Cambios morfométricos de las células del endotelio corneal en el síndrome pseudoexfoliativo y glaucoma pseudoexfoliativo

ObjetiveTo evaluate the corneal endothelial morphometry and central corneal thickness (CCT) in pseudoexfoliative (PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open-angle glaucoma (POAG).MethodA total of 166 patients were included in this study: 36 eyes with pseudoexfoliation syndrome (PXS), 30 eyes with pseudoexfoliation glaucoma (PXG), 40 eyes with POAG, and 60 normal eyes. Corneal endothelial cell density (ECD), coefficient of variation (CV) in cell size, and percentage of hexagonal cells, were measured using a non-contact specular microscope, whereas CCT was measured with an ultrasonic pachymeter.ResultsECD and percentage of hexagonal cells were lower in PEX groups and in the POAG group compared with normal eyes, while the CV in cell size was greater. There was a tendency for greater cell loss and morphological abnormalities of the corneal endothelial cells in PXG eyes compared to PXS eyes, when all pseudoexfoliative eyes were analyzed together. Changes in endothelial cells increased with age. There were no significant differences in mean CCT between the four groups.ConclusionEndothelial cell density is significantly decreased, and pleomorphism and polymegathism of cells are increased in PEX eyes, particularly when intraocular pressure is high.     

Long-term follow-up of changes in corneal endothelium after primary and secondary intraocular lens implantations in children

Background

To evaluate long-term changes in corneal endothelial cell count and morphology after congenital cataract extraction and intraocular lens implantation.

Methods

Cataract extraction and posterior chamber intraocular lens (IOL) implantation was performed on 54 congenital cataract patients (83 eyes). The corneal endothelial cell density (ECD), coefficient of variation (CV), hexagonality, and central corneal thickness (CCT) were measured for a retrospective analysis of long-term changes in corneal endothelial characteristics.

Results

The mean age at the time of IOL implantation was 5.00 (3.62) years [mean (SD)], and the mean follow-up period was 8.83 (1.49) years. In a comparison of the treated and normal eyes of patients who underwent unilateral surgery, the treated eyes showed a significantly greater CCT (p?<?0.05), and there was no significant difference in ECD, CV, and hexagonality (p?>?0.05). In addition, there was no statistically significant difference in the ECD and CCT between the primary and secondary IOL implantation groups.

Conclusions

Our results did not show any significant corneal endothelial cell loss in congenital cataract patients; however, their CCTs were increased.     

Corneal endothelial cells and central corneal thickness in patients with neurofibromatosis type 1

Purpose:The aim of this study was to evaluate the morphological properties of corneal endothelial cells and central corneal thickness (CCT) in patients with neurofibromatosis type 1 (NF1) and to compare them with age-matched healthy controls.Methods:Nineteen NF1 patients and 38 healthy individuals were recruited. All participants underwent complete ophthalmological examination as well as noncontact specular microscopy to measure endothelial cell density (ECD), average cell area (AVG), coefficient of variation of cell area (CV), the percentage of hexagonal cells, and CCT. Eyes with previous ocular trauma, inflammation or surgery, and preexisting corneal and ocular surface diseases were excluded.Results:NF1 patients had higher ECD compared to healthy controls of the same age (2764.2 ± 270.4 versus 2570.4 ± 449.2 cells/mm, respectively), although at a borderline level (P = 0.051). Patients with NF1 presented significantly lower CV and AVG when compared to controls (32.9 ± 4.6 versus 37.8 ± 9.5%, P = 0.011 and 364.9 ± 34.4 versus 406.0 ± 107.4 µm, P = 0.038, respectively). The NF1 group had significantly higher hexagonality in comparison with controls (55.7 ± 6.5 versus 50.5 ± 9.9%, P = 0.025). CCT was similar between the two groups (P = 0.955).Conclusion:Our results show that corneal endothelium has more favorable morphological characteristics in NF1 patients compared to healthy individuals of the same age.     

