Corneal Subbasal Plexus in Eyes with Fuchs’ Endothelial Corneal Dystrophy after Two Different Endothelial Surgeries

Purpose. To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs’ endothelial corneal dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods. We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results. Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant ( P = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson’ chi-square, 0.755). Conclusions. Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.

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To compare corneal confocal microscopy of eyes with Fuchs’ endothelial corneal dystrophy after two different endothelial surgeries

European Journal of Ophthalmology ◽

10.1177/11206721211009451 ◽

2021 ◽

pp. 112067212110094

Author(s):

Domenico Schiano-Lomoriello ◽

Irene Abicca ◽

Valeria Bono ◽

Daniela Giannini ◽

Rossella Annamaria Colabelli-Gisoldi ◽

...

Keyword(s):

Confocal Microscopy ◽

Visual Outcome ◽

Corneal Dystrophy ◽

Curve Analysis ◽

Corneal Oedema ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Corneal Confocal Microscopy ◽

Corrected Distance Visual Acuity

Purpose: To study the features of corneal confocal microscopy of eyes with Fuchs’ endothelial corneal dystrophy (FECD) after successful Descemet stripping automated endothelial keratoplasty (DSAEK) versus Descemet membrane endothelial keratoplasty (DMEK). Methods: Thirty-two eyes affected by FECD with corneal oedema requiring a corneal graft were treated with DSAEK (15 eyes) or DMEK (17 eyes). All patients underwent in vivo corneal confocal microscopy (IVCCM) at 6 months postoperatively. We evaluated preoperative and postoperative corrected distance visual acuity (CDVA) and the correlation with IVCCM characteristics. Results: Using IVCCM, Z-scan curve analysis showed similar subepithelial reflectivity peaks between the two groups (DSAEK 1256 SU ± 514 vs DMEK 1118 SU ± 408, p = 0.411), while the interface reflectivity was significantly higher in the DMEK group (1511 SU ± 357) than in the DSAEK group (1029 SU ± 413, p = 0.002). Conclusion: Comparing the corneal confocal microscopic characteristics after DMEK with those after DSAEK and their correlation with visual outcome at 6 months, we hypothesized that the presence of a third reflectivity peak in the Z-scan curves of DSAEK patients could justify the poorer visual outcome with this endothelial surgery than with DMEK.

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Safety and efficacy of repeated crosslinking assisted by transepithelial double-cycle iontophoresis in keratoconus progression after primary corneal crosslinking

Eye ◽

10.1038/s41433-020-01365-1 ◽

2021 ◽

Author(s):

Huping Wu ◽

Lan Li ◽

Shunrong Luo ◽

Xie Fang ◽

Xumin Shang ◽

...

Keyword(s):

Visual Acuity ◽

Corneal Thickness ◽

Good Alternative ◽

Persistent Epithelial Defect ◽

Safety And Efficacy ◽

Corneal Epithelial ◽

Epithelial Damage ◽

Corneal Confocal Microscopy

Abstract Objectives To evaluate the safety and efficacy of repeated corneal collagen crosslinking assisted by transepithelial double-cycle iontophoresis (DI-CXL) in the management of keratoconus progression after primary CXL. Methods A retrospective analysis was conducted in the patients who underwent repeated CXL between 2016 and 2018. These patients were treated with DI-CXL if keratoconus progression was confirmed after primary CXL. Scoring of ocular pain and corneal epithelial damage, visual acuity, corneal tomography, in vivo corneal confocal microscopy (IVCM) was performed before and at 3, 6, 12, and 24 months after DI-CXL. Results Overall, 21 eyes of 12 patients (mean age 17.3 ± 1.9 years) were included in this study. Before DI-CXL, an average increase of 4.26 D in Kmax was detected in these patients with a mean follow-up interval of (23.0 ± 13.7) months. After DI-CXL, corneal epithelial damage rapidly recovered within days. Visual acuity remained unchanged with follow-up of 24 months. When compared to baseline, significant decreases were observed in Kmax (at 3 months) and K2 (at 3 and 6 months) after DI-CXL. Corneal thickness of thinnest point significantly decreased at 3 months postoperatively. When compared to baseline, no significant differences were found in any of the refractive or tomographic parameters at 12 and 24 months. IVCM revealed trabecular patterned hyperdense tissues after DI-CXL in the anterior stroma at the depth of 200 μm or more. No corneal infiltration or persistent epithelial defect was recorded after DI-CXL. Conclusion DI-CXL is safe and effective as a good alternative in stabilizing keratoconus progression after primary CXL.

