The fellow eye of patients with aphakic bullous keratopathy

The fellow normal-appearing eyes of 23 patients with unilateral aphakic bullous keratopathy were examined by wide-field specular microscopy and pachymetry. All patients had: pseudophakic or aphakic bullous keratopathy in one eye; unoperated fellow eye on no medication; no other ocular disease; and no endothelial guttata seen by slitlamp biomicroscopy or specular microscopy. Three of 23 patients had endothelial cell counts less than 1,000 cells/mm2. There was no correlation between cell density and corneal thickness, but a negative correlation existed between age and endothelial cell density. Preoperative specular microscopy is indicated in patients who have developed bullous keratopathy in the fellow eye after cataract surgery.     

Changes in corneal endothelial cell density and morphology after Ahmed glaucoma valve implantation during the first year of follow up

Purpose: To determine the effect of Ahmed glaucoma valve (AGV) implantation on corneal endothelial cells. Methods: Ahmed glaucoma valves were implanted in 30 eyes of 30 patients with refractory glaucoma. Corneal endothelial cell density and shape was prospectively evaluated in both the subject and fellow eyes of each patient. Corneal specular microscopy was performed on the superior, superotemporal, superonasal and central corneal areas before and at 1, 6 and 12 months after surgery. Results: A statistically significant decrease in average corneal endothelial cell density was observed 12 months postoperatively in the subject eyes compared with the baseline value (P = 0.001). No such changes were observed in the fellow eyes during follow‐up period. The mean percentage decrease in corneal endothelial cell density in subject eyes was 3.5% at 1 month, 7.6% at 6 months and 10.5% at 12 months after surgery. The superotemporal area, which was closest to the tube, showed the greatest decrease in endothelial cell density at 1 year after surgery, while the central cornea showed the least decrease. In terms of endothelial cell morphology, polymegathism and pleomorphism increased in the early postoperative periods, and then gradually approached the preoperative status by 6 months after surgery. Conclusion: Corneal endothelial cell density progressively decreased after AGV implantation. These findings indicate that particular care should be taken during intraoperative and postoperative management of AGV implantation patients in order to minimize damage to the endothelium.     

Corneal Endothelial Changes in Primary Acute Angle-closure Glaucoma

In 20 patients, corneal endothelium was examined by specular microscopy after acute angle-closure glaucoma, and before any surgical treatment in order to assess possible damage during pressure induced abnormal hydration of the cornea. The mean intraocular pressure was elevated to 55 mm Hg and had lasted, on an average, 47 (5–192) hours. The mean endothelial cell density in the affected eye was 1534 and in the nonaffected fellow eye 2243 cells/mm² (mean decrease 33%, P = 0.002). The amount of cell loss correlates with the duration of the intraocular pressure increase. Thirty-five percent of these patients presented a bilateral cornea guttata. This high incidence of endothelial dystrophy was confirmed in a retrospective specular microscopic study in 20 patients with a history of unilateral acute angle-closure glaucoma. The decreased number of endothelial cells after acute angle-closure glaucoma frequently combined with bilateral cornea guttata, accounts for the corneal degeneration in these patients following a later cataract extraction.     

Long-term endothelial changes after implantation of anterior chamber intraocular lenses in cataract surgery