Evaluation of early results of quick-chop phacoemulsification in the patients with high myopic cataract

AIM:To assess the early surgical outcomes ofquick-chop phacoemulsification technique in patients with high myopia.METHODS: The data of patients with high myopia who underwent quick-chop phacoemulsification were reviewed retrospectively. There were 42 eyes of 31 patients. The axial length was more than 26 mm in all eyes. All eyes underwent quick-chop phacoemulsification surgery with the placement of an intraocular lens (IOL) in the capsular bag. Postoperative visits were performed at 1, 3d; 2wk, 1mo. Early postoperative best corrected visual acuity (BCVA), preoperative and postoperative corneal endothelial cell density (ECD), central corneal thickness (CCT) and postoperative complications were assessed. Paired sample t-test or Wilcoxon tests were used to compare data between preoperative and postoperative data.RESULTS:There was no statistically significant difference between preoperative and postoperative ECD and CCT. Retinal detachment was developed in one eye at postoperative first day. There was an iris prolapsus from side port insicion.CONCLUSION: Quick-chop phacoemulsification technique is a safe surgical technique. However we can encounter some complications in high myopic eyes due to histopathological differences. Both side port and clear corneal tunnel insicion size is crucial for preventing postoperative complications. If any persistent leakage is noticed, suture should be placed.     

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...     

重力液流系统和主动控制液流系统对白内障超声乳化术中累积释放能量及术后视力恢复和角膜内皮参数的影响

目的　对比重力液流系统和主动控制液流系统对白内障超声乳化手术中累积释放能量（cumulative dissipated energy,CDE）及术后视力恢复、角膜内皮参数的影响。方法　选取2017年10月至12月于首都医科大学附属复兴医院眼科行白内障手术患者96例（96眼）。所有患者均患有年龄相关性白内障,LOCS III晶状体核透光性和晶状体核颜色评分为4.0~6.9分。依照液流系统选择情况分为:重力组（48例48眼）,使用Centurion重力液流系统;主控组（48例48眼）,使用Centurion主动控制液流系统。术中记录每例患者CDE;术后1周、1个月、3个月复诊,行眼科常规检查,包括视力、眼压、裂隙灯、眼底镜等;所有患者术前行非接触角膜内皮镜检查,记录角膜内皮细胞密度（endothelial cell density,ECD）、内皮细胞变异系数（coefficient of variance,CV）、角膜六角形内皮细胞比率（percentage of hexagonal endothelial cells,6A）及中央角膜厚度（central corneal thickness,CCT）。每次复查均行角膜内皮镜检查获取ECD、内皮细胞CV、6A、CCT等数据。结果　术前重力组和主控组患者的年龄、性别、晶状体核透光性、晶状体核颜色评分比较,差异均无统计学意义（均为P＞0.05）。术前两组患者最佳矫正视力比较,差异无统计学意义（P＞0.05）,术后1周主控组患者最佳矫正视力较重力组明显提高,差异有统计学意义（P＜0.05）,术后1个月和3个月两组间最佳矫正视力差异均无统计学意义（均为P＞0.05）。重力组与主控组术中CDE差异无统计学意义（P＞0.05）。总体CDE均与术前晶状体核分级呈正相关性（晶状体核透光性:r=0.703,P=0.001;晶状体核颜色评分:r=0.804,P=0.000）,术前晶状体核分级越高术中CDE越大。重力组和主控组术前ECD、内皮细胞CV、6A、CCT相似,差异均无统计学意义（均为 P＞0.05）。术后1周ECD、内皮细胞CV、6A比较,两组间差异均无统计学意义（均为P＞0.05）,但重力组CCT［（570.60±34.99）μm］明显大于主控组［（554.67±30.71）μm］,差异有统计学意义（P＜0.05）;术后1个月和3个月两组ECD、内皮细胞CV、6A、CCT比较,差异均无统计学意义（均为P＞0.05）。结论　Centurion超声乳化手术系统中重力液流系统及主动控制液流系统对术中CDE及角膜内皮的影响相似,主动控制液流系统能够更有效地减轻术后角膜水肿,使患者在术后早期视力恢复更迅速。     

角膜内皮细胞形态异常白内障患者超声乳化吸除手术的临床观察

目的：观察角膜内皮形态异常白内障患者行白内障超声乳化吸除联合人工晶状体(IOL)植入术的安全性及手术效果。

方法：回顾性系列病例研究。对2018-01/2020-01在新疆医科大学第一附属医院确诊为年龄相关性白内障患者角膜内皮细胞密度(CD)>2 000cell/mm²,但形态异常的72例90眼作为病例组,以形态正常的120例158眼作为对照组,分别行白内障超声乳化吸除联合IOL植入术,检测术前、术后1wk,1、3mo时CD、细胞面积变异系数(CV)、角膜内皮六角形细胞百分比(HEX)、中央角膜厚度(CT)的变化,分析两组间的差异。

