Comparison between the protective effect of Ophthalmic Viscoelastics on the corneal endothelium in phacoemulsification

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S M A Saleh ◽  
R M F Elghazawy ◽  
A I Elawamry ◽  
R G Zaki
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Protective Effect ◽  
Cell Count ◽  
Corneal Endothelium ◽  
Hydroxypropyl Methylcellulose ◽  
Methyl Cellulose ◽  
Endothelial Cell Count ◽  
Significant Difference ◽  
Group 2

Abstract Background Phacoemulsification is one of the most common surgical interventions done worldwide; the ultrasound power used to emulsify and remove the cataractous lens is hazardous to corneal endothelium and can lead to permenant damage. Thats why ophthalmic viscoelastics have been developed and used to protect the corneal endothelium and ensure safety of intraocualr surgeries. Objective To study the effect of different concentrations of methyl cellulose on the corneal endothelium during phacoemulsification using specular microscopy. Patients and Methods Sixty patients with Immature Senile Cataract (IMSC) are equally distributed into two groups according to the concentration of Hydroxypropyl Methylcellulose (HPMC) used during phacoemulsification. In the first group HPMC 2% was used and in the second group HPMC 2.4% was used. Preoperative and one month postoperative examination was done including visual acuity testing, slit lamp examination using Topcon SL-3C, intraocular pressure measurement using Goldmann Applanation Tonometer (GAT), fundus examination, corneal edndothelium assessment by Tomey Specular Microscope EM-3000. Results Preoperatively, no significant difference was observed in age, sex, visual acuity, introcular pressure and endothelial cell count among the two groups. Postoperatively, the two groups had a significant decrease in endothelial cell count, but the decrease was less in group 2 using Methyl cellulose 2.4% (13.494%) than in group 1 using Methyl cellulose 2% (14.515%).There was an equal and significant increase in visual acuity in the two groups. Discussion Many studies have been done to compare the efficacy of different viscoelastics (OVDs) in the protection of corneal endothelium during phacoemulsification. In our study we compared the protective effect of two different concentrations of HydroxyPropyl MethylCellulose (2% &2.4%) on the corneal endothelium during phacoemulsification. We compared the demographic data as regarding age and sex of the patients in the two groups, also we compared the preoperative endothelial cell count in the two groups using Specualr Microscopy and the result showed no significant difference between the 2 groups. The endothelial cell loss was comparable in the 2 groups, in group 1 it was 362.267 ± 52.020 (14.515 % ± 1.458) and in group 2 it was 335.667 ± 21.170 (13.494% ±0.667) with slightly better protection in the second group. So these results shows that HPMC 2.4% gives better protection than HPMC 2% on corneal endothelium during phacoemulsification on terms of the postoperative endothelial cell count and the endothelial loss after phacoemulsification. Many studies have been done to compare the efficacy and the protective effect of different viscoelastics during phacoemulsification for example the studies done by Miller et al, Maar et al, Vajpayee et al and Storr-Paulsen et al, these studies showed results similar to our study as regards the protective effect of methyl cellulose with its different concentrations on the corneal endothelium during phacoemulsification, so both concentrations (2% and 2.4%) can be used safely and effectively in phacoemulsification to decrease the endothelial loss and ensure patients safety. Conclusion Methyl cellulose 2.4% and Methyl cellulose 2% were comparable in their ability to protect the corneal endothelium during phacoemulsification, in general both viscoelastics can be efficiently and safely used in performing phacoemulsification.