PURPOSE: To determine and quantify corneal endothelial damage after primary or secondary implantation of anterior chamber intraocular lenses (AC IOLs). SETTING: Eye Clinic, University of Trieste, Trieste, Italy. METHODS: This retrospective study comprised 125 patients who had implantation of an AC IOL from January 1987 to December 1998. The mean follow-up was 5.2 years. The IOLs were the Domilens Chiron Vision Z (n = 52), the Iolab U85J (n = 38), and the AMO AC51B (n = 35). The Konan specular microscope was used to perform full morphometric analysis of the corneal endothelium. The values obtained were compared with those in fellow eyes, which were phakic or pseudophakic with a posterior chamber IOL (PC IOL). Two years later, 63 patients (mean follow-up 2.1 years) had another morphometric analysis and the values obtained were compared with those in the same eye at the previous examination. The Student t test for unpaired groups was used to compare the results at a 5% significance level. RESULTS: The mean endothelial cell density (ECD) was significantly lower in eyes with primary or secondary AC IOL implantation than in unoperated phakic eyes (P<.01). Patients who had primary AC IOL implantation in 1 eye and PC IOL implantation in the fellow eye had a difference in ECD that was not statistically significant. The endothelial cell difference was significantly greater in aphakic patients who had a secondary AC IOL implantation (P<.05). The ECD ranged from 1015 to 2980 cells/mm(2). The endothelium in the various groups showed no significant changes in the coefficient of variation (CV) in cell size. The ECD and endothelial CV in the same eyes at the second examination were not significantly different from the values 2 years previously. CONCLUSIONS: Anterior chamber IOL implantation did not appear to alter corneal endothelial function. Results indicate that the endothelial cell loss was related to surgical trauma rather than the presence of an IOL in the anterior chamber.     

Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty

PURPOSE: To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating keratoplasty. DESIGN: Longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon. METHODS: Regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness using specular microscopy. The presence of glaucoma, graft rejection, and graft failure were recorded. RESULTS: The 67 patients examined at 15 years represented 30% of the available clear grafts. Endothelial cell loss from preoperative donor levels was 71 +/- 12% (mean +/- standard deviation, n = 67), endothelial cell density was 872 +/- 348 cells/mm(2), and corneal thickness was 0.59 +/- 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years, whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 +/- 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and 6 of the 8 graft failures after 10 years resulted from late endothelial failure. CONCLUSIONS: From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.     

Endothelial cells in capsular glaucoma

The clinical specular microscope has made it possible to study corneal endothelial cells in vivo. In this study we report for the first time cell densities of unilateral glaucoma patients compared to the normotensive control eyes of the same patient. The corneal endothelium of 27 unilateral capsular glaucoma patients was photographed with a clinical specular microscope. The endothelial cell density was lower in the affected eye than in the normotensive fellow eye in 15 cases. In 10 patients the cell density was the same in both eyes. In two cases the glaucoma eye had a higher density than the fellow eye. Comparison of the above groups showed a statistical difference in the number of glaucoma eyes with a lower cell density (15 lower against 2 higher). The endothelial cell density could not be correlated with the duration of treatment of severity of the glaucoma.     

Intraindividual comparison of surgical trauma after bimanual microincision and conventional small-incision coaxial phacoemulsification

PURPOSE: To compare the surgical trauma after microincision phacoemulsification and small-incision coaxial phacoemulsification after implantation of conventional, foldable, hydrophobic acrylic intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: A prospective investigator-masked case series comprised patients with bilateral cataract who had cataract surgery on the same day. Thirty-three patients (66 eyes) were randomized. Microincision cataract surgery (MICS) was performed through 2, 1.4 mm clear corneal incisions (CCIs) using bimanual sleeveless phacoemulsification (cool phaco) in 1 eye. Small-incision cataract surgery (SICS) was performed on the other eye through a 3.2 mm CCI. In all cases, an AcrySof SA60AT IOL was inserted, in the MICS group after the CCI was enlarged. Laser flare photometry, specular microscopy, corneal endothelial cell density, and pachymetry were evaluated preoperatively and postoperatively. Intraindividual comparison and statistical analyses were performed. RESULTS: There were no relevant clinical differences or perioperative complications in either group. There were no statistically significant differences between preoperative and postoperative anterior chamber flare or endothelial cell loss. On the first postoperative day, the MICS group had statistically significantly increased corneal swelling (P = .008). Postoperatively, the mean endothelial cell density loss was higher in the MICS group (6.2%) than in the SICS group (3.10%); however, the difference between groups was not significant (P = .08) CONCLUSIONS: Microincision cataract surgery was a safe and reproducible technique. The postoperative results in the MICS group were comparable to those in the SICS group.     