结果：两组患者CD、CV、HEX、CT术后1wk,1mo比较均有差异,而术后3mo两组间CD、HEX有差异,而CV、CT无差异。

结论：CD正常而形态异常的白内障患者行超声乳化吸除联合IOL植入术后角膜内皮损伤程度更重,术前应充分重视,术中同样需要保护角膜内皮,谨慎操作。     

Fuchs角膜内皮营养不良患者白内障手术的临床观察

目的 观察Fuchs角膜内皮营养不良（FED）患者行白内障摘除联合IOL植入术的安全性及手术效果.方法 回顾性系列病例研究.对2009年12月至2012年12月在青岛眼科医院确诊为FED合并有白内障的18例患者（30眼）分别行白内障超声乳化摘除联合IOL植入术（27眼）或白内障囊外摘除联合IOL植入术（3眼）.观察手术前后角膜内皮细胞密度（CD）、细胞面积变异系数（CV）、中央角膜厚度（CCT）以及视力、眼压的变化,分析影响角膜内皮细胞变化的因素.数据采用配对t检验、Wilcoxon秩和检验、Pearson相关进行分析.结果 30眼中有5眼术前术后CD测不出,其余25眼手术前后CV差异无统计学意义（t=0.444,P＞0.05）,手术前后CD分别为（2 270.6＆#177;559.0）cells/mm2和（1 750.4＆#177;585.0） cells/mm2,差异有统计学意义（t=4.759,P＜0.01）.角膜内皮细胞丢失率为（21.78＆#177;20.67）％.术后CCT为（543.0＆#177;34.5） μm,术后视力较术前提高（Z=-4.693,P＜0.01）.术后CCT与术后CD（r=-0.428,P＜0.05）、CV （r=0.434,P＜0.05）显著相关.术后角膜内皮细胞丢失率与累积释放能量呈正相关（r=0.466,P＜0.01）.无一例发生角膜内皮功能失代偿.结论 FED患者行白内障摘除联合IOL植入术是安全、有效的,术中应采取相应措施尽量减少内皮细胞的损伤.     

夜戴角膜塑形镜对青少年角膜内皮细胞的影响

目的：探讨夜戴型角膜塑形镜对青少年角膜内皮细胞数量和形态的影响。方法：回顾性自身对照研究。以2015-2017年在北京大学第三医院验配角膜塑形镜且连续戴镜1年以上的20例单眼近视青少年为研究对象。配戴角膜塑形镜的20只近视眼纳入研究组；未配戴角膜塑形镜的20只对侧眼纳入对照组。戴镜前及戴镜1年，使用角膜内皮镜检查双眼角膜内皮。采用配对t检验比较2组中央角膜内皮细胞密度（ECD）、六角形细胞百分比（HEX）和细胞面积变异系数（CV）的差异。结果：对照组与研究组戴镜前ECD、HEX和CV差异无统计学意义（P>0.05）。对照组ECD呈下降趋势（t=2.490，P=0.022），每年下降1.99%；HEX亦呈下降趋势（t=4.096，P=0.001），每年下降4.23%。研究组ECD亦呈下降趋势（t=5.802，P<0.001），每年下降1.64%；HEX呈下降趋势（t=3.728，P=0.001），每年下降4.82%。研究组和对照组CV在随访期间差异无统计学意义（P>0.05）。对照组与研究组治疗1年后ECD、HEX和CV变化值的差异均无统计学意义（t=-0.453、0.258、-0.392，均P>0.05）。结论：夜戴角膜塑形镜1年对角膜内皮细胞数量和形态没有显著性影响。     

