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Purpose: This study aimed to compare and correlate specular microscope indices and corneal topography indices in different stages of keratoconus. Methods: Two hundred forty-six eyes of 123 participants were enrolled in the study. Corneal topography was performed using Sirius (CSO, Italy), with a rotating Scheimpflug camera and a Placido disc topographer. Corneal endothelial cell indices were assessed using a specular microscope (Nidek CEM-530, Japan). Eyes were graded as keratoconus stages 0–4 according to the Amsler-Krumeich classification. Corneal topography and endothelial cell indices were compared among the groups, and the correlations between them were analyzed. Results: The mean age of the patients was 23.26 ± 6.75 years (range, 14–47 years). Forty-eight cases were male (39%) and 75 were female (61%). There were no statistically significant age (p = 0.578) or sex ratio (p = 0.529) differences between the groups. Twenty-nine eyes were included in the control group (11.78%), while 41 (16.67%) had stage 1 keratoconus, 88 (35.77%) had stage 2, and 88 (35.77%) had stage 3. Measurement was not possible in stage 4 keratoconus. No statistically significant difference was determined in specular microscopy values according to the stage of keratoconus, except for the number of analyzed cells (NUM) (p > 0.05). The lowest NUM values were observed in stages 1, 2, and 3, with values of 184.34 ± 67.62 cells/mm2, 155.07 ± 59.48 cells/mm2, and 127.06 ± 64.39 cells/mm2, respectively (p = 0.001). In the keratoconus group, weak statistically significant negative correlations were observed between NUM and SimK1, SimK2, KVf, BCVf, KVb, and BCVb, while a weak positive correlation was noted between NUM and central corneal thickness (p < 0.05). Conclusions: NUM seems to decrease, while endothelial cell density exhibits no significant changes, with the progression of keratoconus. It appears that as keratoconus index values increase, NUM may decrease in different stages of keratoconus. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effects of severe COVID-19 infection on the corneal endothelium via in vivo specular microscopy. Methods: This was an observational, prospective, and controlled study including 56 eyes of 56 severe COVID-19 patients, compared to after-recovery and 56 eyes of 56 age- and gender-matched healthy controls. Results: Endothelial cell density was lower in the active disease period compared to healthy controls (p =.001) and decreased even more after recovery (p <.0001). After recovery, the average cell area and coefficient of variation were higher compared to the active disease period (p <.0001 and p =.008, respectively) and the healthy controls (for both, p <.0001), whereas hexagonality was lower (p <.0001). Central corneal thickness increased in the active disease period compared to after recovery (p <.0001) and healthy controls (p =.002). Conclusions: These results may be due to direct host-virus interaction or linked to immune dysregulation, subclinical corneal endotheliitis, or still yet a viral-mediated inflammation. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the relationship between corneal endothelial layer features and the severity of age-related macular degeneration (AMD). Methods: The study included 119 patients, with 47 females and 72 males. Patients were categorized into four groups based on the AREDS grading system: no AMD (group 1), mild AMD (group 2), moderate AMD (group 3), and advanced AMD (group 4). Only the right eye of patients with both eyes suitable for the study was included. Corneal endothelial cell density (CD), coefficient of variation (CoV), hexagonal cell ratio (HEX), and central corneal thickness (CCT) were measured using specular microscopy (Konan Medical Inc., Nishinomiya, Japan). Results: Group 1 had 40 patients, group 2 had 27 patients, and groups 3 and 4 had 26 patients each. Significant differences were observed between the mean endothelial CD, CoV, and HEX values among the groups, while no significant difference was found in CCT values (p = 0.049, p = 0.002, p = 0.004, and p = 0.883, respectively). A mild negative correlation was observed between AMD severity and CD and HEX values, while a mild positive correlation was found between AMD severity and CoV. Conclusion: Increasing severity of AMD may negatively impact corneal endothelial layer values. [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]

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: To determine if smoking has an effect on corneal endothelium. Study Design: Descriptive observational. Place and Duration of Study: Lamar eye center in Kerbala city in Iraq during December, 2023 and January, 2024. Methods: A total of 108 eyes were selected, 54 eyes of smokers and 54 eyes of non-smokers. The smokers included in this study had history of smoking for more than twenty years and they smoke more than 40 cigarettes per day. All the participants were male. Specular microscopy was used to determine four corneal parameters; cell density, hexagonality, coefficient of variation and central corneal thickness. Results: Patients age ranged from 50 to 60 years. Central Corneal Thickness was 515.29±40.62 and 522.37±36.68 in smokers and non-smokers respectively with p=0.32. Coefficient of variation and, Cell Density and Hexagonal shape parameters were also not statistically different between the two groups (p>0.05). Conclusion: Smoking does not have a statistically significant effect on the corneal endothelium in terms of cell density, hexagonality, coefficient of variation, and central corneal thickness. However, more studies are needed to provide further evidence. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this study was to compare two commercially available specular microscopes (Tomey EM-4000 and Nidek CEM-530) in a real-life clinical setting in terms of intra- and interdevice variability. The study was conducted on all patients seen in a clinical practice specializing in anterior segment pathologies, regardless of the purpose of their visit. Materials and Methods: In total, 112 eyes of 56 patients (age 23–85 years old) were included in the study. Each eye was measured three times with each device (for a total of six measurements), and results for central corneal thickness (CCT) and corneal endothelial cell density (ECD) were recorded. The results were then evaluated with the D'Agostino–Pearson normality test and compared with a Wilcoxon signed-rank test, t-test, ANOVA or Mann–Whitney test for intra- and interdevice variability. Results: Both specular microscopes produced very reliable reproducible intradevice results: The Tomey EM-4000 measured an ECD of 2390 ± 49.57 cells/mm2 (mean ± standard error of mean); the range was 799–3010 cells/mm2. The determined CCT was 546 ± 5.104 µm (mean ± standard error of mean [SEM]); the range was 425–615 µm. The measurements with the Nidek CEM-530 revealed an ECD of 2417 ± 0.09 cells/mm2 (mean ± SEM); the range was 505–3461 cells/mm2 (mean ± SEM). The mean CCT detected was 546.3 ± 4.937 µm (mean ± SEM); the range was 431–621 µm. The interdevice differences were statistically significant for both parameters, ECD (p = 0.0175) and CCT (p = 0.0125) (p < 0.05). Conclusions: The Nidek CEM-530 and the Tomey EM-4000 both produced reliable and reproducible results in terms of ECD and CCT. The absolute measurements were statistically significantly different for CCT and ECD for both devices; the Nidek produces slightly higher values. [ABSTRACT FROM AUTHOR]

Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. Moreover, FECD is associated with alterations in all corneal layers, such as thickening of the Descemet membrane, stromal scarring, subepithelial fibrosis, and the formation of epithelial bullae. Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. The application of novel technologies, including image processing technology and artificial intelligence, that are expected to further enhance the accuracy, precision, and speed of the imaging technologies will also be discussed. [ABSTRACT FROM AUTHOR]

Background: Cornea is the most important refractive media in the eye, and damage to the corneal endothelium is one of the most common causes of poor visual outcome following cataract surgery, particularly in those with predisposing factors. The role of phaco tip position during phacoemulsification on corneal endothelial damage is ambiguous, and there is no consensus regarding the most cornea-friendly phaco tip position (bevel-up or bevel-down). The objective of the trial is to compare the effect of phaco tip position (bevel-up vs. bevel-down) during phacoemulsification using direct chop technique on corneal endothelial cell count. Methods and design: TIPS is a randomised, multicentre, parallel-group, triple-masked (participant, outcome assessor, and statistician) trial with 1:1 allocation ratio. A total of 480 eligible participants, aged > 18 years with immature cataract, will be randomly allocated into bevel-up and bevel-down groups at two centres. Randomisation will be stratified according to the cataract grade. The primary outcome is postoperative endothelial cell count at 1 month. Secondary outcomes are central corneal thickness on postoperative days 1, 15, and 30 and difference in intraoperative complications. Conclusion: In this paper, we describe the detailed statistical analysis plan (SAP) for the TIPS trial, which was prepared prior to database lock. The SAP includes details of planned analyses and unpopulated tables, which will be reported in the publications. We plan to lock the database in July 2023 and publish the results later in the same year. SAP Version 0.1 (dated: 28 April 2023) Protocol version:2.0 Trial registration: Clinical Trial Registry of India CTRI/2019/02/017464. Registered on 5 February 2019; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=29764&EncHid=&userName=2019/02/017464 [ABSTRACT FROM AUTHOR]

PurposeTo define the normal range of central corneal thickness (CCT) and corneal endothelial cell density (ECD) in rhesus macaques (Macaca mulatta) and the effects of age, body weight, sex, and intraocular pressure (IOP) on these parameters.MethodsOphthalmic examinations were performed on 144 rhesus macaques without anterior segment pathology. The CCT was measured via ultrasound pachymetry (USP) and specular microscopy, and the ECD was semiautomatically and manually counted using specular microscopy. Rebound tonometry was used to measure IOP. Linear regression and mixed-effects linear regression models were used to evaluate the effects of age, body weight, sex, and IOP on CCT and ECD.ResultsWe included 98 females and 46 males with an age range of 0.2 to 29.4 years. The mean CCT by USP and specular microscopy were 483 ± 39 and 463 ± 33 µm, respectively, and were statistically different (P < 0.001). The ECDs were 2717 ± 423 and 2747 ± 438 cells/mm2 by semiautomated and manual analysis, respectively. Corneal endothelial degeneration was identified in one aged rhesus macaque.ConclusionsThe mean USP and specular microscopy CCT values differed significantly, whereas the semiautomatic and manual ECD did not. The CCT was associated with the IOP and sex, whereas the ECD was associated with body weight and age (P < 0.05). As in humans, corneal disease in rhesus macaques is uncommon.Translational relevanceEstablishing reference values is fundamental to use rhesus macaques as a model for corneal disease or to identify toxicity in studies of ocular drugs or devices.

Purpose: To evaluate the effects of torsional and transverse phacoemulsification modes on corneal endothelial health. Material and Methods: Forty-nine eyes of 49 patients who were operated for cataracts were randomized into two groups. 27 patients in the first group were operated in the torsional phacoemulsification mode, and 22 patients in the second group were operated using the transversal mode. Preoperative, postoperative first day and postoperative first month; endothelial cell density (ECD), coefficient of variation (CV), hexagonality (HEX) and central corneal thickness (CCT) were analyzed. Results: The mean age was 67.89 ± 9.98 years in the first group and 66.77 ± 10.78 years in the second group. There was no significant difference between the groups in terms of mean age and ultrasound power (p=0.71 and p=0.26). While CCT increased significantly on the postoperative first day in both groups (p=0.001 and p=0.002), it returned to baseline at the postoperative first month. Although ECD decreased significantly at postoperative first month in both study groups (p=0.001 and p=0.005), it was above 1400 cells/µ2 in all cases. When the ECD, CV, 6A and CCT measurements performed before the operation, on the postoperative first day and at the postoperative first month were compared between the groups, it was observed that there was no significant difference. Conclusion: It was evaluated that phaco surgery performed with both modes is safe in terms of corneal thickness and endothelial health. However, it should be considered that phaco surgery slightly reduces the endothelial number and endothelial health should be evaluated before surgery. [ABSTRACT FROM AUTHOR]

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX. Methods: This prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT. Results: By the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction. Conclusion: Patients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications. Study registration number: The study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168). [ABSTRACT FROM AUTHOR]