Retained presumed intraocular cotton fiber after cataract operation: long-term follow-up with in vivo confocal microscopy

PURPOSE: To evaluate the long-term clinical outcomes in eyes with retained presumed intraocular cotton fibers after cataract surgery. SETTING: Hong Kong Eye Hospital, Hong Kong, The People's Republic of China. METHODS: A retrospective review of 19 eyes with retained presumed intraocular cotton fibers after cataract surgery was performed. Outcome measures were fiber-related complications. In vivo confocal microscopy was performed in eyes with entrapped cotton fibers at the wound site. RESULTS: The duration of retained presumed cotton fibers ranged from 5 to 110 months (mean 42.3 months). No complications were noted in any of these eyes, including endophthalmitis, persistent uveitis, or corneal endothelial cell loss. In vivo confocal microscopy in eyes with entrapped fibers at the wound site showed normal corneal endothelium morphology with no keratocyte activation or inflammatory response. CONCLUSIONS: Retained presumed fibers after cataract operations are more common than anticipated. In contrast to other organic foreign bodies, these retained fibers appear to be well tolerated. Conservative treatment can be adopted for these fibers as these pose minimal toxicity to the eye.     

Long-term results of out-of-the-bag intraocular lens implantation

PURPOSE: To evaluate long-term results of out-of-the-bag intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Tenri Yorozu Hospital, Nara, Japan. METHODS: This study comprised 22 patients, 13 women and 9 men, who had cataract surgery by phacoemulsification and out-of-the-bag IOL implantation because of a posterior lens capsule rupture. Sixteen patients had in-the-bag IOL implantation in the fellow eye, and these eyes were used as a control group. The IOL's position was determined by ultrasound biomicroscopy (UBM). Anterior chamber flare counts were measured by a laser flare meter. The corneal endothelium was observed by specular microscopy. RESULTS: Mean follow-up after cataract surgery was 35 months +/- 22 (SD). The UBM revealed that in the 19 eyes with sulcus-to-sulcus IOL fixation, the optics touched the iris. In 3 eyes, 1 haptic was fixated at the sulcus and the other at the ciliary body. In 2 of these eyes, the optics did not touch the iris. Anterior chamber flare counts in eyes with sulcus-to-sulcus IOL fixation were significantly higher than in eyes with in-the-bag or sulcus-to-ciliary-body fixation (P < .05). There were no statistical differences in corneal endothelial cell counts based on haptic placement. CONCLUSION: Rubbing between the IOL optic and iris seems to contribute to the high flare counts in eyes with a sulcus-to-sulcus IOL fixation. A larger haptic angle may be needed to prevent contact between the iris and IOL optic in such cases.     

低密度角膜内皮细胞白内障超声乳化术的临床观察

目的评价超声乳化吸除术在治疗低密度角膜内皮细胞白内障患者的可行性和手术效果。方法对10例（12只眼）角膜内皮细胞密度〈1500个/mm^2的白内障患者行白内障超声乳化吸除人工晶状体植入术。其中Fuchs角膜营养不良3只眼,抗青光眼术后4只眼,颗粒状角膜营养不良2只眼,穿透性角膜移植术后3只眼。使用角膜内皮显微镜检查所有患者术前术后角膜内皮细胞密度,并观察术后视力及角膜水肿变化。结果所有患者术后视力均有不同程度提高,术后3个月最佳矫正视力0.1-0.4者8只眼,≥0.5者4只眼。术后角膜水肿为轻中度,常于术后5-7 d恢复,无角膜内皮细胞失代偿。内皮细胞损失率8.83%。结论低密度角膜内皮细胞白内障患者在一定程度上可行白内障超声乳化联合人工晶状体植入术。严格掌握手术适应证、术中注意保护角膜内皮细胞和由经验丰富的术者完成手术是疗效满意的重要保证。     