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A Case Report Illustrating the Postoperative Course of Descemetorhexis without Endothelial Keratoplasty with Topical Netarsudil Therapy

Case Reports in Ophthalmological Medicine ◽

10.1155/2019/6139026 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Pimpiroon Ploysangam ◽

Sangita P. Patel

Keyword(s):

Corneal Thickness ◽

Corneal Transplantation ◽

Corneal Dystrophy ◽

The United States ◽

Attractive Alternative ◽

Specular Microscopy ◽

Endothelial Keratoplasty ◽

Rock Inhibitor ◽

Data Set ◽

Microscopy Data

Fuchs endothelial corneal dystrophy (FECD) is the most common indication for corneal transplantation in the United States. Recently, descemetorhexis without endothelial keratoplasty (DWEK) or Descemet’s stripping only (DSO) has become an attractive alternative to corneal transplantation for these patients. DSO circumvents the challenges associated with cadaveric donor corneal transplantation by tapping into the potential of the patient’s own corneal endothelium to repair defects. Outcomes have been variable with emerging knowledge on predictive factors for success. Our case describes a 51-year-old patient with visually significant confluent central guttae from FECD who underwent a successful DSO with immediate post-operative use of the Rho-associated protein kinase (ROCK) inhibitor (netarsudil). We report the preoperative and post-operative slit lamp images, specular microscopy data, and corneal topography, thickness, and densitometry data. These represent a unique data set for this new surgical treatment option for FECD. Despite a small descemetorhexis, we show the improvement in corneal thickness and opacity extends beyond the boundaries of the descemetorhexis. Early initiation of a ROCK inhibitor was a successful treatment for this patient.

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Fuzzy tissue detection for real-time focal control in corneal confocal microscopy

at - Automatisierungstechnik ◽

10.1515/auto-2019-0034 ◽

2019 ◽

Vol 67 (10) ◽

pp. 879-888

Author(s):

Andreas Bartschat ◽

Stephan Allgeier ◽

Tim Scherr ◽

Johannes Stegmaier ◽

Sebastian Bohn ◽

...

Keyword(s):

Real Time ◽

Focal Plane ◽

Laser Scanning ◽

Nerve Fibers ◽

Laser Scanning Microscopy ◽

Confocal Laser ◽

Loop Control ◽

Visual Words ◽

Corneal Confocal Microscopy

Abstract Corneal confocal laser scanning microscopy is a promising method for in vivo investigation of cellular structures, e. g., of nerve fibers in the sub-basal nerve plexus. During recording, even slight displacements of the focal plane lead to images of adjacent tissue layers. In this work, we propose a closed-loop control of the focal plane. To detect and evaluate the visible tissues, we utilize the Bag of Visual Words approach to implement a customizable image processing pipeline for real-time applications. Furthermore, we show that the proposed model can be trained with small classification datasets and can be applied as a segmentation method. The proposed control loop, including tissue detection, is implemented in a proof-of-concept setup and shows promising results in a first evaluation with a human subject.

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Neurotropic Grades in Lattice Corneal Dystrophy Based on in Vivo Confocal Microscopy Observation

10.21203/rs.3.rs-114232/v1 ◽

2020 ◽

Author(s):

ming li ◽

Fengjiao Zhu ◽

Chun Zhang ◽

Chan Chen ◽

Fangwei Ying ◽

...

Keyword(s):

Confocal Microscopy ◽

Laser Scanning ◽

Corneal Dystrophy ◽

Amyloid Deposit ◽

Laser Scanning Confocal Microscopy ◽

Nerve Fibers ◽

Scanning Confocal Microscopy ◽

Lattice Corneal Dystrophy ◽

Corneal Nerves

Abstract Background: To investigate the corneal neurotropic phenomenon in patients with lattice corneal dystrophy (LCD) with in vivo laser scanning confocal microscopy (IVCM). Methods: IVCM was performed on a total of 15 patients (28 eyes) with LCD annually at a follow-up. A collection of the data was acquired to be analyzed. Results: As indicated by the analysis, the LCD patients’ normal corneal stromal nerves (Grade 0) presented a decline with the prolongation of the follow-ups, corresponding to a gradual increase in grade I and II involving amyloid-wrapped nerve fibers, which demonstrated that the growing amount of amyloid deposit due to the corneal nerve invasion increased slowly over time. Conclusions: The neurotropic phenomenon could increase with its severity in the corneal lesion of the patients with LCD, and also reflect the distribution of the corneal nerves, to some extent. IVCM provides a rapid, noninvasive way to observe the corneal nerves, which can be an efficient means of better understanding the development of LCD.