Objective:To compare quality and utilisation of donor cornea received by hospital cornea retrieval program (HCRP) vs voluntary donation Methods: Retrospective, observational study based on records of cornea collected through HCRP and Voluntary donation in the eye bank of a tertiary care centre in Jharkhand from January 2019 to April 2023. Quality of cornea was graded on slit lamp biomicroscopy. Also specular microscopy was done to evaluate status of endothelium. Results: A total of 144 corneas from 72 donors were collected, out of which 102(70.8%) were through HCRP and 42 were through Voluntary Donation.50% cornea were optical grade in the HCRP grp and 45.2% were optical in the Voluntary donation group. The utilisation rate in HCRP group was around 58.8% and 41.1% got rejected, where as in the voluntary group, 52.3% corneas were utilised and 47.6% got discarded. Conclusion: Optical grade quality and utilisation of cornea was significantly higher in the HCRP group as compared to voluntary donation group. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of this study was to compare two commercially available specular microscopes (Tomey EM-4000 and Nidek CEM-530) in a real-life clinical setting in terms of intra- and interdevice variability. The study was conducted on all patients seen in a clinical practice specializing in anterior segment pathologies, regardless of the purpose of their visit. Materials and Methods: In total, 112 eyes of 56 patients (age 23–85 years old) were included in the study. Each eye was measured three times with each device (for a total of six measurements), and results for central corneal thickness (CCT) and corneal endothelial cell density (ECD) were recorded. The results were then evaluated with the D’Agostino–Pearson normality test and compared with a Wilcoxon signed-rank test, t-test, ANOVA or Mann–Whitney test for intra- and interdevice variability. Results: Both specular microscopes produced very reliable reproducible intradevice results: The Tomey EM-4000 measured an ECD of 2390 ± 49.57 cells/mm2 (mean ± standard error of mean); the range was 799–3010 cells/mm2. The determined CCT was 546 ± 5.104 µm (mean ± standard error of mean [SEM]); the range was 425–615 µm. The measurements with the Nidek CEM-530 revealed an ECD of 2417 ± 0.09 cells/mm2 (mean ± SEM); the range was 505–3461 cells/mm2 (mean ± SEM). The mean CCT detected was 546.3 ± 4.937 µm (mean ± SEM); the range was 431–621 µm. The interdevice differences were statistically significant for both parameters, ECD (p = 0.0175) and CCT (p = 0.0125) (p < 0.05). Conclusions: The Nidek CEM-530 and the Tomey EM-4000 both produced reliable and reproducible results in terms of ECD and CCT. The absolute measurements were statistically significantly different for CCT and ECD for both devices; the Nidek produces slightly higher values.

The aim of this study was to evaluate the influence of ultrasounds used in phacoemulsification during cataract surgery on the corneal structure and morphology in patients over 65 years. We compared the outcomes of phacoemulsification techniques in terms of corneal cell morphology in 77 patients over 65 years old and 43 patients under 65 years old. Corneal cell density, central corneal thickness and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of gender, axial length and anterior chamber depth on the parameters of corneal endothelium were evaluated. In both groups, a progressive decrease in endothelial cells was observed, starting from the first week post-surgery until the fourth postoperative week. The central corneal thickness increased in both groups with maximum values at the first week postoperatively, while their initial values were restored in the fourth week post-surgery, with no statistical difference between groups. Statistically significant differences were noticed in terms of cell hexagonality in the group over 65, showing smaller hexagonality at all preoperative and postoperative time points compared to group under 65. Our result highlights the importance of routine specular microscopy performed before surgery, regardless the age of the patients, with caution and careful attention to the phaco power intensity, ultrasound energy consumption and intraoperative manipulation of instruments, as well as proper use of viscoelastic substances to reduce corneal endothelium damage, especially in elderly patients.

Purpose: To present a case of irreversible corneal edema after 10 years of amantadine use. A literature review was carried out to describe the clinical characteristics and outcomes of amantadine-induced corneal edema. Observations: A 36-year-old woman presented with a 6-week history of gradually progressive bilateral painless visual loss with visual acuity (VA) of 20/350 and 20/300 in the right and left eye, respectively. Examination showed bilateral diffuse central corneal edema with multiple Descemet membrane folds without endothelial guttata, keratic precipitates or intraocular inflammation. This did not respond to hypertonic saline drops and empirical treatment for presumed herpetic endotheliitis with oral acyclovir. Medication review revealed the use of amantadine 100mg daily for the past 10 years, prescribed by her neurologist for fatigue. Despite discontinuing amantadine, corneal edema was irreversible due to a markedly reduced endothelial cell count of 625 (right) and 680 cells/mm2 (left). Conclusions and Importance: This case highlights the need to consider amantadine as a cause of unexplained bilateral non-guttae corneal edema. A literature review of 33 case reports revealed broadly similar features of amantadine-induced corneal edema; whilst most cases had favorable outcomes with median VA 20/25 (interquartile range IQR 20/20–20/30) and complete resolution of corneal edema within 30 days (IQR 14–35) of amantadine discontinuation, most experienced low endothelial cell density 759 cells/mm2 (IQR 621–1078). Taken together, screening specular microscopy ought to be considered for those in whom amantadine is likely required long-term.

Objective: The study aimed to assess the effect of Neodymium: Yttrium Aluminium Garnet laser (ND:YAG laser) on endothelial cell count loss and anterior segment elements. Study Design: Quasi-experimental. Place and Duration Of Study: Armed Forces Institute of Ophthalmology, Rawalpindi from Jul 2021 to Feb 2022. Methodology: A total of 60 patients with a history of posterior capsular opacities planned for Neodymium: Yttrium Aluminium Garnet laser posterior capsulotomy were included. Specular microscopy was done pre and post-laser to study and parameters such as central corneal thickness, endothelial cell count, intra-ocular pressure was noted. Data were analyzed by using the Statistical Package for the Social Sciences version 23 software Result: After four weeks of Neodymium: Yttrium Aluminium Garnet laser, there was no significant change in the intraocular pressure (p=0.334), however, the visual acuity improved from 0.6±0.3-0.05±0.1 (p<0.001) along with a decrease in endothelial cell count 2101±485-1919±427 (p<0.001) and central corneal thickness 0.504±0.03-0.502± 0.03 (p=0.010). A similar trend of changes in the parameters was observed for lower (1.0-1.2MJ) and higher energy (2.1-2.5MJ) in the sample for posterior capsulotomy. Conclusion: Our study concluded that the corneal structural changes occur post-Neodymium: Yttrium Aluminium Garnet posterior capsulotomy, including changes in endothelial cell count. However, there is no significant disturbance in the intraocular pressure after the procedure. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate corneal endothelial cell morphology in patients with thyroid-associated ophthalmopathy (TAO). Method: Seventy-two eyes of 36 patients with TAO presenting to the ophthalmology department between January 2018 and January 2022 were included in the study. The findings were compared with 98 eyes of 49 healthy individuals. Mean endothelial cell density (ECD), coefficient of variation (CV), maximum cell area, minimum cell area, average cell area, and hexagonality ratio were obtained using non-contact specular microscopy. The thicknesses of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were measured using optical coherence tomography (OCT). Results: The TAO group consisted of 36 patients, 11 (30.6%) men and 25 (69.4%) women, and the control group of 49 healthy individuals, 14 (28.6%) men and 35 (71.4%). No significant differences were determined between the TAO and control groups in terms of the specular microscopy findings of mean ECD, CV, or hexagonality ratio values (p > 0,05). However, the mean Hertel values differed significantly between the two groups (p = 0.001). When the TAO group was divided into two subgroups based on patients who had previously received prednisolone therapy and those who had not, significant differences were observed in terms of mean ECD, CV, and hexagonality ratio values (p > 0.05). Conclusion: Comparison of patients diagnosed with active TAO and receiving prednisolone therapy and the TAO patients with inactive disease revealed lower ECD, higher CV values, and lower hexagonality ratios in the prednisolone therapy group. These findings all suggest that inflammation in patients undergoing active disease affects the corneal endothelium. [ABSTRACT FROM AUTHOR]