Long-term follow-up of leiske closed-loop anterior chamber intraocular lenses

PURPOSE: To provide long-term follow-up on the rates of endothelial cell loss in eyes with retained closed-loop anterior chamber intraocular lenses (IOLs). SETTING: Private practices, Chicago, Illinois, USA. METHODS: In 1980 to 1982, 3 surgeons performed 587 intracapsular cataract extractions with implantation of Leiske closed-loop anterior chamber IOLs. During the prospective part of the study from 1991 to 1996, 59 patients with 83 eligible eyes were followed using specular microscopy and pachymetry. The mean follow-up of the prospective study was 41.9 months, or 12.9 years from the original cataract surgery. RESULTS: No specific preoperative or postoperative factor except the behavior of the fellow eye (P =.022) predicted the rate of endothelial cell loss. During the prospective study, 6 patients required IOL exchange and corneal transplantation. The rate of corneal decompensation was heavily dependent on the initial measurement of endothelial cell density. Corneas with initial endothelial cell counts greater than 1000 cells/mm(2) had a decompensation rate of 1.5%, and corneas with counts of 500 cells/mm(2) or less had a decompensation rate of 57.1% (P <.01). CONCLUSIONS: Clinical examination and serial measurements of endothelial cell density provide the most reliable methods for monitoring patients with closed-loop anterior chamber IOLs. Endothelial cell counts can predict the rate of corneal decompensation. Patients with endothelial cell counts greater than 1000 cells/mm(2) usually do not require an IOL exchange.     

Evaluation of corneal endothelium after pediatric cataract surgery in children and adolescents

PURPOSE: to evaluate the effects of cataract extraction and lens implantation on corneal endothelium morphology. MATERIAL AND METHODS: In 21 eyes of 14 children with congenital or developmental cataract, corneal endothelium was studied. Patient age was 9 to 19 years (mean 12.9 years). In all eyes extracapsular cataract extraction (ECCE) with PMMA intraocular lens implantation was performed, without primary posterior capsulotomy or anterior vitrectomy. Lens wearers, patients with traumatic cataract or external eye diseases and ocular surgery in history were excluded. The endothelium was imaged by non-contact microscope Topcon SP-2000P. This examination was done preoperatively and 1 month, 6 months and 1 year postoperatively. Corneal thickness (T), corneal endothelial density (ECD) and mean cell area (AVG) of endothelial cells were examined. RESULTS: Mean corneal thickness was 0.55 mm after 1 month, 0.54 mm after 6 months and 0.54 mm after 12 months. The mean preoperative endothelial cell density was 3231.1 cells/mm2. ECD after 1.6 and 12 months was 2874.3; 2639.2 and 2479.9 cells/mm2 respectively. Mean endothelial cell loss was 10.94% after 1 month, 17.85% after 6 months and 22.68% after 12 months. AVG before operation was 315.8 mm2, after 1 month 355.8 mm2, after 6 months 382.4 mm2 and 399.5 mm2 after 12 months. CONCLUSIONS: Changes in corneal endothelium morphology had no effect on transparency of the cornea.     

DuoVisc黏弹剂对白内障超声乳化术低密度角膜内皮细胞的保护作用

目的:临床观察DuoVisc黏弹剂对白内障超声乳化术中低密度角膜内皮细胞的保护效果。方法:观察12例角膜内皮细胞密度为652.9～930.3个/mm²的白内障超乳手术眼,术前记录角膜内皮细胞密度、中央角膜厚度,行白内障超声乳化吸出及后房型折叠人工晶状体植入术,术中应用DuoVisc黏弹剂,术后观察角膜内皮细胞变化,计算术后7d内角膜内皮细胞密度及中央角膜厚度。结果:术后早期部分角膜轻度水肿,药物治疗后恢复透明,术后7d内角膜内皮细胞密度为735.6±92.6个/mm²,较术前（798.2±113.1个/mm²）无明显减少(P=0.145),中央角膜厚度（0.53±0.02mm）正常,同术前（0.51± 0.014mm）相比差异无统计学意义(P=0.144)。结论:熟练掌握超声乳化术的情况下,应用DuoVisc黏弹剂行角膜内皮细胞密度低者的白内障超声乳化术是可行的。     