飞秒激光辅助的超声乳化手术对小梁切除术后并发性白内障患者角膜的影响

目的　比较飞秒激光辅助的超声乳化手术和常规超声乳化手术对小梁切除术后并发性白内障患者角膜的影响。方法　前瞻性研究。选取我院2017年1月至12月收治的小梁切除术后并发性白内障患者100例100眼,利用随机数字表法将患眼分为两组,分别为行飞秒激光辅助的超声乳化手术的试验组和行常规超声乳化手术的对照组,每组各50例50眼。记录两组患者术前最佳矫正视力(best corrected visual acuity,BCVA)及术后裸眼视力(uncorrected visual acuity,UCVA)。用非接触角膜内皮显微镜（SP-2000P）分别于术前及术后 1个月、3个月测量角膜内皮细胞密度（endothelial cell density,ECD）;用 Pentacam分析仪分别于术前及术后1 d、1个月、3个月测量中央角膜厚度（central corneal thickness,CCT）和角膜体积（corneal volume,CV）。对比两组术中各项超声参数及术后各指标间的差异。结果　两组患者核硬度分级、手术时间、灌注液量相比,差异均无统计学意义（均为P＞0.05）。两组间超声时间、超声能量、超声累积释放能量之间,差异均有统计学意义（均为P＜0.05）。两组术后1 d UCVA相比差异有统计学意义(P=0.025),术前BCVA和术后1个月UCVA两组相比差异均无统计学意义(均为P＞0.05)。术前两组患者的 ECD、CCT、CV相比,差异均无统计学意义（均为P＞0.05）。术后1个月、3个月两组间ECD相比差异均有统计学意义（均为P＜0.05）,但ECD减少率相比差异均无统计学意义（均为P＞0.05）。术后1 d、1个月两组间CCT、CV相比差异均有统计学意义（均为P＜0.05）,而术后3个月两组间的 CCT、CV相比差异均无统计学意义（均为P＞0.05）。术后 1 d、1 个月,两组间 CCT、CV增加率相比差异均有统计学意义（均为P＜0.05）。术后 3 个月,两组患者的 CCT、CV 增加率相比差异均无统计学意义（均为P＞0.05）。结论　飞秒激光辅助的超声乳化手术能够减轻手术对角膜内皮细胞的损害,缩短角膜水肿恢复时间,降低术后角膜内皮失代偿的风险,提高小梁切除术后并发性白内障手术的安全性。     

角膜内皮移植联合超声乳化白内障吸除及人工晶状体置换手术的疗效评价

目的 探讨角膜后弹力层剥除自动角膜刀取材内皮移植术(DSAEK)联合超声乳化白内障吸除及人工晶状体置换手术治疗角膜内皮失代偿并有白内障或人工晶状体异常患者的疗效和并发症情况.方法 回顾性临床自身对照研究.对2007年12月至2008年12月在北京大学第三医院就诊的各种原因引起的角膜内皮失代偿合并有晶状体异常的患者18例(20只眼)分别行DSAEK联合超声乳化白内障吸除人工晶状体植入手术5例(7只眼)、DSAEK联合前房型人工晶状体取出与前段玻璃体切除及后房型人工晶状体悬吊术7例(7只眼)或DSAEK联合前段玻璃体切除及后房型人工晶状体悬吊术6例(6只眼).术后观察视力、角膜透明性的恢复、植片厚度、角膜内皮细胞丢失、植片的脱位率及排斥反应发生情况.采用治疗前后均数比较t检验.结果 术后18例患者眼部刺激症状均消除,角膜水肿全部消退,术前和术后的角膜厚度分别为859μm、553 μm,差异有统计学意义(t=5.303,P＜0.01);术前供体角膜内皮细胞密度为2987个/mm2,术后3个月角膜内皮细胞密度为1803个/mm2,内皮细胞丢失率为41%.术后除去患有眼底病变的患者9只眼,其余患者视力均有大幅度的提高,视力恢复到0.8以上的有6只眼,在眼底正常的患者中占55%(6/11).术后前房人工晶状体眼炎症反应最重,其余患者反应轻微;术后有6只眼植片脱位(30%,6/20)、术后5例出现眼压升高、1例发生植片排斥反应,均为前房人工晶状体眼的患者.结论 DSAEK联合超声乳化白内障吸除及人工晶状体置换手术对于治疗角膜内皮失代偿并有晶状体或人工晶状体异常患者是一种较安全、有效的手术方法.前房人工晶状体眼行DSAEK术后并发症较多,对虬膜、房角结构异常的患者行角膜内皮移植手术应谨慎.

