小梁切除术对角膜内皮细胞的影响

目的探讨滤过手术对角膜内皮细胞的影响及其原因。方法检查64只接受小梁切除的原发性青光眼，手术前、后的角膜内皮细胞数量及术后前房深度的变化和炎症反应情况。结果术后64只眼角膜内皮细胞数均比术前减少，差异有显著性（t＝2．508，P＜0．05）；术后前房越浅，内皮细胞损失率越大，相关分析表明，两者间存在着一定的相关关系，（r＝0．7587，t＝9．170，P＜0．01）；炎症反应重的眼比炎症反应轻的眼内皮细胞损失率高。结论提高手术质量，减少术后浅前房和炎症反应的发生或缩短其存在的时间，可降低术后内皮细胞的损失率。     

Effect of Head Position and Tube Entry on Corneal Endothelial Cells in Patients with Glaucoma Drainage Implants: A Cross-sectional Study

PurposeTo investigate the effect of head tilt on the tube position of the Ahmed glaucoma valve (AGV) implanted in patients with glaucoma and to assess how the head tilt-induced alterations of tube parameters and the level of tube entry influence corneal endothelial cell density (ECD).MethodsA total of 29 eyes of 26 patients with AGV implantation were included. Tube-cornea distance, tube-cornea angle, and intracameral tube length were measured using anterior segment optical coherence tomography in three different head positions (neutral, 30° temporalward tilt, and 30° nasalward tilt). The tube entry was assessed using static gonioscopy. ECD was measured using specular microscopy before and after surgery.ResultsThe mean tube-cornea distance, tube-cornea angle, and intracameral tube length (neutral: 0.87 ± 0.39 mm, 30.56 ± 5.89˚, and 3.10 ± 0.82 mm, respectively) decreased with head tilts (temporalward: 0.82 ± 0.39 mm, 29.27 ± 5.82˚, and 3.04 ± 0.82 mm, respectively; nasalward: 0.83 ± 0.40 mm, 29.61 ± 6.04˚, and 3.05 ± 0.81 mm, respectively; all p < 0.01). The multivariate analyses found age and the tube insertion level to be associated with postoperative changes in the central ECD (p = 0.039 and 0.013, respectively), and the postoperative follow-up period and tube insertion level to be associated with the difference between the inferonasal and superotemporal ECDs (p = 0.034 and 0.007, respectively).ConclusionsMild alterations of head positions induced changes in the intracameral tube positions of AGV implants; nevertheless, it did not significantly affect ECD loss. However, the eyes with tubes inserted anteriorly to Schwalbe’s line may be more susceptible to corneal ECD loss.     

Risk Factors for Endothelial Cell Loss after Phacoemulsification: Comparison in Different Anterior Chamber Depth Groups

Purpose

To assess the risk factors for endothelial cell loss after phacoemulsification with implantation of intraocular lens according to anterior chamber depth (ACD).

Methods

This prospective study included 94 eyes of 94 patients undergoing phacoemulsification cataract surgery. To assess the risk factors for corneal endothelial cell loss, we examined seven variables at 1 day, 1 week, 6 weeks, and 12 weeks postoperatively in each ACD-stratified group.

Results

Multiple linear regression analysis showed that the only variable influencing the percentage decrease in corneal endothelial cell density throughout the postoperative follow-up period in the long ACD group (ACD III) was nucleosclerosis. The variables influencing the percentage decrease in corneal endothelial cell density in the short ACD group (ACD I) at one day and one week postoperatively were corneal incisional tunnel length and nucleosclerosis.

Conclusions

Risk factors for endothelial cell loss after phaoemulsification were different according to ACD. Long corneal tunnel length can be one of the risk factors for endothelial cell loss in short ACD eyes.     

超声乳化对小梁切除术后白内障患者角膜内皮细胞的影响

目的 探讨白内障超声乳化术对小梁切除术后的白内障患者角膜内皮细胞的影响.方法 选取30例曾行小梁切除术的白内障患者为研究组,另选取30例年龄相关性白内障患者作为对照组.分别在术前、术后3个月检测两组患者的角膜内皮细胞密度,角膜内皮细胞大小变异系数,六边形细胞百分比.并应用SPSS统计软件进行统计学分析.结果 术后3个月研究组的角膜内皮细胞密度减少265.81个/mm2（11.4％）,对照组减少72.88个/mm2（4.3％）,两组之间差异具有统计学意义（P=0.000）,六边形细胞百分比较对照组低,且差异具有统计学意义.两组患者的细胞变异系数之间无差异.结论 白内障超声乳化联合人工晶体植入术后3个月,小梁切除术后的白内障患者角膜内皮细胞损失较正常年龄相关性白内障患者严重,且恢复慢.因此术前应行角膜内皮细胞检查,严格掌握手术适应症;术中注意操作技巧,减少对角膜内皮的损伤.     