The utility of contact lens-assisted corneal cross-linking (CACXL) in progressive keratoconus patients with thin corneas

2022 ◽  
pp. 112067212110709
Author(s):  
Bilgehan Sezgin Asena ◽  
Mahmut Kaskaloglu
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Count ◽  
Contact Lens ◽  
Corneal Thickness ◽  
Hydroxypropyl Methylcellulose ◽  
Cross Linking ◽  
Demarcation Line ◽  
Endothelial Cell Count ◽  
The Mean

Purpose To evaluate efficacy and safety of contact lens-assisted corneal cross-linking (CACXL) among progressive keratoconus patients with thin corneas. Setting Private eye hospital Design Cross-sectional study Methods Thirty-six eyes of 36 consecutive patients with progressive keratoconus and thinnest corneal thickness of 380–400 µm after epithelium removal were included. CACXL was performed based on use of a dextran-free isotonic (>0.1%) riboflavin solution with hydroxypropyl methylcellulose (HPMC, 1.1%) after epithelial removal and placement of a riboflavin-soaked contact lens without an ultraviolet filter on the cornea and ultraviolet irradiance. Data on best distance corrected (CDVA) and uncorrected (UDVA) visual acuity, manifest sphere (D), manifest cylinder (D), K1 (D), K2 (D), mean keratometry (D) and Kmax (D) values, endothelial cell count and mean depth of demarcation line were recorded preoperatively and at the postoperative 1-year Results Post-operative 1-year data revealed significant increases in UDVA (0.23  ±  0.15 vs. 0.17  ±  0.13 D, p < 0.001) and CDVA (0.44  ±  0.18 vs. 0.36  ±  0.17 D, p < 0.001) values and a significant reduction in the mean Kmax (from 56  ±  3.3D to 55  ±  3.2 D, p < 0.001), K2 (from 49.7  ±  3.2 D to 49.52  ±  3.11 D, p  =  0.049), manifest sphere (from −1.93  ±  2.21 D to −1.55  ±  2.02 D, p  =  0.001) and manifest cylinder (from −2.83  ±  1.67 D to −2.39  ±  1.36 D, p < 0.001) values along with a similar endothelial cell count. The mean depth of demarcation line was mean 230 (SD17.05, range 200 to 262) at postoperative 1-month. Conclusions Our findings indicate favourable 1-year postoperative outcome of CACXL in progressive keratoconus patients with thin cornea in terms of improved visual acuity and keratectasia status as well as endothelial safety.

scholarly journals A Comparative Study of Two Types of Implantation Surgery Methods for Implantable Collamer Lenses

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Hao Liu ◽  
Denghao Dong ◽  
Chunlin Chen ◽  
Jian Ye
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Count ◽  
Anterior Chamber ◽  
Operation Time ◽  
Corneal Endothelial Cell ◽  
Distance Visual Acuity ◽  
Endothelial Cell Count ◽  
Group 2 ◽  
Group 1

Purpose. To investigate the effects of two different surgical methods of implantable collamer lens (ICL) implantation on the operation time, visual outcomes, corneal endothelial cell count, and intraocular pressure (IOP). Methods. This was a contralateral eye comparison study, a total of 192 eyes from 96 patients were included, and the two eyes from the same patient were randomly assigned to two groups (group 1 and group 2, with 96 eyes in each group). In group 1, after making the corneal incision, ophthalmic viscosurgical devices (OVDs) were first injected into the anterior chamber followed by ICL implantation. In group 2, the ICL was first implanted into the anterior chamber followed by OVDs injection. The operation time, uncorrected distance visual acuity, corrected distance visual acuity, spherical equivalent, corneal endothelial cell count, and IOP were recorded and analyzed. Results. The operative time in group 1 was significantly longer than that in group 2 ( P  = 0.002 < 0.05). There were significant differences between IOP measured 2 hours following surgery of the two groups ( P  = 0.026 < 0.05), Furthermore, the rate of IOP change 2 hours following the operation was significantly higher in group 1 than in group 2 ( P  = 0.019 < 0.05). There were significant differences in the anterior chamber angle 2 hours after surgery compared with that before surgery in both groups ( P  = 0.014 < 0.05 and P  = 0.029 < 0.05, respectively). No significant differences were observed in the other parameters measured (all P  > 0.05). Conclusion. The two ICL implantation methods had similar clinical outcomes and effects on the corneal endothelial cell count. Additionally, the implantation of an intraocular lens prior to injecting OVDs reduces the operation time and lowers the rate of IOP rise in the early postoperative period, making it safe and effective for ICL implantation.