Abstract：

Objective To evaluate the effect and explore the complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulcification cataract surgery or lens exchange in corneal endothelial dysftnction eyes with lens disorders. Methods Retrospective case series.Eighteen consecutive cases (20 eyes) were performed DSAEK combined with lens surgery from December 2007 to December 2008 in Department of Ophthalmology, Peking University Third Hospital. Five cases (7 eyes) were performed DSAEK combined with phacoemulcification and intraocular lens (IOL) insertion.Seven cases were combined with anterior chamber IOL extraction, anterior vitrectomy and posterior chamber IOL insertion. Six aphakia cases were performed with DSAEK combined with anterior vitrectomy and sclera fixation posterior chamber IOL insertion. Postoperatively, the visual acuity, corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD) and complications were observed during the follow-up. Results The irritation was disappeared in all of patients. All of the corneas became transparent.The preoperative and postoperative mean CCT of the recipient beds was 859 μm and 553 μm respectively. T value was 5.303 ( t = 5.303, P ＜ 0.01 ). It was extremely significant difference. The mean ECD of the donors was 2987 cells/mm2. The ECD was 1803 cells/mm2 in three months postoperatively. The rate of endothelial cells loss was 41%. The visual acuity improved significantly except 9 eyes which had fundus disorders. Six eyes were better than 0.8. It was 55% in normal retinal function patients (6/11). The inflammatory reaction of the anterior chamber IOL eyes was most serious. Six eyes underwent graft dislocation. Five cases underwent high intraocular pressure. One case occurred graft rejection.These complications occurred in anterior chamber IOL eyes. Conclusions DSAEK combined with phacoemulcification cataract surgery or lens exchange is a safe and effective surgical treatment for corneal endothelial dysfunction with lens disorders. More complications occur in anterior chamber IOL eyes. DSAEK should be cautiously chosen in abnormal iris and chamber angle structural eyes.     

Corneal endothelial changes following a single session of selective laser trabeculoplasty for pseudoexfoliative glaucoma

Purpose

To evaluate corneal endothelial cell parameters after a single session of selective laser trabeculoplasty (SLT) in pseudoexfoliative glaucoma (PEG) patients.

Methods

Corneal endothelial cell parameters of 18 PEG patients were compared with 18 healthy subjects following SLT treatment. All patients underwent SLT treatment to 180 degrees of inferior trabecular meshwork. Corneal measurements were performed using specular microscopy (Noncon Robo SP8000, Konan Medical, Hyogo, Japan). Endothelial cell density (ECD), hexagonal cell ratio (HEX), coefficient of variation (CV) of the corneal endothelial cell layer and central corneal thickness of the patients were measured at each visit.

Results

There was a statistically significant decrease in ECD (p = 0.004) and a statistically significant increase in CV (p = 0.041) at superior cornea 1 week after SLT. They returned to pre-SLT values at 1 month. One hour post-SLT HEX of inferior cornea was statistically significantly reduced (p = 0.01). At central cornea, there was a significant increase in HEX after 1 week (p = 0.001). Post-SLT IOP showed a significant positive correlation with CV and significant negative correlation with HEX at superior and inferior cornea. There was no correlation between total laser energy used and endothelial cell parameters.

Conclusion

Effect of a single session of SLT on corneal endothelium of PEG patients appears to be transient, and superior cornea was more affected than central and inferior cornea. All parameters returned to pre-SLT values at 1 month after treatment.

     

Corneal Endothelial Cell Loss after Phacoemulsification in Eyes with a Prior Acute Angle-closure Attack

PurposeTo evaluate endothelial damage after cataract surgery in eyes affected by an angle-closure attack (ACA) and compare it to that in the unaffected fellow eyes (FEs) of patients with ACA and normal eyes (NEs).MethodsThe medical data of eyes affected by ACA, FEs (with no history of acute glaucoma attack), and NEs of patients who underwent cataract surgery with simultaneous intraocular lens implantation were retrospectively reviewed. Endothelial cell density (ECD) and central corneal thickness (CCT) measured before surgery and at 1 week, 1 month, and 3 months after surgery were analyzed, and the percentages of loss in ECD and increase in CCT of the three groups were compared.ResultsThe study enrolled 140 eyes from 100 patients (50 eyes in the ACA group, 40 eyes in the FE group, and 50 eyes in the NE group). The mean ECD was significantly lower in the ACA group than in the other groups (p < 0.001). However, the percentage of ECD reduction was not significantly greater in the ACA group than in the other groups (p > 0.05). None of the eyes developed corneal edema at 3 months postoperatively. Moreover, the CCTs of the three groups were similar throughout the follow-up period (p > 0.05).ConclusionsPhacoemulsification was not associated with greater endothelial cell loss in the ACA group than in the NE and FE groups. This finding shows that ACA history may not contribute to the exacerbation of corneal endothelial damage in cataract surgery.     