Fuchs角膜内皮营养不良患者白内障手术疗效分析

评价Fuehs角膜内皮营养不良(FED)患者行白内障摘除人工晶状体植入术的临床效果。方法对连续的2026例(2026只眼)老年性白内障患者行白内障摘除人工晶状体植入术,其中术前行角膜内皮细胞检查确诊为FED患者17例(17只眼),记录手术方式、术中保护角膜内皮细胞的方法,观察手术前、后角膜内皮细胞的变化,以及术后视力和角膜状况。结果老年性白内障患者中FED的发生率为0．8％(17／2026)。白内障摘除人工晶状体植入术后角膜内皮细胞的丢失率为16．2％(324／1998)。94．1％(16／17)患者术后最佳矫正视力≥0．5。随访时间6-36个月,无角膜内皮功能失代偿者。结论白内障摘除术前对老年性白内障患者进行角膜内皮细胞检查具有十分重要的临床意义;白内障摘除术中对FED患者的角膜采取保护措施和由技术熟练的术者完成手术,是手术获得满意疗效的重要保证。     

Nd:YAG激光乳化和超声乳化白内障术后角膜内皮细胞变化的远期观察

目的比较Nd:YAG激光乳化和超声乳化白内障摘出术对角膜内皮细胞密度、形态及角膜厚度的影响。方法选取9例(18眼)老年性白内障患者,双眼分别行Nd:YAG激光乳化和超声乳化白内障摘出术联合人工晶状体植入术,术后随访37个月,比较双眼视力、眼压、角膜内皮细胞计数以及角膜厚度等情况。结果术后37个月,Nd:YAG激光乳化眼角膜内皮细胞密度为(1715.4±627.9)mm-2,超声乳化眼角膜内皮细胞密度为(2330.7±426.5)mm-2,2组比较差异具有统计学意义(P<0.05);2组角膜内皮细胞六角形比例、角膜内皮细胞形态变异率和角膜厚度比较,差异均无统计学意义(均为P>0·05)。2组术后视力、眼压差异也均无统计学意义(均为P>0·05)。结论 Nd:YAG激光乳化白内障摘出术后远期角膜内皮细胞数明显减少,应慎重施行激光乳化白内障摘出术。     

Characteristics of corneal endothelial cells in Fuchs' heterochromic cyclitis

We studied the corneal endothelial cells in 14 patients (6 men and 8 women, ranging in age from 15 to 70 years) with unilateral Fuchs' heterochromic cyclitis (FHC) by means of specular microscopy. The healthy fellow eyes of the patients served as control material. Two affected eyes had undergone an intracapsular cataract extraction before specular microscopy. In one patient, the cyclitic eye also had glaucoma. Changes of the endothelium characterized by intra- and intercellular dark bodies, larger dark defects spanning several endothelial cells and bright irregular patchy areas crossing cell borders on the specular reflex were found in all eyes with FHC. Individual cell analysis did not reveal any significant differences in the endothelial cell density, cell area, coefficient of variation for cell area, cell perimeter, cell shape and in the number of endothelial cell apices between unoperated cyclitic and healthy fellow eyes. The mean cell density was 4.9% lower in the unoperated eyes with FHC than in the control eyes. A significant negative correlation was observed between the patients' age and the cell density both in the healthy and the cyclitic eyes. On the other hand, the correlation between follow-up period and cell density was not statistically significant in the cyclitic eyes. Although FHC does not seem to accelerate significantly the age-related cell density reduction, the magnitude of the cell loss found in the two operated eyes (45.5% and 49.8%) and in the eye with glaucoma (45.2%) may indicate altered tolerance against endothelial traumas in this disease.     