晶体摘除术后角膜内皮细胞丧失与角膜水肿直线性相关

100只兔眼囊外法摘除品体,根据术后中心部、周边部角膜内皮细胞丧失百分率(ΔEN)和1、3、7、10、40天角膜水肿增厚百分率(ΔCT)分组,分别行直线性相关分析。提示:ΔEN 与ΔCT 呈明显直线性相关,根据ΔCT 可以计算和判断ΔEN。     

Long-term Evaluation of Endothelial Cell Changes in Fuchs Corneal Dystrophy: The Influence of Phacoemulsification and Penetrating Keratoplasty

Purpose

To evaluate the natural course of the long-term endothelial cell changes in Fuchs corneal dystrophy (FCD) patients and investigate the effects of phacoemulsification on the annual rate of change in endothelial indices in FCD patients.

Methods

Thirty-four patients diagnosed with FCD at Seoul National University Hospital from 1994 to 2010 were retrospectively reviewed. Sixteen patients who had been followed up for more than 1 year were selected and classified into 3 groups: group A, patients with no ocular surgery; group B, patients who had undergone phacoemulsification only; and group C, patients who had undergone penetrating keratoplasty with cataract surgery. Endothelial cell density, polymegethism, pleomorphism, and pachymetry were measured and the exponential rates of endothelial cell and pachymetry change were analyzed.

Results

A non-linear mixed model of non-operated FCD patients showed that only pachymetric data tended to increase with statistical significance (p = 0.001) with a mean follow-up period of 4.15 years. Using an exponential regression analysis fitting curve, the mean rates of annual endothelial cell loss were 0.82%/yr, 20.39%/yr, and 29.27%/yr in groups A, B, and C respectively, and statistical significance was seen only in group C (p < 0.05).

Conclusions

Retrospective long-term follow-up data showed that changes in endothelial density did not significantly decrease over at least 4 years in middle-aged FCD patients. The changes in pachymetric corneal thickness appeared to increase over the same period. Considering that no exponential changes were aggravated after performing cataract surgery alone, cataract surgery would be a preferable option in FCD patients compared to an approach of "wait-and-do" penetrating keratoplasty combined with cataract surgery.     

白内障超声乳化吸除联合房角粘连分离术治疗白内障合并闭角型青光眼的临床分析

目的探讨白内障超声乳化吸除联合或不联合房角粘连分离术治疗白内障合并闭角型青光眼的效果。方法31例（33只眼）随机分为2组：A组行白内障超声乳化吸除人工晶状体植入术；B组行白内障超声乳化吸除人工晶状体植入术联合房角粘连分离术。追踪观察眼压、降眼压药种类、最佳矫正视力、前房角粘连关闭情况。平均随访20个月。结果术后眼压平均降低：A组（1．92±1．65）mmHg，B组（3．64±2.64）mmHg；两组间比较，差异有统计学意义（t=2．206，P〈0．05）；术后降眼压药种类平均减少：A组1．50±1．03，B组1．63±1．02，两组间比较，差异无统计学意义（t=0．344，P〉0．05）；最佳矫正视力≥0．5，A组13只眼（81．2％），B组15只眼（93．8％），两组间比较差异无统计学意义（χ^2=0．286，P〉0．05）；前房角全部开放：A组0只眼（0％），B组10只眼（62．5％），差异有统计学意义（χ^2=11．782，P〈0．005）。结论白内障超声乳化吸除联合或不联合房角粘连分离术都是治疗白内障合并闭角型青光眼的有效方法，联合房角粘连分离术，降低眼压和开放房角的效果更明显。     

Clinical Outcomes of Nanothin Descemet Stripping Automated Endothelial Keratoplasty in Korean Patients with Corneal Endothelial Dysfunction