Comparative evaluation of modified crater (endonucleation) chop and conventional crater chop techniques during phacoemulsification of hard nuclear cataracts: A randomized study

Purpose:To compare the clinical outcomes of endonucleation chop (EC) versus conventional crater (CC) chop techniques in phacoemulsification of hard nuclear cataracts.Methods:In this Prospective, longitudinal, randomized controlled study with double-blinding. Hundred consecutive eyes with uncomplicated cataracts (nucleus grades 3 and 4) were equally divided into Group A (EC) and Group B (CC). Intraoperative effective phacoemulsification time (EPT) and balanced salt solution (BSS) volume used was noted. Postoperative central corneal thickness (CCT), endothelial cell density (ECD), uncorrected Visual Acuity (UCVA), best-corrected visual acuity (BCVA), and IOP were recorded at days 1, 7, 30, and 90 postoperatively. The Chi-square test (categorical data), Mann–Whitney U test, and t-tests for other parameters were done.Results:The mean EPT in Groups A and B were 6.6 and 14.25 s, respectively (P < 0.001). The BSS volume used was 105.9 and 221.7 mL, respectively (P < 0.001). At 3 months, the ECD loss was 4.35 and 8.6%, respectively (P = 0.025). The-first day CCT was significantly increased in Group B but was the same in both groups at 3 months. A significant improvement in BCVA was noted in both groups. This new technique significantly reduces EPT, the BSS used, and ECD loss.Conclusion:Compared with the CC chop technique, the EC technique for phacoemulsification of hard nuclear cataracts conserved phacoemulsification energy and minimized exposure to the intraocular irrigating solution, provided a significant reduction in corneal endothelial damage, and led to faster visual rehabilitation.     

Management of pseudophakic bullous keratopathy by combined Descemet-stripping endothelial keratoplasty and intraocular lens exchange

PURPOSE: To evaluate visual recovery results in 11 patients with anterior pseudophakia and corneal endothelial dysfunction who had Descemet-stripping endothelial keratoplasty (DSEK) combined with anterior chamber intraocular lens (IOL) removal and scleral fixation of a posterior chamber IOL. SETTING: Department of Ophthalmology, District Railway Hospital Katowice, Katowice, Poland. METHODS: Eleven consecutive patients had DSEK combined with IOL exchange. Corneal transparency, central corneal thickness (CCT), endothelial cell density (ECD), visual outcomes, and complication rates were measured during the follow-up. RESULTS: The mean age of patients was 76 years. All corneas remained clear during the mean 19.3-month follow-up. At the last visit, the mean uncorrected visual acuity was 0.16 (range 0.001 to 0.50) and the mean best corrected visual acuity, 0.36 (range 0.001 to 0.80). The mean spherical equivalent was +0.30 diopter (D) (range -2.00 to +2.25 D) and the mean astigmatism, 2.20 D (range 1.25 to 3.00 D). Three eyes with endothelial disk detachment required reinjection of air. Corneal rejection was observed in 1 eye 3 months postoperatively. Two eyes had flap erosion over the fixation suture. The mean CCT was 0.837 microm preoperatively and 0.605 microm postoperatively. The mean ECD was 3198 cells/mm(2) in donor lenticules and 2048 cells/mm(2) at the last follow-up visit. Endothelial cell loss was 36%. CONCLUSION: Descemet-stripping endothelial keratoplasty combined with anterior chamber IOL replacement with a scleral-fixated posterior chamber IOL was a safe method for the management of pseudophakic bullous keratopathy.     