Purpose: To examine the long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the corneal endothelium. Methods: This was a comparative, cross-sectional study that included subjects who had recovered from SARS-CoV-2 infection for at least 6 months (group 1) and a group of age- and sex-matched controls with no prior symptomatology or documentation of SARS-CoV-2 infection (group 2). After full ophthalmological evaluation, specular microscopy was used to examine the endothelial cell parameters, including endothelial cell density, coefficient of variation, hexagonality, average area, and central corneal thickness. Results: Sixty-four and 53 right eyes were included in groups 1 and 2, respectively. No statistically significant differences were detected in any of the examined specular parameters between the two groups. Conclusion: SARS-CoV-2 infection may have no delayed sequel on the corneal endothelium. Future prospective studies with repeated examinations in the same subjects would be useful. [ABSTRACT FROM AUTHOR]

Abstract Background Corneal collagen cross-linking (CXL) is a procedure utilized for halting keratoconus progression with different approved protocols. The current study aimed to assess the corneal endothelial changes following the relatively new accelerated pulsed high-fluence protocol of epithelium-off corneal cross-linking for the treatment of mild to moderate keratoconus. Methods This prospective case series study enrolled 45 eyes of 27 patients with mild to moderate progressive keratoconus who underwent accelerated pulsed high-fluence CXL (pl-ACXL, 30 mW/ cm2 UVA at 365 nm wavelength, 8 min pulsed mode 1 s on / 1 s off with a total energy of 7.2 J/ cm2). The main outcome measures were corneal endothelial changes assessed by specular microscopy at 3 and 6 months postoperatively including endothelial cell density (ECD), coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes. Demarcation line depth was assessed 1 month following surgery. Results The mean age of the studied sample was 24.89 ± 7.21. The mean preoperative ECD (2944.6 ± 247.41 cell/mm2) showed non-significant reduction at 3 and 6 months postoperatively (2931.03 ± 253.82 and 2924.7 ± 224.88 cell/mm2, respectively, P-value = 0.361). There were no significant changes in the mean coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes at 3 and 6 months following pl-ACXL (P-value > 0.05). The mean demarcation line depth 1 month after pl-ACXL was 214 ± 17.43 μm. Conclusions Corneal endothelial changes following accelerated pulsed high-fluence CXL were minimal with stability of endothelial cell count and non-significant morphological changes. Trial Registration Clinicaltrials.gov: NCT04160338 (13/11/2019).

Based on population research, it has been found that more than 74% of elderly individuals in India have either undergone cataract surgery or have cataracts, and women are more likely than males to acquire cataracts. A cataract is one of the primary causes of blindness in India and around the world, but it's also the leading cause of avoidable blindness. There have been many advances in cataract surgery including advancements in surgical techniques and the availability of various intra-ocular lenses for better visual rehabilitation of the patient. Phacoemulsification is now one of the most commonly used surgical techniques for cataract extraction, it is done under local anesthesia or under topical anesthesia. As with all cataract surgeries, there is corneal decompensation even with phacoemulsification. Our study aims to compare three different nucleotomy approaches used for topical phacoemulsification: Divide & Conquer, Stop & Chop, and Direct Chop. We will assess which technique yields the best visual prognosis postoperatively, causes less corneal decompensation and has fewer complications. Specular microscopy will be used in patients who are to be operated for cataract extraction. Before the operation, we can use specular microscopy to determine the number of Corneal Endothelial cells and Central Corneal Thickness of the patient. Then, after the surgery, we can conduct another specular microscopy test to compare the techniques used for nucleotomy. This will help us determine which technique results in less loss of corneal endothelial cells and less reduction in central corneal thickness. Thus, we will use specular microscopy as a diagnostic tool and also a prognostic indicator in our study. Visual acuity of the patient will be measured preoperatively and again post operatively to compare which surgical technique achieves best visual rehabilitation for the patient.

Fuchs endothelial corneal dystrophy (FECD) is a complex genetic disorder characterized by the slow and progressive degeneration of corneal endothelial cells. Thus, it may result in corneal endothelial decompensation and irreversible corneal edema. Moreover, FECD is associated with alterations in all corneal layers, such as thickening of the Descemet membrane, stromal scarring, subepithelial fibrosis, and the formation of epithelial bullae. Hence, anterior segment imaging devices that enable precise measurement of functional and anatomical changes in the cornea are essential for the management of FECD. In this review, the authors will introduce studies on the application of various imaging modalities, such as anterior segment optical coherence tomography, Scheimpflug corneal tomography, specular microscopy, in vitro confocal microscopy, and retroillumination photography, in the diagnosis and monitoring of FECD and discuss the results of these studies. The application of novel technologies, including image processing technology and artificial intelligence, that are expected to further enhance the accuracy, precision, and speed of the imaging technologies will also be discussed.