PurposeTo evaluate the clinical outcomes of nanothin Descemet stripping automated endothelial keratoplasty (DSAEK) in Korean patients with corneal endothelial dysfunction.MethodsWe retrospectively reviewed medical records of the patients who underwent nanothin DSAEK (graft thickness ≤50 μm) due to corneal endothelial dysfunction and followed up more than 1 year. We evaluated best-corrected visual acuity (BCVA), central corneal thickness, and corneal endothelial cell density at preoperative and 1, 3, 6, and 12 months postoperatively.ResultsSixteen eyes of 16 patients with the mean follow-up period of 13.00 ± 0.96 months were included. The mean graft thickness after deswelling was 45.25 ± 4.59 μm (range, 38.0–50.0 μm). The mean logarithm of the minimum angle of resolution BCVA improved from 1.37 ± 0.53 preoperatively to 0.68 ± 0.46, 0.55 ± 0.35, 0.40 ± 0.25, and 0.39 ± 0.25 at 1, 3, 6, and 12 months postoperatively (p = 0.005, p < 0.001, p < 0.001, and p < 0.001), respectively. The mean central corneal thickness improved from 752.00 ± 129.11 to 555.75 ± 54.66 μm at 12 months postoperatively (p = 0.006). The mean graft endothelial cell density decreased from 2,859.62 ± 228.34 to 1,542.25 ± 627.34 cells/mm² at 12 months postoperatively (p = 0.012). The postoperative complications included increased intraocular pressure (n = 3, 18.75%) and graft dislocation (n = 1, 6.25%), all of which were successfully managed by anterior chamber paracentesis or rebubbling. No other serious complications were encountered.ConclusionsNanothin DSAEK produced significant and stable visual improvements without severe postoperative complications in Korean patients with corneal endothelial dysfunction.     

Monitoring for Continuing Endothelial Cell Loss With Cataract Extraction and Intraocular Lens Implantation

For a period of three years, more than 2,700 endothelial cell density measurements were performed in over 1,000 patients undergoing cataract extraction with and without intraocular lens implantation. We concluded the following from the data: (1) Significant cell loss occurred with all surgical procedures, averaging between 11.6% and 25.6%, depending on type of procedure and implant used; anterior chamber phacoemulsification without intraocular lens implantation caused the most cell loss. (2) Patients with Medallion suture implants produced by one of two manufacturers studied demonstrated statistically significant cell loss during the first (15.6% additional cells lost) and second (22.9% additional cells lost) postoperative years following the initial cell loss due to surgery. This evidence for continuing cell loss with the Medallion suture lens correlated with the clinical observation of an increasing incidence of late bullous keratopathy in these patients. (3) No other surgical procedure or implant type, including Choyce and Shearing implants and Medallion style lenses from another manufacturer, demonstrated any evidence of continuing endothelial cell loss following the initial loss due to surgery.     

Effect of Rho-kinase Inhibitor,Y27632, on Porcine Corneal Endothelial Cell Culture,Inflammation and Immune Regulation

Purpose: To investigate the effect of the Rho-kinase inhibitor, Y27632, on pig corneal endothelial cell (pCEC) culture, and on inflammation and immune regulation of the responses of human cells to pCECs.

Methods: pCECs were cultured with/without Y27632 to assess cell proliferation and in vitro wound healing assay. The level of MCP-1 and VEGF in pCECs stimulated with human TNF-α were measured. Proliferation of human PBMCs stimulated with pCECs, and cytokine production in human T cells, and monocyte migration after stimulation were investigated.

Results: Y27632 promoted pCEC proliferation, prevented pCEC death, and enhanced in vitro wound healing. After stimulation, there were significantly lower levels of MCP-1 and VEGF measured in pCECs cultured with Y27632, and significantly reduced human PBMC proliferation, cytokine production, and monocyte migration.

Conclusions: The application of the Rho-kinase inhibitor will be beneficial when culturing pCECs, and may provide a novel therapy to reduce inflammation after corneal xenotransplantation.     

急性闭角型青光眼高眼压状态下行白内障摘除对角膜内皮细胞的影响

目的：观察急性闭角型青光眼高眼压状态下行白内障摘除联合人工晶状体植入对角膜内皮细胞的 影响。方法：回顾性系列病例研究。选择2018年1月至2021年8月在同济大学附属同济医院眼科就 诊的急性闭角型青光眼发作且药物保守治疗及前房穿刺不能稳定控制眼压患者41例（55眼）,眼压 （47.3±4.8）mmHg（1 mmHg=0.133 kPa）,同时伴不同程度晶状体混浊。所有患者行白内障摘除联合 人工晶状体植入及房角分离术。术前及术后3个月内行常规眼科检查,并获取角膜内皮相关指标, 包括角膜内皮细胞密度（ECD）、中央角膜厚度（CCT）及变异系数（CV）等。手术前后各指标差值比 较采用配对t检验或Wilcoxon符号秩和检验。结果：术后第1天眼压为（16.7±3.7）mmHg,其中4眼 眼压仍高（[ 24.9±2.2）mmHg]需药物控制,其余患眼眼压在正常范围内;术后3个月眼压为（15.7±3.1） mmHg,与术前相比差异有统计学意义（t=36.48, P<0.001）。术后ECD[（1 023±344）个/mm2]明显 较术前 [（2 062±300）个/mm2]下降（t=-22.75, P<0.001）。术后CV（33.5%±6.8%）明显较术前CV （22.7%±2.6%）增大（t=13.62, P<0.001）。手术前后患眼最佳矫正视力明显改善（Z=-4.94, P<0.001）。 所有患者均未发生术中或术后并发症。结论：急性闭角型青光眼高眼压状态下行白内障摘除联合人 工晶状体植入可快速有效控制眼压,但角膜内皮细胞损伤明显。     