飞秒激光辅助超声乳化与微切口超声乳化白内障手术的疗效比较

目的:比较不同眼轴长度的白内障患者飞秒激光辅助的白内障手术(FLACS)与传统超声乳化白内障手术(PHACO)的临床疗效与安全性。方法:白内障手术患者按眼轴长度分为正常眼轴组(22mm≤AL<24mm组)、中长眼轴组(24mm≤AL<26mm)及长眼轴组(AL≥26mm),每组各100眼。每组中各有50眼随机接受FLACS及PHACO手术方案。术前及术后3mo行BCVA、视觉质量及角膜内皮细胞计数检查,并对结果进行统计学分析。结果:各组患者术后视力较术前均有提高(P<0.01),不同眼轴组FLACS术后视力提升较PHACO术后好,但组间均无差异(P>0.05)。PHACO组除中长眼轴组外其他各组患眼术后strehl ratio值均较术前提高,但仅正常眼轴组的斯特列尔比(strehl ratio)增加有统计学意义(P<0.05)。各眼轴组内FLACS组与PHACO组比较,strehl ratio值变化均无差异(P>0.05)。FLACS组术后角膜内皮计数均较术前减少(P<0.01);PHACO组除中长眼轴组外术后角膜内皮计数均较术前减少(P<0.01);FLACS与PHACO组间术后角膜内皮计数均无差异(P>0.05)。结论:飞秒激光辅助白内障手术比传统超声乳化手术能有效提高不同眼轴长度的白内障患眼术后BCVA以及术后视觉质量,两种手术方式均会对角膜内皮造成损伤,但无差异。     

拦截劈裂法结合手法挽核在硬核白内障手术中的应用

目的探讨硬核白内障超声乳化人工晶状体植入手术的技巧和效果。方法对Ⅳ级和Ⅴ级硬核白内障患者29例29眼施行超声乳化拦截劈裂法结合手法挽核手术，观察术中术后并发症、术后视力等，并进行分析。结果超声乳化时间为0．3～0．8min，平均0．5min。切口无热损伤。无严重并发症发生。28眼顺利一期囊袋人工晶状体植入，其中1眼为晶状体半脱位，改为前房型人工晶状体植入。术后第1天裸眼视力≥1．0者14眼。≥0．5者25眼。〈0．5者4眼。术后1周裸眼或矫正视力≥1．0者21眼，〈0．5者4眼，其中2眼为老年性黄斑变性，1眼为糖尿病视网膜病变，1眼为继发性视神经萎缩。术中后囊破裂2眼，角膜内皮水肿4眼，后发性白内障2眼。结论超声乳化拦截劈裂法联合手法挽核技术可以减少超声乳化时间，降低超声能量，具有损伤小、术中术后并发症少、手术时间短、术后反应轻和视力恢复快等优点，是硬核白内障可供选择的较好的手术方式。[眼科新进展2007；27（3）：218-220】     

Long term observations on an anterior chamber Ridley intraocular lens

In 1965 the patient, aged 6, sustained a perforating eye injury which was repaired and a traumatic cataract was aspirated within five weeks. Five years later a Ridley Mk 2 A/C intraocular lens was inserted. Several episodes of blunt trauma occurred over a three year period following this procedure. This paper reports the clinical, corneal pachometric and specular microscopic findings of both traumatized and normal fellow eyes 18 years after the initial incident. The corneal endothelial mosaic of the traumatized right eye was very irregular in the vicinity of the initial site of perforation. These marked variations in cell size and shape were less apparent at peripheral corneal areas. The estimated cell loss to the traumatized eye was in the region of 74% although in spite of this corneal function was maintained. The effects of trauma on the corneal endothelium are discussed and a brief review of the literature presented.