Copyright of MN Opthalmology / MN Oftalmoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background To study the endothelial cell layer 3 months after Descemet membrane endothelial keratoplasty (DMEK) using specular microscopy to provide data about the endothelial cell density (ECD), endothelial cell loss (ECL) percentage, and changes in endothelial cell shape (hexagonality) and size [coefficient of variation (CV)] and to study the factors causing these changes in endothelial cell layer after DMEK. Patients and methods This study included 20 patients investigated by specular microscopy 3 months after DMEK. We discuss the postoperative ECD, factors that affect the ECD, factors that affect hexagonality and CV, visual outcome, and advantages of DMEK. The study was approved by the ethics committee of Ain Shams University. Results This study showed that the mean ECD postoperative was 1664.80 cells/mm2, with mean ECL of 34.67%. This cell loss increased in cases of difficult graft unfolding. Donor age and preservation time had no effect on postoperative ECD. A percentage decrease in hexagonal cells and a percentage increase in CV were noticed in cases that received grafts from donors with history of diabetes mellitus. Postoperative ECD and hexagonal cell percentage had no correlation with central corneal thickness in this study. Conclusion DMEK results in significant improvement of postoperatively visual acuity (VA). Advantages of DMEK like no corneal sutures, short recovery time, less cylindrical aberration, decreased incidence of graft rejection, and good visual outcome make it the best choice to treat eyes with corneal endothelial dysfunction.

Abstract Background To investigate the possible association of different pattern of diabetic retinopathy (DR) on corneal endothelium cells in type 2 diabetes mellitus patients. Methods In this descriptive-analytical cross-sectional study, corneal endothelium parameters including endothelial cell density (ECD), average cell size (AVG), coefficient of variation in cell size (CV), and hexagonality (Hex) were evaluated by non-contact specular microscopy. Results One hundred and thirty-four eyes of 134 diabetic patients including 77 females (57.5%) with a mean age of 61.03 ± 8.08 years were enrolled. The overall corneal parameters in diabetic patients with and without retinopathy were not significantly different (P > 0.05). There is a significant relationship between CV and the duration of the disease with age variable control (B = 0.369, p-value

Background: Corneal collagen cross-linking (CXL) is a procedure utilized for halting keratoconus progression with different approved protocols. The current study aimed to assess the corneal endothelial changes following the relatively new accelerated pulsed high-fluence protocol of epithelium-off corneal cross-linking for the treatment of mild to moderate keratoconus. Methods: This prospective case series study enrolled 45 eyes of 27 patients with mild to moderate progressive keratoconus who underwent accelerated pulsed high-fluence CXL (pl-ACXL, 30 mW/ cm2 UVA at 365 nm wavelength, 8 min pulsed mode 1 s on / 1 s off with a total energy of 7.2 J/ cm2). The main outcome measures were corneal endothelial changes assessed by specular microscopy at 3 and 6 months postoperatively including endothelial cell density (ECD), coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes. Demarcation line depth was assessed 1 month following surgery. Results: The mean age of the studied sample was 24.89 ± 7.21. The mean preoperative ECD (2944.6 ± 247.41 cell/mm2) showed non-significant reduction at 3 and 6 months postoperatively (2931.03 ± 253.82 and 2924.7 ± 224.88 cell/mm2, respectively, P-value = 0.361). There were no significant changes in the mean coefficient of variation, percentage of hexagonal cells, average, minimum and maximum endothelial cell sizes at 3 and 6 months following pl-ACXL (P-value > 0.05). The mean demarcation line depth 1 month after pl-ACXL was 214 ± 17.43 μm. Conclusions: Corneal endothelial changes following accelerated pulsed high-fluence CXL were minimal with stability of endothelial cell count and non-significant morphological changes. Trial Registration: Clinicaltrials.gov: NCT04160338 (13/11/2019). [ABSTRACT FROM AUTHOR]

Background To study the endothelial cell layer 3 months after Descemet membrane endothelial keratoplasty (DMEK) using specular microscopy to provide data about the endothelial cell density (ECD), endothelial cell loss (ECL) percentage, and changes in endothelial cell shape (hexagonality) and size [coefficient of variation (CV)] and to study the factors causing these changes in endothelial cell layer after DMEK. Patients and methods This study included 20 patients investigated by specular microscopy 3 months after DMEK. We discuss the postoperative ECD, factors that affect the ECD, factors that affect hexagonality and CV, visual outcome, and advantages of DMEK. The study was approved by the ethics committee of Ain Shams University. Results This study showed that the mean ECD postoperative was 1664.80 cells/mm², with mean ECL of 34.67%. This cell loss increased in cases of difficult graft unfolding. Donor age and preservation time had no effect on postoperative ECD. A percentage decrease in hexagonal cells and a percentage increase in CV were noticed in cases that received grafts from donors with history of diabetes mellitus. Postoperative ECD and hexagonal cell percentage had no correlation with central corneal thickness in this study. Conclusion DMEK results in significant improvement of postoperatively visual acuity (VA). Advantages of DMEK like no corneal sutures, short recovery time, less cylindrical aberration, decreased incidence of graft rejection, and good visual outcome make it the best choice to treat eyes with corneal endothelial dysfunction. [ABSTRACT FROM AUTHOR]