Evaluation of striate keratopathy after manual small-incision cataract surgery and its final outcomes in a tertiary hospital

Purpose:To study the demographic profile, contributing and precipitating factors, the severity of striate keratopathy and its relation with endothelial cell count, and evaluate the final treatment outcome of striate keratopathy.Methods:This observational analytical cohort study was conducted on 75 patients developing striate keratopathy after MSICS in the immediate postoperative period. Demographic profile, preoperative risk factors, and intraoperative complications were evaluated retrospectively. Postoperatively, slit-lamp grading of striate keratopathy was done, and specular microscopy of both eyes was taken. Treatment of striate keratopathy was initiated, and patients were followed up for 6 to 10 weeks for improvement.Results:Striate keratopathy was most commonly associated with surgeries performed by resident surgeons (92%), longer duration of surgery, associated predisposing factors, and intraoperative or postoperative complications. On postoperative day 1, the majority of patients had moderate and severe striate keratopathy (66% and 32%, respectively). It was associated with significant endothelial cell loss (ECL) at the final follow-up (P = 0.0016). Striate keratopathy resolved in 97.3% of patients, irrespective of the treatment with hypertonic saline. At 6 to 10 weeks, 92% of patients achieved a BCVA of ≥6/9.Conclusion:A careful preoperative evaluation, adequate training of resident surgeons, meticulous surgical technique, and prompt management of postoperative complications can lead to a decrease in the incidence of striate keratopathy in the majority of cases. The use of hypertonic saline eye drops does not change the final outcome, and most cases resolve spontaneously during follow-up.     

Mitochondria as a Platform for Dictating the Cell Fate of Cultured Human Corneal Endothelial Cells

PurposeAiming to clarify the role of mitochondria in cell fate decision of cultured human corneal endothelial cell (cHCEC) subpopulations.MethodsThe mitochondrial respiratory ability were examined with Mito stress and Mito fuel flex test assays using an extracellular flux analyzer (XFe24; Agilent Technologies; Santa Clara, CA) for human corneal endothelium tissues, mature cHCECs and a variety of cell state transitioned cHCECs. Tricarboxylic acid cycle and acetyl-coenzyme A–related enzymes was analyzed by proteomics for cell lysates using liquid chromatography–tandem mass spectrometry for cHCEC subpopulations.ResultsThe maximum oxygen consumption rate was found to become stable depending on the maturation of cHCECs. In the Mito stress tests, culture supplements, epidermal growth factor, SB203580, and SB431543 significantly repressed oxygen consumption rate, whereas a Rho-associated protein kinase inhibitor Y-27632 increased. Tricarboxylic acid cycle and mitochondria acetyl-coenzyme A–related enzymes were selectively upregulated in mature cHCECs, but not in cell state transitioned cHCECs. The maximum oxygen consumption rate was found to be higher in healthy human corneal endothelium tissues than those with deeply reduced cell density. An upregulated tricarboxylic acid cycle was linked with metabolic rewiring converting cHCECs to acquire the mitochondria-dependent oxidative phenotype.ConclusionsMitochondrial metabolic intermediates and energy metabolism are tightly linked to the endothelial cell fate and function. These findings will help us to standardize a protocol for endothelial cell injection.     

超声乳化联合小梁切除术治疗闭角型青光眼伴白内障

目的探讨闭角型青光眼伴白内障行超声乳化联合小梁切除术的手术方式及临床效果。方法回顾性分析41例（46眼）闭角型青光眼伴白内障行超声乳化联合小梁切除术的临床资料。结果术后随访12个月,裸眼视力0．3及其以上者为36眼（78．26％）,0．05及其以上脱盲率为100％。术后眼压全部降至正常范围,由术前的（32．5±6．2）mmHg降至术后（14．2±4．6）mmHg（1mmHg=0．133kPa）,术前与术后眼压相比差异有统计学意义（t=7．71,P〈0．01）。角膜内皮细胞密度术前与术后1周、1个月、3个月时相比差异有统计学意义（t=4．29～4．331,P〈0．01）,但术后1周、1个月、3个月之间的差异无统计学意义（t=0．025～0．097,P〉0．05）。结论闭角型青光眼伴白内障行超声乳化联合小梁切除术获得良好疗效,是一种有效的手术方式。     