Effect of Hydroxypropylmethylcellulose versus Sodium Hyaluronate on corneal endothelial cell count in patients undergoing cataract surgery by phacoemulsification

2021 ◽  
Vol 15 (8) ◽  
pp. 2064-2066
Author(s):  
Faisal Anwar ◽  
Mohammad Hasan Bokhari ◽  
Muhammad Tahir Ghaffar ◽  
Ahsan Irshad ◽  
M. Shoaib Khan ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Cell Count ◽  
Hydroxypropyl Methylcellulose ◽  
Sodium Hyaluronate ◽  
Cell Loss ◽  
Corneal Endothelial Cell ◽  
Endothelial Cell Count ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective: To compare the effect of Hydroxypropyl methylcellulose versus Sodium Hyaluronate on corneal endothelial cell count in patients undergoing cataract surgery by phacoemulsification. Design: It was a randomized clinical trial. Study Settings: This study was conducted at the Eye Unit III, Mayo Hospital / KEMU, Lahore over 12 months period from June 2014 to May 2015. Hypothesis: There is a significant difference in protective effect on corneal endothelial cell loss with dispersive (Hydroxypropyl methylcellulose) viscoelastic agent as compared to cohesive (sodium hyaluronate) viscoelastic agent used during phacoemulsification with intraocular lens for the treatment of cataract. Material and Methods: Total 80 patients from both the genders aged between 40-70 years with cataract undergoing phacoemulsification surgery were involved in this study. Two equal treatment groups were made by random allocation. Patients in Group-A (n=40) received Hydroxypropyl methylcellulose as viscoelastic agent while patients in Group-B (n=40) received treatment with Sodium Hyaluronate. Surgery was carried out by phacoemulsification technique and follow-up was done at first week, 1st month and 3rd month post-operatively. Data was collected in terms of endothelial cell count by noncontact specular microscope. Results: Patients age was in the range of 40 to 70 years with a mean of 57.26 ± 8.00 years. There were 31 (38.75%) females and 49 (61.25%) male patients with a female to male ratio of 1.6:1. Both the groups had no statistically significant difference in the mean corneal cell count before surgery (2839.67±368.71 cells/mm2 vs. 2801.36 ± 332.52 cells/mm2; p-value= 06.27). Post-operative mean corneal cell count at 1 week, 1 month and 3 months was significantly higher in patients in Group-A compared to Group-B. Similarly, significant difference was noted across various subgroups of both the groups on the basis of patient’s age and gender. Conclusion: This study concluded that there is less corneal endothelial cell loss with dispersive Hydroxypropyl methylcellulose viscoelastic agent as compared to cohesive sodium hyaluronate viscoelastic agent used during phacoemulsification surgery with intraocular lens implant for the treatment of cataract. Keywords: Cataract, phacoemulsification, viscoelastic agents, corneal, endothelial cell.

scholarly journals Effect of donor and host factors on corneal graft transparency

2021 ◽  
Vol 6 (4) ◽  
pp. 56-61
Author(s):  
Dr. Amisha Jain ◽  
◽  
Dr. Hema Joshi ◽  
Dr. Nimish Jain ◽  
◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Cell Count ◽  
Graft Survival ◽  
Graft Failure ◽  
Failure Group ◽  
Endothelial Cell Count ◽  
Donor Factors ◽  
Group 2 ◽  
Group 1