Background: Pseudoexfoliation causes characteristic corneal endothelial changes leading to corneal decompensation and loss of corneal transparency severely affecting vision. Objectives: To evaluate morphological changes in corneal endothelial cells and central corneal thickness in pseudoexfoliation syndrome (PXS) and to compare it with age matched patients without pseudoexfoliation syndrome. Material and Methods: A hospital based, cross sectional analytical study was conducted at Upgraded Department of Ophthalmology, Government Medical College/hospital, Jammu in which total of 46 patients planned for cataract surgery were included (23 patients with pseudoexfoliation syndrome and 23 patients without pseudoexfoliation syndrome). Corneal endothelial cell density (ECD), percentage of hexagonal cells, coefficient of variation (CV) in cell size, and central corneal thickness (CCT) were measured using specular microscopy. Results: The mean ECD was 2325.1 ± 383.1 in the PXS group and 2763 ± 351.3 in the control group respectively, and ECD in the PXS group was significantly lower than in that in the control group (p=0.0002). The percentage of hexagonal cells was 48.3 ± 5.7 in PXS group and 51.5 ± 4.6 in the control group respectively, and percentage of hexagonal cells was significantly lower than that in the control group (p=0.04). The cell size coefficient of variation was 33.9 ± 2.6 in the PXS group and 33.0 ± 3.1 in the control group respectively, and patients with PXS had no statistically significant difference in cell size coefficient of variation compared to control group (p=0.29). The CCT was 509.0 ± 27.3 in the PXS group and 529.0 ± 23.6 in the control group respectively, and CCT in the PXS group was significantly lower than that in the control group (p=0.01). Conclusion: In our study the ECD and CCT was significantly lower in patients with pseudoexfoliation syndrome regardless of the presence of pseudoexfoliative glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to evaluate Ocular Response Analyzer (ORA) measurements and endothelial cell density (ECD) in patients who received intravitreal dexamethasone implant (Ozurdex®) injection for diabetic macular edema. Methods: Twenty-three eyes of 13 patients who receive intravitreal dexamethasone implant injection (Group 1) for diabetic macular edema and 33 eyes of 33 healthy individuals (Group 2) were included in the study. All participants underwent a complete ophthalmologic examination including intraocular pressure measurement with Goldmann applanation tonometer (IOP-GAT), ORA measurements, and specular microscopy. Results: The mean age of the patients was 65.43±8.20 (49-75) in Group 1 and 61.94±4.52 (56-71) in Group 2 (p=0.114). The mean IOP-GAT was significantly higher in Group 1 (18.22±3.41; range 12-28 mmHg) than in Group 2 (15.41±3.07; range 8-21 mmHg) (p=0.02). The mean ECD was 2632.4±209.6 (2232-3067) cell/mm2 in Group 1 and 2567±206.37 (2140-2854) cell/mm2 in Group 2 (p=0.60). The mean corneal resistance factor (CRF) was 12.16±2.35 (7.4-15.3) mmHg in Group 1 and 10.18±1.83 (6.7-14.2) mmHg in Group 2 (p=0.02). Mean corneal hysteresis (CH) in Groups 1 and 2 was 8.87±2.45 (4.1-13.4) mmHg and 10.47±1.43 (6.9-13.2) mmHg, respectively (p=0.001). Mean corneal compensated IOP and Goldman correlated IOP (IOPg) were higher in Group 1 (24.72±7.12; range 12.1-36.4 mmHg and 23.21±7.01; range 14.2-36.2 mmHg) than in Group 2 (14.95±3.6; range 8.3-22.9 mmHg and 14.33±3.84; range 6.3-21.7 mmHg) (p<0.001). IOP-GAT was correlated with IOPg (p=0.01). Conclusion: Intravitreal Ozurdex® injection effects IOP, while it has no significant effect on ECD. Ozurdex® injections changed corneal biomechanical properties such as CH and CRF. Thus, ORA may be a useful to avoid underestimating the IOP and missing the alteration of elastic properties of the cornea. [ABSTRACT FROM AUTHOR]

Purpose: To assess corneal topography and specular microscopy values in juvenile idiopathic arthritis-related uveitis (JIA-U). Methods: This case–control study included 30 eyes from JIA-U patients, 20 eyes from JIA patients, and 50 eyes from age- and gender-matched healthy subjects. Patients with a history of ocular diseases or intraocular surgery were excluded. Corneal topography maps (Pentacam HR) and specular microscopy images (CellChek SL) were obtained. The measurements of the groups were compared. Results: Keratometric astigmatism was higher in the JIA-U group than in the control group (p = 0.040). Patients with astigmatism greater than 1.50D were more common in the JIA-U group than in the control group (p = 0.026). The JIA-U group had higher anterior and posterior elevation values than the control group (p = 0.006, p = 0.025). The density of endothelial cells, coefficient of variation, and hexagonality did not change across groups (p = 0.465, p = 0.096, p = 0.869). The total number of exacerbations and the duration of anterior chamber inflammation were both positively correlated with posterior elevation (r = 0.600, p 0.001; r = 0.583, p 0.001). The age of diagnosis was found to be negatively correlated with anterior elevation (r = −0.412, p = 0.021). Conclusion: Corneal astigmatism, as well as anterior and posterior elevation values, were all higher in JIA-U patients. Endothelial cell density and morphology, on the other hand, did not differ significantly between groups. Chronic inflammation's impact on stromal remodelling could explain these corneal alterations. The positive correlation between posterior elevation and the number of flares and duration of inflammation represents the importance of early diagnosis and effective treatment. [ABSTRACT FROM AUTHOR]

Background: Pseudoexfoliation causes characteristic corneal endothelial changes leading to corneal decompensation and loss of corneal transparency severely affecting vision. Objectives: To evaluate morphological changes in corneal endothelial cells and central corneal thickness in pseudoexfoliation syndrome (PXS) and to compare it with age matched patients without pseudoexfoliation syndrome. Material and Methods: A hospital based, cross sectional analytical study was conducted at Upgraded Department of Ophthalmology, Government Medical College/hospital, Jammu in which total of 46 patients planned for cataract surgery were included (23 patients with pseudoexfoliation syndrome and 23 patients without pseudoexfoliation syndrome). Corneal endothelial cell density (ECD), percentage of hexagonal cells, coefficient of variation (CV) in cell size, and central corneal thickness (CCT) were measured using specular microscopy. Results: The mean ECD was 2325.1 ± 383.1 in the PXS group and 2763 ± 351.3 in the control group respectively, and ECD in the PXS group was significantly lower than in that in the control group (p=0.0002). The percentage of hexagonal cells was 48.3 ± 5.7 in PXS group and 51.5 ± 4.6 in the control group respectively, and percentage of hexagonal cells was significantly lower than that in the control group (p=0.04). The cell size coefficient of variation was 33.9 ± 2.6 in the PXS group and 33.0 ± 3.1 in the control group respectively, and patients with PXS had no statistically significant difference in cell size coefficient of variation compared to control group (p=0.29). The CCT was 509.0 ± 27.3 in the PXS group and 529.0 ± 23.6 in the control group respectively, and CCT in the PXS group was significantly lower than that in the control group (p=0.01). Conclusion: In our study the ECD and CCT was significantly lower in patients with pseudoexfoliation syndrome regardless of the presence of pseudoexfoliative glaucoma.

Purpose: to present the signs, symptoms and management of two cases of traumatic dislocation of implantable collamer lens (ICL) after direct blunt trauma. Observations: at presentation, we noted diffuse conjunctival hyperemia, and clear cornea in the right eye of the first patient. The anterior chamber showed +2 pigmented cells, a distorted, nasally peaked pupil with one-foot plate in front of the iris. The second case had a dislocation of the inferonasal footplate into the anterior chamber without endothelial touch. Conclusions and importance: Dislocation of an implantable collamer lens (ICL) is rare but carries the risk of long-term complications, particularly after trauma. Ophthalmologists should identify dislocation and timely intervention can mitigate the risk of complications.ICL dislocation can be vision threatening. Ophthalmologists should identify dislocation and timely intervention can mitigate the risk of complications.

