efficacy and safety of filtration surgery using the EX-PRESS glaucoma filtration device in patients with normal-tension glaucoma (NTG). Study design: Prospective, single-arm, multicenter interventional case series. Methods: Eyes with NTG underwent EX-PRESS implantation with or without cataract surgery. The efficacy and safety were assessed at 1 day; 1 and 2 weeks; and 1, 3, 6, and 12 months after surgery. The main outcome measure was reduction in intraocular pressure (IOP) from baseline at 3, 6, and 12 months after surgery. Safety assessments included adverse event incidence, postoperative inflammation, and corneal endothelial cell density. Results: Thirty-two Japanese patients (37 eyes) with NTG were enrolled. The mean IOP decreased from 14.8 ± 2.3 mmHg at baseline to 10.0 ± 3.1 mmHg at 12 months after surgery (mean reduction 4.9 ± 4.2 mmHg [31.1%]; P <.0001). IOP-lowering medication use decreased from a mean of 3.3 medications per eye before surgery to 0.1 medications per eye at 12 months after surgery. IOP reductions > 20% were achieved by 61.5% of the eyes at 12 months. Adverse events were typical for filtration procedures, and none was deemed device-related. Postoperative inflammation was mild and self-limiting. The mean corneal endothelial cell density had decreased by 3.3% at 12 months after surgery. Conclusion: The EX-PRESS glaucoma filtration device is safe and effective for filtration surgery in patients with NTG, providing mean IOP reduction consistent with recommendations based on the Collaborative NTG Study. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (preoperative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients. Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed. Results: Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant. Conclusion: There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage. Materials and methods: In this prospective and non-randomized study, three groups were identified each consisting of 20 eyes (Group I phacotrabeculectomy, group II trabeculectomy, group III phacoemulsification). In the pre- and postop month 1, corneal endothelial cell density (CECD), coefficient of variation (CV) (polymegathism) and hexagonality (Hex) (pleomorphism) were measured by means of a non-contact specular microscope (Nidek CEM-530, NIDEK Co., Ltd. Japan). Results: The postop CECD in each of the three groups showed a significant decrease when compared with the preop period (6.1% in the phacotrabeculectomy group, 4.9% in the trabeculectomy group and 7.4% in the phacoemulsification group). The amount of decrease in the preop and postop CECD values showed no significant difference among these three groups. The postop CV value in each of the three groups showed a significant increase when compared with the preop period. The postop Hex value in each of the three groups showed no significant change when compared with the preop period. Conclusion: In our study, we observed that performing a combined phacotrabeculectomy on patients with glaucoma and cataract association in the same session did not do more harm to the corneal endothelium than other surgical methods. For this reason, this method can be applied safely to a patient population that is likely to develop corneal decompensation. [ABSTRACT FROM AUTHOR]