抗青术后白内障行Phaco后角膜内皮和形态学参数的变化

目的:比较抗青光眼术后白内障眼和正常白内障眼行超声乳化手术后角膜内皮和角膜形态学参数的变化。方法:前瞻性系列病例研究。 我院2010-01/12行白内障超声乳化患者160例200眼,其中包括抗青光眼术后白内障和正常眼白内障各100眼。以抗青光眼术后白内障作为实验组,正常眼白内障作为对照组。用非接触角膜内皮显微镜（SP-2000P）分别于术前,术后1, 3mo测量角膜内皮密度（endothelial cell density,ECD）;用Pentacam分析仪分别于术前,术后1,3mo测量角膜形态学参数,包括角膜中央厚度（central corneal thinkness,CCT）和角膜体积（corneal volume,CV）。结果:术前实验组平均的ECD（1203±245个/mm²）比对照组（2648±167个/mm²）小（P＜0.01）,而实验组的平均CCT（543±32μm）值较对照组（525±36μm）大（P＜0.01）,实验组的平均CV(59.14±2.79mm³)值较对照组（57.26±3.24mm³）大（P＜0.05）,有统计学意义。术后1,3mo实验组平均的ECD较对照组明显减少（P＜0.01）,而CCT值较对照组明显增加（P＜0.01）,CV值较对照组也明显增加（P₁＜0.01,P₂＜0.05）,有统计学意义。术后1,3mo角膜内皮细胞丢失百分率（％）在实验组比对照组大（P₁=01145,P₂=0.2018),但无统计学意义。CCT值增加百分率（％）实验组比对照组在1mo时要显著增加（P=0.0142）,有统计学意义,而在3mo时两者无明显差异（P=0.3562）。CV值增加百分率（％）实验组比对照组在1mo时要显著增加（P=0.0134）,有统计学意义,而在3mo时两者无明显差异（P=0.4538）。结论:抗青光眼术后白内障眼术前ECD较正常眼低,行白内障超声乳化手术术后的角膜内皮细胞丢失率比正常眼要大,术后短期角膜水肿较正常眼严重,所以抗青光眼术后白内障眼只有更精密的规划手术和更精细的手术操作,才能在术中尽量减少对内皮细胞的损害,缩短角膜水肿恢复的时间,降低术后角膜内皮失代偿的风险。     

Evaluation of changes in corneal endothelium in chronic kidney disease

Purpose:Chronic kidney disease (CKD) is an emerging health problem worldwide. In CKD corneal endothelial changes also occur probably due to accumulation of inflammatory cytokines and increased multiple toxic products. The aim of this study was to analyze the effect of CKD on corneal endothelium and correlate the findings with severity of disease with help of noninvasive technique.Methods:The study comprised 75 eyes of 75 cases divided into three groups with group A comprising of CKD cases on dialysis, group B of nondialysis CKD cases, and group C of controls. Each group had 25 cases each of either sex and between 15–80 age groups. All patients were investigated for blood urea, serum creatinine, and blood sugar and underwent complete ophthalmic examination of both eyes along with wide-field specular microscopy examination.Results:The majority of patients (33.3%) belonged to age range of 61–70 years with male predominance and the most common cause of CKD was found to be diabetes with 17 (34%) cases. We found normal corneal endothelial cell density (ECD) with the mean ECD of 2364.52 ± 397.72 mm² in the dialysis group, 2467.8 ± 352.88 mm² in nondialysis group, and 2521.68 ± 250.26 mm² in the control group of patients. However, we found significant increase in coefficient of variation (CV) with 36 ± 5.8% in dialysis group, 37 ± 4.5% in nondialysis group and 32 ± 0.8% in controls (P = 0.001) and decreased hexagonality (Hx) with 47 ± 7.3% in dialysis group, 46 ± 4.7% in nondialysis group and 51 ± 6.7% in the controls (P = 0.031). This showed increased tendency of pleomorphism and polymegathism in corneal endothelial cells in CKD cases. No correlation was found between blood urea or serum creatinine levels with endothelial parameters in any group.Conclusion:CKD causes morphological changes like polymegathism and pleomorphism in corneal endothelium and hence these cases are more vulnerable and special care should be taken before any intraocular surgical procedure.     