PURPOSE: The purpose of this study was to compare ultrasound pachymetry Ultrasound pachymetry (UP), specular microscopy (SM), and anterior segment optical coherence tomography (ASOCT) in the measurement of central corneal thickness (CCT) in cases of corneal edema before and after uncomplicated phacoemulsification. METHODS: Preoperative pachymetric measurements were performed in all patients before cataract surgery. Sixty -seven patients who developed corneal edema after routine faoemulsification surgery were included in the study. CCT measurements were made the day before surgery and on the 1st, 7th, and 14th days after surgery. Correlation and agreement between the devices were quantified with the intraclass correlation coefficient (ICC), limits of agreement, and Bland--Altman plots. RESULTS: The mean age of the patients was 70.99 ± 9.56 (36-92) years. While CCT could be measured in all eyes with ASOCT after surgery, the number of eyes measured with UP and SM were 24 (11.7%) and 27 (16.1%), 55 (82.1%) and 52 (77.6%), and 46 (88.8%) and 45 (86.9%) on postoperative days 1, 7, and 14, respectively. ICC values between UP and SM, UP and ASOCT, and SM and ASOCT, respectively, were: preoperative 0.91, 0.94, and 0.92; 1st postoperative day 0.93, 0.86, and 0.93; 7th postoperative day 0.94, 0.85, and 0.96; and 14th postoperative day 0.95, 0.92, and 0.96. CONCLUSION: In all eyes with corneal edema, CCT measurements can be taken with ASOCT; however, in some cases, CCT measurements with SM and UP cannot be taken. However, there is a good correlation between measurements taken with these devices. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the prevalence and severity of cornea guttata (CG) in grafts after Descemet membrane endothelial keratoplasty (DMEK) and to investigate its impact on various clinical parameters during follow‐up. Methods: This retrospective study included 664 operations (DMEK and triple‐DMEK) on 466 patients. The prevalence and progression of CG after the operation were examined using endothelial specular microscopy images. The severity grade of CG was classified into four grades: G0 without CG, G1 – G3 with increasing severity of CG. Clinical parameters such as central corneal thickness (CCT), visual acuity (VA), endothelial cell density (ECD), pleomorphism and polymegalism were examined during a postoperative follow‐up time of 19.6 ± 15.8 months. Results: Cornea guttata (CG) appeared postoperatively in 124 (18.7%) eyes. 112 (16.9%) could be classified as G1, 9 (1.4%) as G2 and only 3 (0.5%) as G3. The examination of clinical parameters showed significant differences between healthy and low‐grade CG (G0/G1) and high‐grade CG (G2/G3). A significant deterioration was found in the corrected distance visual acuity (CDVA) (p = 0.02). CCT showed an increase between G0 (534 ± 58 μm) and G2 (549 ± 71 μm)/G3 (558 ± 56 μm) with a p‐value of 0.02. Additionally, a significant increase in pleomorphism (p = 0.003) and polymegalism (p = 0.04) was detected. Conclusion: Cornea guttata (CG) prevalence after DMEK and triple‐DMEK was found to be 18.7%, although most of these cases were classified as low‐grade CG and showed no clinical significance. Around 1.9% were classified as high‐grade CG and significantly affected several clinical parameters during the follow‐up. [ABSTRACT FROM AUTHOR]

Background: To investigate the possible association of different pattern of diabetic retinopathy (DR) on corneal endothelium cells in type 2 diabetes mellitus patients.Methods: In this descriptive-analytical cross-sectional study, corneal endothelium parameters including endothelial cell density (ECD), average cell size (AVG), coefficient of variation in cell size (CV), and hexagonality (Hex) were evaluated by non-contact specular microscopy.Results: One hundred and thirty-four eyes of 134 diabetic patients including 77 females (57.5%) with a mean age of 61.03 ± 8.08 years were enrolled. The overall corneal parameters in diabetic patients with and without retinopathy were not significantly different (P > 0.05). There is a significant relationship between CV and the duration of the disease with age variable control (B = 0.369, p-value < 0.001).Conclusions: Corneal endothelial parameters were not associated with DM in patients without and with DR. There is a significant relationship between CV and the duration of the disease with age variable control. [ABSTRACT FROM AUTHOR]

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

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

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

Purpose: To evaluate the corneal endothelium of patients with pseudoexfoliation syndrome (PES) by specular microscopy (SM). Materials and Methods: In this prospective controlled study, two groups were formed, namely the PES group and the control group. The right eyes of 50 patients were diagnosed with pseudoexfoliation material by slit lamp biomicroscopy performed in the ophthalmology outpatient clinic, and the right eyes of 50 patients in control group without any health problems were examined. Results: There was no difference between the control and patient groups in terms of gender and age distribution (p>0.005). Statistically, no difference was found between the groups in corneal thickness (p=0.105). However, coefficient of variation, corneal endothelial cell density and hexagonal cell ratio were found to be statistically significant between the two groups. Conclusion: Serious morphological changes occur in the corneal endothelium in patients with PES. Because of these changes in the corneal endothelium, it is recommended to perform specular microscopy measurement before cataract surgery of all patients who have PES detected in their examination.

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

Objective: To evaluate changes in corneal endothelium in patients with anterior uveitis by using specular microscopy and compare it with the corneal endothelium of healthy subjects. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jun 2018 to Jun 2019. Methodology: This study included 65 eyes of 65 patients with anterior uveitis and 65 eyes of healthy subjects. Corneal endothelium was assessed in all participants of both Groups by using Specular microscopy. Corneal endothelial markers like central corneal thickness (CCT), cell density (CD), cell minimum area, cell maximum area, the average of cell size, percent of hexagonality (HEX%), coefficient of variation (CV) were compared in both Groups. The Uveitis Group was further subdivided into active and inactive Uveitis Subgroups, and corneal endothelium markers were also compared in these Subgroups. Results: The mean endothelial cell density was 2626.0±413.0 cells/mm² in patients with uveitis, whereas cell density was 2766.0±327.0 cells/mm² in healthy subjects. The difference in endothelial cell density was statistically significant between the Groups (p=0.03). The difference between central corneal thickness, maximum cell area, average cell size and hexagonality values between Groups was also statistically significant, whereas there was no difference in terms of cell minimum area between these Groups. There was no statistically significant difference between inactive and active uveitis when corneal endothelial markers were compared between them (p>0.05). Conclusion: There was an effect of uveitis on central corneal thickness, endothelial cell density, cell size, and morphology compared to healthy subjects,......