Objective: To study the correlation between donor factors and recipients' factors on graft clarity.Materials and methods: The study comprised 30 cases of Keratoplasty surgery with a follow up of6 months. All donor corneas were evaluated by Konan specular microscope for endothelial cellcount; details of the donor like age, cause of death were noted. The patients were divided into twogroups, Group 1 had graft failure, and Group 2 had clear corneas. Observation and Result: Therewere 12 patients in group 1 and 18 patients in group 2 with six months of follow up. The meanendothelial cell count in group 1 was 1942.3/mm2, and group 2 was 2334.8/mm2. There is asignificant difference in the mean endothelial cell count between the two groups. On analysing theindication for Keratoplasty in two groups, the outcome was best for the corneal opacity group duringworst for the graft failure group. Conclusion: Donor endothelial cell count significantly influencedgraft outcome; rest donor factors (age, death enucleation interval, enucleation surgery interval)don't affect graft survival. Indication for Keratoplasty is a significant predictor of graft survival.

scholarly journals Standardized Flanged Intrascleral Intraocular Lens Fixation with the Double-Needle Technique for Cataract Luxation in the Vitreous Chamber during Phacoemulsification

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Gianluca Besozzi ◽  
Chiara Posarelli ◽  
Maria Carmela Costa ◽  
Alessio Montericcio ◽  
Giuseppe Nitti ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Count ◽  
Intraocular Lens ◽  
Spherical Equivalent ◽  
Refractive Outcome ◽  
Endothelial Cell Count ◽  
Corrected Visual Acuity ◽  
Target Refraction ◽  
Best Corrected Visual Acuity

Purpose. To assess the visual and refractive outcome of immediate intraoperative vitrectomy and intrascleral intraocular lens implantation using a “standardized” sutureless Yamane technique during cataract luxation in the vitreous chamber as a complication of phacoemulsification. Design. A prospective, interventional, consecutive case series. Materials and Methods. Twelve patients underwent vitrectomy and intrascleral intraocular lens fixation using a standardized Yamane technique as the primary procedure during complicated phacoemulsification. Patients were evaluated preoperatively and 6 months postoperatively for best-corrected distance visual acuity, correspondence to the preoperative refractive target in the spherical equivalent, endothelial cell count, and complications. Results. Mean preoperative best-corrected visual acuity was 1.16 ± 0.3 logarithm of the minimum angle of resolution (logMAR), the endothelial cell count was 1910.5 ± 297.64, and target refraction at baseline was −0.197 ± 0.087. Postoperatively, best-corrected visual acuity was significantly improved; the mean value was 0.05 logMAR ± 0.06. Mean baseline target refraction in the spherical equivalent was −0.20 ± −0.09 (range: −0.08 to −0.37), and mean final refraction was −0.44 ± −0.14 (range: −0.25 to −0.75) with no significant difference p = 0.87 . No complication was registered intra- and postoperatively. Conclusion. Standardization of the Yamane technique seemed a valuable option for patients who had complicated phacoemulsification to achieve a predictable refractive outcome. Synopsis. The predictable refractive outcome could be achieved with the immediate standardized Yamane technique in patients with intraoperative cataract luxation in the vitreous chamber during phacoemulsification.

scholarly journals Dispersive viscosurgical devices demonstrate greater efficacy in protecting corneal endothelium in vitro

2019 ◽  
Vol 4 (1) ◽  
pp. e000227 ◽  
Author(s):  
Timur Mert Yildirim ◽  
Gerd U Auffarth ◽  
Hyeck-Soo Son ◽  
Ramin Khoramnia ◽  
Donald John Munro ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Cell Count ◽  
Corneal Endothelium ◽  
In Vitro Study ◽  
Endothelial Cell Count ◽  
Cell Counts ◽  
Young Pigs ◽  
Endothelial Surface ◽  
Ophthalmic Viscosurgical Device