Objective: To explore the efficacy of implantable collamer lense (ICL) combined with laser keratectomy via corneal epithelium Trans-PRK in the treatment of patients with high myopia and its effect on corneal endothelial cell density. Methods: A prospective analysis was performed on patients with ultra-high myopia admitted to the department of ophthalmology of our hospital from March 2014 to March 2017. Six months after ICL implantation, the patients still had myopia and received Trans PRK treatment again. The number of cases was 30 and 52 eyes. Patients were followed up postoperatively. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), dioptre (D), intraocular pressure, ICL arch height, anterior chamber volume, anterior chamber depth, and changes in corneal endothelial cell counts were observed preoperatively, 6 months after ICL implantation and 6 months after Trans PRK so as to assess the effectiveness and safety of the surgery. Results: UCVA and BCVA of the eyes were significantly higher 6 months after ICL implantation and 6 months after Trans-PRK than those before the surgery, and UCVA of the eyes 6 months after Trans-PRK was significantly higher than that 6 months after ICL implantation. There was no increase in intraocular pressure in all patients after surgery. There was no significant difference in intraocular pressure preoperatively, 6 months after ICL implantation and 6 months after Trans PRK. The ICL arch height of the eyes 6 months after Trans-PRK was slightly lower than that 6 months after ICL implantation, but the difference was not statistically significant. Both anterior chamber volume and anterior chamber depth were significantly lower 6 months after ICL implantation and 6 months after Trans PRK than whose before the surgery, and anterior chamber depth 6 months after Trans PRK was significantly lower than that 6 months after ICL implantation. The number of corneal endothelial cells 6 months after ICL implantation was slightly less than that before surgery, but it was not statistically significant. The number of corneal endothelial cells 6 months after Trans PRK was higher than that 6 months after ICL implantation and close to the preoperative level. Conclusion: Trans PRK can effectively improve the eye diopter of patients with high myopia and residual myopia after ICL implantation. It has little effect on the density of corneal endothelial cells, can significantly improve visual acuity, and achieve the expected operation effect with safe operation, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Purpose: To assess the surgical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed by trainees.Study design: Retrospective, case control comparative study.Methods: This study compared cases performed by trainees with those performed by an experienced surgeon. First 10 cases of DSAEK performed by trainees with more than 6 months follow-up periods were recruited. The surgical outcomes of DSAEK performed by the trainees (Trainee group) were compared with disease-matched pairs of cases performed by an experienced surgeon (Experienced group). Graft clarity, best spectacle-corrected visual acuity, corneal endothelial cell density, and incidence of intra- or post-operative complications were studied.Results: Forty-one pairs were recruited. The graft clarity rate was not different between the Trainee and Experienced groups, with 95.1% and 97.6%, respectively, maintaining clear grafts at 12 months postoperatively. Trainee best spectacle corrected visual acuity was significantly worse at 6 and 12 months postoperatively compared with the Experienced group, and percent decreases in corneal endothelial density was more in the Trainee group at 3 months following surgery (P = 0.0029). While intra- or late post-operative complication rates were similar in both groups, incidences of early post-operative complications such as double chamber formation or pupillary block were observed more frequently in the Trainee group than in the Experienced group (P = 0.049).Conclusion: DSAEK can be performed relatively safely by training physicians with careful preparation and supervision by attending physicians. However, careful case selection and education on management of air injected in the anterior chamber seemed to be a key to long-term success. [ABSTRACT FROM AUTHOR]

AIM: To investigate the effect of Ahmed glaucoma drainage valve implantation on corneal endothelial cell density and intraocular pressure in patients with neovascular glaucoma. METHODS: Totally 200 cases(200 eyes)of patients with neovascular glaucoma in our hospital from June 2013 to June 2016 were enrolled in this study. All patients were treated with glaucoma drainage valve implantation. The medical records of the patients were retrospectively analyzed; the evaluation of operation completion was made; intraocular pressure at preoperative and postoperative 1wk, 1mo, 1a was detected using non-contact tonometry; the corneal endothelial cell density at preoperative and postoperative 1wk, 1mo and 1a was tested by corneal endothelial microscopy, and visual acuity of patients before operation and at 1a after operation was recorded. All patients' complications and intervention methods were followed-up and recorded. RESULTS: All patients' complete success rate was 81.0%, the conditional success rate was 92.0%. The proportion of preoperative and postoperative vision without light perception, hand moving to 0.01,0.02-0.05, 0.06-P>0.05). Intraocular pressure before treatment was 42.43±3.43mmHg, and were 13.45±2.34mmHg, 15.89±2.67mmHg, 16.34±2.88mmHg at 1wk, 1mo and 1a after operation respectively, showing significant difference(F=4570.62, P2, and were 2216.67±332.32/mm2, 2087.34±326.45/mm2, 1959.67±303.34/mm2 at 1wk, 1mo and 1a after operation respectively,holding significantly different(F=83.42, PCONCLUSION: Ahmed glaucoma drainage valve implantation for neovascular glaucoma can effectively control intraocular pressure but the presence of corneal endothelial cell loss exists, can effectively protect and recover residual vision of patients, relief complications and recover it after simple intervention,it is an effective method for neovascular glaucoma.