Effect of fluidics on corneal endothelial cell density,central corneal thickness,and central macular thickness after phacoemulsification with torsional ultrasound

Aim:To study the relative effects of high and low fluidic parameters on endothelial cell density (ECD), central corneal thickness (CCT), and central macular thickness (CMT) after phacoemulsification with torsional ultrasound.Results:Cumulative dissipated energy was significantly higher in the low flow group (16.44 ± 9.07 vs. 11.74 ± 6.68; P = 0.002). No statistically significant difference was noted between the two groups in the ECD, CCT, CMT, or corrected distance visual acuity at the end of 6 weeks.Conclusions:No significant difference was noted in the postoperative outcome between high and low flow groups. Parameters can be modified to suit the surgeon''s preference, as both high and low flow parameters were found to have comparable postoperative outcomes.     

Corneal thickness and endothelial cell density measured by non-contact specular microscopy and pachymetry in Rhesus macaques (Macaca mulatta) with laser-induced ocular hypertension

PURPOSE: Sustained increase in intraocular pressure (IOP) in humans results in a loss of corneal endothelial cells and an increase of corneal thickness. The effects of chronically elevated IOP on the corneal endothelium of monkeys with laser-induced ocular hypertension, a commonly used animal model of human glaucoma have not been documented. This study examined the central corneal thickness (CCT), the corneal endothelial cell density (ECD), and the corneal endothelial cell size (ACS) in Rhesus monkeys with experimental ocular hypertension.Materials and methods. Ten male monkeys with argon laser-induced ocular hypertension in one eye for an average duration of 2.4+/-0.7 years, were sedated with ketamine hydrochloride, and the CCT, ECD, and ACS measured at the center of the cornea of both eyes with a Topcon SP-2000P non-contact specular microscope (Topcon America Corporation((R)), Paramus, NJ, USA). CCT was also measured using a DHG-500 Pachette ultrasonic pachymeter (DHG Technology Inc., Exton, PA, USA). Mean and standard deviation (S.D.) of CCT, ECD and ACS for each eye was calculated and statistically compared.Results. Mean CCT in the hypertensive and normal eyes measured by specular microscopy was 0.477+/-0.023mm and 0.468+/-0.020 mm, respectively. Mean ECD in the hypertensive and normal eyes was 2601.7+/-631.8 and 3990.2+/-402.9 cells mm(-2), respectively. The mean size of the endothelial cells was 252.4+/-23.9 micro m(2) in the normal eye and 408.7+/-115.0 microm m(2) in the hypertensive eye. No significant difference in the measurement of CCT was observed between the specular microscope and the pachymeter (p=0.46).No significant difference in the mean CCT was observed between the two eyes (p=0.4820), whereas the mean ECD was significantly lower in the hypertensive eye than in the normal eye (p<0.001). The ECD was inversely related to the length of IOP elevation (p<0.001). CONCLUSIONS: No difference in the corneal thickness measurement was observed between the specular microscopy and the pachymetry techniques. Chronic ocular hypertension did not significantly affect the CCT, but caused a significant loss of endothelial cells in the center of the cornea of the laser treated eyes compared to the normotensive eyes. The duration of elevated IOP was the most important factor affecting the ECD.     

基于倾向性评分匹配分析SMILE术治疗高度近视的疗效

目的：基于倾向性评分匹配分析全飞秒小切口角膜基质透镜取出术(SMILE)治疗高度近视的疗效。方法：选取2019-05/2021-05在本院行SMILE术的高度近视患者48例48眼作为观察组，以倾向性评分匹配法进行1：1匹配纳入行FS-LASIK术的高度近视患者48例48眼作为对照组。术后随访6mo，比较两组患者柱镜度、角膜中央厚度、裸眼视力(UCVA)、角膜内皮细胞相关指标[六边形内皮细胞百分比(6A)、内皮细胞面积的变异系数(CV)、中央角膜内皮细胞密度(ECD)]及角膜生物力学指标[模拟Goldmann眼压(IOPg)、角膜滞后量(CH)、角膜阻力因子(CRF)、角膜补偿眼压(IOPcc)]的变化，记录两组患者并发症发生情况。结果：与术前比较，两组患者术后3、6mo柱镜度和UCVA均显著改善，角膜中央厚度、角膜内皮细胞和角膜生物力学相关指标均降低，且观察组变化更为显著(均P&#x003C;0.05)。随访期间，观察组和对照组并发症发生率无显著差异(8% vs 17%，P&#x003E;0.05)。结论：SMILE术治疗高度近视疗效确切，有助于改善视力。