A Clinical Comparison of Safety and Efficacy in Phacoemulsification with versus without Ophthalmic Viscoelastic Device

Abstract

Purpose: To evaluate in a comparative manner the safety and efficacy of 1.0% sodium-Hyaluronate used during capsulorhexis and intraocular lens (IOL) implantation in phacoemulsification surgery. Materials and Methods: 1.0% sodium-Hyaluronate, which is commonly used as one of the ophthalmic viscoelastic devices, was compared to intraocular irrigating solution, which can bring up these effects. In addition, the effect of both methods on occurring corneal endothelial cell (CEC) loss was investigated. Results: Each group comprised 19 eyes. The mean preoperative CEC density was 2525.68?±?181.85 in Group H and 2514.16?±?174.59 in Group V; no statistically significant difference was found between the groups (p?>?0.05). Preoperative and postoperative first and twelfth week CEC densities were 2438.21?±?198.12 (p?<?0.001) and 2390.74?±?202.31, respectively, in group H (p?<?0.001). Preoperative and postoperative first and twelfth week CEC densities were 2415.32?±?197.24 (p?<?0.001) and 2353.47?±?212.69 in group V (p?<?0.001). Compared with preoperative values, decrease in CEC density on the postoperative first and twelfth weeks was not statistically significant in either group (p?>?0.05). Conclusion: Although it was found that there was no statistically difference in terms of preventing CEC loss between 1.0% sodium-Hyaluronate and the irrigation method during phacoemulsification, it was observed clinically that 1.0% sodium-hyaluronate can make the procedure easy, safer, very helpful, especially for understanding phacoemulsification.     

双切口囊外白内障摘除术治疗低角膜内皮细胞数硬核白内障的疗效探讨

目的探讨双切口囊外白内障摘除术(ECCE)治疗低角膜内皮细胞数的硬核白内障的疗效及安全性。方法病例对照研究。收集2009年6月至2018年12月于山东省眼科医院就诊的角膜内皮细胞数低的硬核白内障患者46例(47只眼),其中男性22例,女性24例,年龄(63.8±6.3)岁。入选标准:患者术前角膜内皮细胞计数<1000个/mm2且白内障核硬度≥Ⅳ级。根据ECCE手术方法分为两组:单切口组(24只眼),双切口组(23只眼)。双切口组手术方法为:采取先行上方巩膜预切口,从颞侧或鼻侧2.6 mm透明角膜隧道切口完成常规撕囊,水分离,切开上方巩膜切口,娩出晶体核,巩膜切口缝合,从角膜切口灌吸残余皮质,折叠式人工晶状体植入,吸除黏弹剂。观察术中前房维持情况,术后角膜水肿情况。术后随访6个月,对比两组角膜内皮计数及视力、散光情况。采用χ^2检验对计数资料、t检验对计量数据进行比较。结果两组患者年龄、术前视力、核硬度分级等差异均无统计学意义(P>0.05)。双切口与单切口组患者术前角膜内皮细胞计数分别为(827±164)和(802±121)个/mm^2,差异无统计学意义(t=1.12,P=0.28)。术后6个月双切口组与单切口组患者角膜内皮细胞计数分别为(793±147)和(706±101)个/mm2,差异有统计学意义(t=4.37,P<0.01);角膜内皮细胞丢失率分别为4.16%±3.12%和11.69%±2.96%,差异亦有统计学意义(t=9.52,P<0.01);角膜内皮六边形细胞比例分别为9.67%±6.11%和28.33%±8.39%,差异有统计学意义(t=5.52,P<0.05)。随访6个月,双切口组所有患者均未出现角膜内皮功能失代偿,单切口组3只眼出现角膜大泡、角膜内皮功能失代偿。两组患者术后散光度数和术源性散光度数差异均无统计学意义(t=-0.71,0.15;P>0.05)。结论采用巩膜大切口娩出硬核联合角膜隧道切口完成其余手术步骤的双切口ECCE,对低角膜内皮细胞数硬核白内障是安全、有效的手术治疗方式。     

维吾尔族假性剥脱综合征患者角膜内皮形态学分析

目的：:对比分析维吾尔族假性剥脱综合征（PEX）、剥脱综合征性青光眼（PEXG）、原发性开角型青光眼（POAG）及年龄相关性白内障（ARC）角膜内皮形态学差异。方法：:回顾性病例对照研究。选取2019年7月至2020年8月在中国人民解放军新疆军区总医院全军眼科中心就诊治疗的维吾尔族PEX患者76例（76眼）,PEXG患...