AIM:To investigate the effect of small incision non-phacoemulsification cataract surgery on corneal endothelial cell.METHODS: Totally 140 cataract patients(152 eyes)treated in our hospital from August 2013 to March 2016 were selected. All of the patients underwent small incision non-phacoemulsification cataract surgery. Before surgery and at 1wk, 1mo and 3mo after surgery, we measured the corneal endothelium of upper cornea, the central cornea and the lower part of cornea. The proportion and density of hexagonal cells, loss rate and cell area in corneal endothelial cells were calculated and compared. RESULTS: Postoperatively 36 eyes had posterior elastic layer folds, aqueous flare, which disappeared after treatment. After surgery, corneal incision was found to have mild corneal edema. No other complications were found. A total of 128 patients(137 eyes)were followed up for a total of up to 3mo, with a loss of follow-up in 12 patients(15 eyes). After surgery, corneal endothelial cell density of the upper part of the cornea, the central cornea and the lower part of cornea, was statistically significantly different with each other(F=3.526, P=0.031), the difference in different time points was statistically significant(F=4.111, P=0.018). The postoperative corneal endothelial cell loss rate was statistically significant different between the three groups(F=3.526, P=0.031), at different time pionts(F=4.111, P=0.018). There was statistical significance of percentage of hexagonal cells between the three groups(F=4.348, P=0.014), the difference was significantly different between different time points(F=4.964, P=0.008). There was statistical significance of corneal endothelial cell area between the three groups(F=3.180, P=0.044), the difference was significantly different between the time points(F=3.511, P=0.032). CONCLUSION: After small incision non-phacoemulsification cataract surgery, corneal endothelial cell density decreased, hexagonal cell proportion decreased, corneal cell area expanded.

AIM: To study the relativity between reject reaction from donation after cardiac death(DCD)and corneal endothelial cell source of corneal graft after penetrating keratoplasty.METHODS:Totally 28 cases of corneal graft rejection after penetrating keratoplasty with cardiac death donor cornea were analyzed using corneal endothelial microscope at less than 1mo, 2-3mo, 4-6mo, 7-12mo after operation.RESULTS:Coefficient variation of corneal endothelial cell of the 28 cases at less than 1mo,2-3mo, 4-6mo and 7-12mo were 38.23%, 49.56%, 57.18%, 65.04%. Corneal endothelial cell density were 2071.15±311.47, 1771.33±348.18, 1626.59±353.92, 1553.14±307.31. The coefficient variation of corneal endothelial cells was positively correlated with rejection(r=0.95, Pr=-0.93, PCONCLUSION: The corneal endothelial cell coefficient variation increased gradually and the corneal endothelial cell density decreased gradually after DCD corneal allograft rejection. Corneal endothelial cell coefficient variation and corneal endothelial cell density can be used as indicators of early detection of postoperative rejection.

Purpose: To evaluate the effect of mitomycin-C (MMC) on corneal endothelial cell density (ECD) and morphology after trabeculectomy. Methods: In this prospective comparative case series, 31 eyes with glaucoma underwent trabeculectomy with (group I), or without (group II) MMC. Specular microscopy was performed pre-, and postoperatively at months 1 and 3. Outcome measures included central corneal endothelial cell count and coefficient of variation (CV) of cell size. Results: Overall, mean preoperative ECD was 2,135.8 ± 397.6 cells/mm2; corresponding values at postoperative months 1 and 3 were 2,019.6 ± 447.2 cells/mm2, and 1,991.4 ± 425.5 cells/mm2, respectively (P > 0.05). Cell loss from month 1 to 3 was 1.3 % (P > 0.05). Subgroup analysis showed significant differences in endothelial cell loss at month 1 (P = 0.048) and month 3 (P = 0.014) between the MMC and control groups with no significant difference between the two groups in terms of cell loss from months 1 to 3, postoperatively (P = 0.968). Overall, mean pre-and postoperative CVs at months 1 and 3 were 27.38 ± 4.55, 27.96 ± 4.26, and 28.35 ± 4.47, respectively, with no significant difference between the two groups (P > 0.05). There was no correlation between preoperative central endothelial cell density (CECD) and MMC related cell loss. Conclusion: MMC application in trabeculectomy seems to cause a small but significant corneal endothelial loss. Most of the damage occurs intraoperatively, or in the early postoperative period, however progressive endothelial cell loss is not a major concern.