ObjectiveDuring phacoemulsification, the corneal endothelium is protected by an ophthalmic viscosurgical device (OVD). In this in vitro study, we assessed six different OVDs for their effectiveness in protecting the corneal endothelium.Methods and analysisPhacoemulsification was performed in cadaver eyes of young pigs. Five syringe units of six different OVDs were tested (Healon EndoCoat, Viscoat, Methylvisc, Healon, Healon GV, ProVisc). After surgery, the area of endothelium coated with OVD was determined in relation to the total endothelial surface. Additionally, an endothelial cell count was obtained. As a control, an endothelial cell count was obtained from freshly trephined corneas. Statistical analysis was performed using the Mann-Whitney U test and the Spearman correlation.ResultsThe least postoperative endothelial coating and cell count were observed in the cohesive OVDs while the dispersive OVDs showed statistically significant higher values. Healon EndoCoat and Viscoat yielded a coating area of 86 (85–92)% and 85 (85-90)%, respectively. Endothelial cell count was highest in the two dispersive groups with 4065 (3928–4088) cells/mm2 (Methylvisc) and 4032 (4015–4115) cells/mm2 (Viscoat). Endothelial coating area and endothelial cell count correlated statistically significantly.ConclusionDispersive OVDs from this study showed greater adherence to the endothelial surface than the cohesive ones. Furthermore, postoperative endothelial cell counts of corneas treated with dispersive OVDs were higher than of corneas treated with cohesive OVDs. Our in vitro results suggest that dispersive OVDs protect the corneal endothelium better during phacoemulsification than cohesive OVDs.

scholarly journals Visual Outcome of Descemet Membrane Endothelial Keratoplasty during the Learning Curve in Initial Fifty Cases

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Sanjay K. Singh ◽  
Sanjeeta Sitaula
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Learning Curve ◽  
Cell Count ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Endothelial Cell Count ◽  
Corrected Visual Acuity

This study was performed to evaluate the clinical outcomes of the first fifty patients who underwent Descemet membrane endothelial keratoplasty (DMEK) during the 3-month postoperative period and to describe the challenges encountered during the learning curve. In this retrospective study, we reviewed the charts of patients who underwent DMEK. All information regarding patient demographics, indication for surgery, preoperative and postoperative visual acuity at 3 months, donor age, and complications encountered intraoperatively and postoperatively was recorded. Donor endothelial cell count at the time of surgery and during the 3-month follow-up was noted. Data were analyzed using SPSS version 17. Fifty eyes of 49 patients were included in the study with majority being female patients (male : female = 2 : 3). Mean age of patients was 56.8 ± 11.4 years with the age range of 22–78 years. The common indications for DMEK were pseudophakic bullous keratopathy –57.1%, Fuchs endothelial dystrophy-34.7%, failed grafts-6.1% (Descemet stripping endothelial keratoplasty (DSEK) and failed penetrating keratoplasty), and others. Preoperative best spectacle-corrected visual acuity was <20/400 in 88% cases. Postoperative best spectacle-corrected visual acuity at 3 months was >20/63 in 41.8% of the cases, and 93% had visual acuity of 20/200 or better. Donor size was 8 mm, and average donor endothelial cell count (ECC) was 2919 ± 253 cells/mm2. Average ECC at 3 months postoperatively was 1750 ± 664 cells/mm2, which showed a 40% decrease in ECC. The most common encountered complication was graft detachment, which occurred in 16% cases for which rebubbling was done. Regular follow-up and timely identification of graft detachment may prevent the need for retransplantation.

scholarly journals Assessment of Corneal Endothelial changes in type II Diabetes Mellitus by Non-Contact Specular Microscope

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
J E F Gendy ◽  
N M Elmowafy ◽  
M M Elfiky ◽  
Y M Shaaban
Keyword(s):  
Diabetes Mellitus ◽  
Endothelial Cell ◽  
Cell Count ◽  
Type Ii Diabetes ◽  
Corneal Endothelium ◽  
Type Ii Diabetes Mellitus ◽  
Diabetic Patients ◽  
Type Ii ◽  
Significant Difference ◽  
Specular Microscope