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Unlike corneas stored in cold storage (CS) which remain transparent and thin, corneas stored in organoculture (OC) cannot be assessed by specular microscopy (SM), because edema and posterior folds occur during storage and prevent from specular reflection. We previously developed an active storage machine (ASM) which restores the intraocular pressure while renewing the storage medium, thus preventing major stromal edema. Its transparent windows allow multimodal corneal imaging in a closed system. Aim: to present SM of corneas stored in this ASM. Methods: Ancillary study of two preclinical studies on corneas stored for one and three months in the ASM. A prototype non-contact SM was developed (CMOS camera, ×10 objective, collimated LED source, micrometric stage). Five non-overlapping fields (935 × 748 μm) were acquired in exactly the same areas at regular intervals. Image quality was graded according to defined categories (American Cornea Donor Study). The endothelial cell density (ECD) was measured with a center method. Finally, SMECD was also compared to Hoechst-stained cell nuclei count (HoechstECD). Results: The 62 corneas remained thin during storage, allowing SM at all time points without corneal deconditioning. Image quality varied depending on donors and days of control but, overall, in the 1100 images, we observed 55% of excellent and 30% of good quality images. SMECD did not differ from HoechstECD (p = 0.084). Conclusions: The ASM combines the advantages of CS (closed system) and OC (long-term storage). Specular microscopy is possible at any time in the ASM with a large field of view, making endothelial controls easy and safe. [ABSTRACT FROM AUTHOR]

AIM: To introduce a technique to improve the excision of primary pterygium and evaluate the surgical outcomes.METHODS: Recorded of consecutive cases were reviewed of pterygium patients treated with pterygium removal between March 2015 and February 2016 in People's Hospital of Guangxi Zhuang Autonomous Region, China. Primary nasal pterygium patients with at least 3mo follow-up periods were included. Finally, 85 patients(85 eyes)were investigated, 44 eyes were operated with 20% ethanol(the study group)and 41 eyes were operated without 20% ethanol(the control group).RESULTS: All of the 85 patients enrolled had no intraoperative and postoperative complications. The mean healing time of the corneal epithelium for the study group was statistically significant different of 2.84±0.43d compared with the control group of 3.12±0.64d(P0.05). Between the two groups, there were no statistically significant differences in best-corrected visual acuity(BCVA)at preoperative, postoperative 2wk and 1mo(all P>0.05), but statistically significant difference was found in BCVA at the 3mo after surgery(P

Background: The cornea is the anterior transparent part of the eye. In addition to its optical and refractive function, it is an important protective structure. Aim: The aim of this study was to assess corneal endothelium (counts, morphology and structure) as well as corneal thickness of Type 2 diabetic participants. Setting: This is a hospital-based case–control study and was carried out at Ibn Al Haitham tertiary eye hospital in Baghdad, Iraq. Methods: The sample size was 240 eyes of 120 diabetic participants and 120 healthy participants. Non-contact specular microscopy was utilised to evaluate corneal endothelial cells, including endothelial cell density (ECD), coefficient of variation in cell area (CV), hexagonality (HEX) of cells as well as central corneal thickness (CCT). Results: The ECD was lower in the diabetic corneas (2584.87 ± 259.15 cell/mm2) compared with the healthy corneas (2717.56 ± 289.67 cell/mm2) (p = 0.017, statistically significant). Coefficient of variance (CV) was greater in the diabetic group (40.8 ± 4.17) as opposed to the group with healthy corneas (37.3 ± 2.89) (p = 0.019, statistically significant). The corneas of the diabetic group showed lower hexagonality (44.36% ± 9.87%) compared with the healthy corneas (59.35% ± 9.67%) (p 0.001, statistically significant). Furthermore, the corneas of the diabetic group had greater central thickness (581.1 ± 32.4 µm) when compared with the control group (511.8 ± 29.8 µm), (p 0.001, statistically significant). No correlation was found between the severity level of diabetic retinopathy and corneal endothelial pathological alterations. Conclusion: Long-term poorly controlled glycaemia has a remarkable impact on corneal endothelium (counts, morphology and structure) as well as corneal thickness.

Background: Diabetes mellitus is one of the commonest chronic disorders worldwide with a rapid rise in prevalence. In Iraq its prevalence is high especially in elderly age group. Patients with type 2 diabetes mellitus have higher vulnerability for complications, whether microvascular or macrovascular. Ocular complications are common in diabetes mellitus, and comprise diabetic retinopathy, diabetic papillopathy, cataract, glaucoma, dry eye disease and diabetic keratopathy. Diabetic keratopathy involves endothelial and epithelial tissues of the cornea, leading to persistent epithelial defect, corneal erosion, or corneal ulcers. Aim of the Study: To compare the mean corneal endothelial cell count between patients with type 2 diabetes mellitus and non-diabetics. Subjects and Methods: This is a case-control study conducted in Ibn Al Haitham Teaching Eye Hospital – Baghdad and included 249 participants, 125 cases with type 2 diabetes and 124 controls who had no diabetes. Endothelial cell count was measured for 1 eye of each participant using TOPCON® SP-3000P microscope. Patients who had diabetes for less than 5 years, and patients who had previous ocular surgery, injury or disorders were excluded. Results: There was a significant difference in endothelial cell count between cases with type 2 diabetes mellitus and controls; P = 0.001. There was also a significant negative correlation between age and endothelial cell count, R = -0.20, P = 0.002. Similarly, there was a significant negative correlation between duration of diabetes mellitus and endothelial cell count, R = -0.44, P < 0.001. Conclusions: Type 2 diabetes mellitus causes significant reduction in mean corneal endothelial cell count. There is also a negative correlation between corneal endothelial cell count and both age and duration of the disease.