Purpose: To compare trabeculectomy with mitomycin-C (MMC) application before versus after scleral flap dissection in terms of corneal endothelial cell loss and surgical outcomes. Methods: In this double blind clinical trial, patients were randomized to MMC 0.02% application before (group A) or after (group B) scleral flap dissection. The main outcome measure was corneal endothelial cell density; secondary outcome measures included IOP, glaucoma medications, success rates (IOP ≤21 and ≤18 mmHg, defined as criterion 1 and 2, respectively) and complications. Results: Overall, 99 eyes of 99 subjects including 72 male and 27 female subjects were operated and followed for at least 6 months. The study groups were comparable in terms of baseline variables. Outcomes of surgery were similar at six months in terms of IOP (11.8±5.8 vs. 11.7±5.5 mmHg, P=0.88) and number of medications (0.2 ±0.6 vs 0.1±0.4, P=0.45). Overall success was comparable at months 1 and 3, but higher in group B at month 6 (82.0% vs. 63.3%, P=0.036 for criterion 1 and 78.9% vs. 59.2%, P=0.044 for criterion 2). Hypotony was more prevalent in group B (8.0% versus 2.0%) but the difference was not significant (P=0.38). Endothelial cell density loss (2.2±7.3 vs 0.9±6.3%, P=0.567) was comparable between the study groups. Conclusion: Corneal endothelial loss following trabeculectomy was comparable with MMC application before and after scleral flap dissection. The sequences were comparable in terms of postoperative IOP and glaucoma medications. Overall success rate was higher at six months in group B and the rate of hypotony was also higher, although insignificantly.

Background: During cataract phacoemulsification surgery, the Alcon Centurion with Active Sentry can achieve a more stable anterior chamber, which allows a lower intraocular pressure (IOP) setting than the gravity fluidics system. In this randomized controlled trial, we compared these two systems' damage to the cornea under different IOP settings., Methods: Seventy-eight eyes of 53 patients with corneal endothelial cell density (ECD) of 500∼1500/mm 2 were enrolled and randomly divided into the active fluidics system (AFS) group using an Active Sentry handpiece with 30 mmHg IOP setting (40 eyes) and the gravity fluidics system (GFS) group using an Ozil handpiece with 80 cmH 2 O IOP setting (38 eyes). Intraoperative parameters, visual acuity, corneal edema ratio, central corneal thickness (CCT) changes as well as loss rate of ECD were analyzed., Results: We observed no significant differences in best corrected visual acuity (BCVA), cumulative dissipated energy (CDE), total case time, estimated fluidics usage (EFU) and ophthalmic viscoelastic devices (OVDs) usage between the two groups. The enrolled eyes were further divided into soft nucleus (27 eyes) and hard nucleus (51 eyes) subgroups. And we found less pain complaint during surgeries, lower corneal edema ratio at 1-day and 1-week visit, smaller CCT changes at 1-day visit and lower ECD loss rate at 1-month visit ( p < 0.05) in both subgroups of the AFS group than in the GFS group, implying higher intraoperative comfort levels and less corneal damage of the AFS group with a low IOP setting., Conclusion: Owing to a lower IOP setting, Centurion ® Vision System with Active Sentry handpiece causes less corneal damage and pain perception during phacoemulsification for patients with low pre-operative ECD., Clinical Trial Registration: https://www.chictr.org.cn, identifier ChiCTR2300077865., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Liu, Hong and Chen.)

AIM: To evaluate the visual acuity and endothelial cell density according to thethickness in Descemet''s stripping automated endothelial keratoplasty (DSAEK) one year after surgery.METHODS: DSAEK patients'' data were reviewed. Thirty-seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy (PBK) were included in this study. Graft thickness was measured with optical coherence tomography (OCT) 12mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick (>200 μm), medium-thick (150-200 μm) and thin (RESULTS:There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12mo, mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts (P=0.001). Thick graft group had 1637.44±88.19-mm2, medium thick graft had 1764.50±34.28-mm2 and thin graft group had 1845.30±65.62-mm2 ECD at 12mo after the surgery. Thin graft group had better ECD at 12mo after surgery (P=0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes with medium-thick and thick grafts one year after surgery.