Abstract Introduction Numerous studies were dedicated to explaining the effect of type II diabetes on corneal endothelium. There seemed to be a conflict in the results of the studies, some highlighted that diabetes did not affect the corneal endothelium but rather the corneal thickness. While others disagreed stating that there was damage to the endothelium. The rest cited low endothelial cell density only in poor glycaemic control. This prospective analytical study will extensively investigate the effect of diabetes on the corneal endothelium using non-contact specular microscopy. Aim Prospective analysis of the effect of type II diabetes mellitus on the corneal endothelium performed by specular microscopic examination using KONAN Non-Contact Specular Microscope CC-5000 Cellchek; with regards to cell count, density, size, morphology and comparing them to normal subjects of the same age group. The aim of the study is to completely understand the changes that occur to the corneal endothelium in diabetic patients. Patients and Methods This is a cross-sectional study, in which 30 Diabetic eyes and 30 Control eyes were examined using non-contact specular microscope. Patients were recruited from the Specialized Eye Hospital Kobry El Kobba Military Medical Complex. Results The study included 17 males and 13 females in the non-diabetic control group while in the diabetic group it included 16 males and 14 females. By comparing the demographic data of the two study groups, no significant difference (p &gt; 0.05) was found. The same results were obtained in data regarding the age. Comparing both groups regarding the cell count, density and average cell size showed a highly significant difference (p &lt; 0.05). While comparing the coefficient of variation and the percentage of hexagonal cells in both groups showed a significant difference (p &gt; 0.05). Conclusion Diabetes has been implicated in the morbidity of the corneal endothelium. Our study concluded that it appears that diabetes has a significant impact on the corneal endothelial anatomy, causing endothelial cell loss and a decrease in cell density producing compensatory polymegathism. Triggering a disturbance in the physiological functions of the endothelium when under stress e.g. trauma, surgery or intraocular inflammation. However, under normal physiological conditions we found out that there was no abnormality or impairment in the corneal endothelial functions; in keeping the corneal deturgesence (relatively dehydrated, 70% hydration). Therefore, we concluded from the results that special caution should be taken in diabetic patients to whom any stress is applied on the corneal endothelium so that they do not develop corneal decompensation leading to significant morbidity.

scholarly journals Management of Corneal Ectasia after LASIK with Phototherapeutic Keratectomy Combined with Photorefractive Keratectomy and Collagen Cross-Linking

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Weiyan Zhou ◽  
Hongya Wang ◽  
Xiao Zhang ◽  
Mingxia Tian ◽  
Changxia Cui ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Endothelial Cell ◽  
Cell Count ◽  
Cross Linking ◽  
Spherical Equivalent ◽  
Corneal Ectasia ◽  
Corneal Haze ◽  
Endothelial Cell Count ◽  
Spherical Equivalent Refraction ◽  
Collagen Cross Linking

Background. To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with photorefractive keratectomy (PRK) and riboflavin with ultraviolet-A collagen cross-linking (CXL), performed sequentially on the same day, in the management of corneal ectasia after LASIK. Methods. This retrospective review comprised consecutive patients with corneal ectasia after LASIK. The patients were administered PTK and PRK on the previous corneal flap, and CXL was given on the same day by the same surgeon. The main outcome measures included age, sex, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction, cylinder equivalent refraction, steep and flat keratometries (K), central corneal thickness (CCT), endothelial cell count, corneal haze, and ectasia stability. Mean follow-up period was 6, 12, and 24 months. Results. Sixteen eyes of twelve patients were included in the study. Twenty-four months after administration of PTK combined with PRK and CXL, a significant improvement in UDVA was observed. Mean cylinder equivalent refraction was significantly reduced at 6, 12, and 24 months postoperatively. However, no significant reduction was observed in spherical equivalent refraction. A significant reduction in the flat K and steep K values was observed. No significant change in mean CCT value was observed. Mean endothelial cell count and morphology were unchanged between preoperative and postoperative patients. In addition, no obvious corneal haze was observed. Conclusions. PTK combined with PRK and CXL on the same day is a safe and effective treatment in improving visual acuity in selected patients with corneal ectasia after LASIK.

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