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Descemet Membrane Endothelial Keratoplasty (DMEK) in Previously Vitrectomized Eyes: Complications and Clinical Outcomes

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1517-4518 ◽

2021 ◽

Author(s):

Wissam Aljundi ◽

Alaadin Abdin ◽

Shady Suffo ◽

Berthold Seitz ◽

Loay Daas

Keyword(s):

Corneal Thickness ◽

Corneal Dystrophy ◽

Control Group ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Group 2 ◽

Postoperative Improvement ◽

Group 1

Abstract Purpose To evaluate the results and complications of Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes. Design Retrospective study of 35 eyes that had undergone DMEK, due to Fuchs endothelial corneal dystrophy (FECD), at our department with a follow-up after 6 months postoperatively. We compared the intraoperative procedure, complications, and results of DMEK between 14 previously vitrectomized pseudophakic eyes (group 1) and a control group of 21 pseudophakic non-vitrectomized eyes (group 2). Results The unfolding time (in minutes) was significantly longer in group 1 than in group 2 (10.5 ± 6.4 vs. 3.2 ± 1.5, p < 0.01). A single re-bubbling was needed in 8 patients in group 1 (57.1%) and in 3 patients in group 2 (14.2%) (p < 0.01). Repeated re-bubbling (≥ 1 time) was performed in only 5 patients of group 1 (35.7%). There was significant postoperative improvement in best-corrected visual acuity (BCVA, in LogMAR) in both groups (p = 0.04 in group 1 and p < 0.01 in group 2). The central corneal thickness (CCT, in µm) did not differ significantly between the two groups preoperatively (p = 0.4) or postoperatively (p = 0.1). However, the CCT decreased significantly postoperatively in both groups (p < 0.01 in both groups). The postoperative endothelial cell density (ECD in cell/mm²) was significantly lower in group 1 than in group 2 (p = 0.03). Conclusion DMEK in previously vitrectomized eyes presents a surgical challenge, which requires special, and sometimes unpredictable, intraoperative maneuvers, but good functional and morphological results can be achieved. The use of the endothelial Descemet membrane lamellae (EDML) of older donors might be recommended to facilitate the intraoperative unfolding process.

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In vivo confocal microscopy qualitative investigation of the relationships between lattice corneal dystrophy deposition and corneal nerves

BMC Ophthalmology ◽

10.1186/s12886-021-02149-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fengjiao Zhu ◽

Ming Li ◽

Chun Zhang ◽

Chan Chen ◽

Fangwei Ying ◽

...

Keyword(s):

Confocal Microscopy ◽

Laser Scanning ◽

Corneal Dystrophy ◽

Amyloid Deposit ◽

Laser Scanning Confocal Microscopy ◽

Nerve Fibers ◽

Scanning Confocal Microscopy ◽

Lattice Corneal Dystrophy ◽

Corneal Nerves

Abstract Background To investigate the corneal neurotropic phenomenon in patients with lattice corneal dystrophy (LCD) with in vivo laser scanning confocal microscopy (IVCM). Methods IVCM was performed on a total of 15 patients (28 eyes) with LCD annually at a follow-up. A collection of the data was acquired to be analyzed. Results As indicated by the analysis, the LCD patients’ normal corneal stromal nerves (Grade 0) presented a decline with the prolongation of the follow-ups, corresponding to a gradual increase in grade I and II involving amyloid-wrapped nerve fibers, which demonstrated that the growing amount of amyloid deposit due to the corneal nerve invasion increased slowly over time. Conclusions The neurotropic phenomenon could increase with its severity in the corneal lesion of the patients with LCD, and also reflect the distribution of the corneal nerves, to some extent. IVCM provides a rapid, noninvasive way to observe the corneal nerves, which can be an efficient means of better understanding the development of LCD.

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In vivo corneal confocal microscopy and optical coherence tomography on eyes of participants with type 2 diabetes mellitus and obese participants without diabetes

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05251-8 ◽

2021 ◽

Author(s):

Noémi Tóth ◽

David M. Silver ◽

Szabolcs Balla ◽

Miklós Káplár ◽

Adrienne Csutak

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Optical Coherence Tomography ◽

Type 2 Diabetes Mellitus ◽

Confocal Microscopy ◽

Nerve Fibers ◽

Corneal Confocal Microscopy ◽

Corneal Nerve

Abstract Purposes To examine corneal nerve and retinal nerve characteristics of participants with type 2 diabetes mellitus (T2DM) compared with obese participants without diabetes to discover potential nerve vulnerabilities. Methods All participants underwent a complete medical examination including a physical examination and blood sample tests. The ophthalmologic examination included best-corrected visual acuity, intraocular pressure, Schirmer test, tear film breakup time, slit-lamp examination, dilated fundus photography, in vivo corneal confocal microscopy (IVCCM), and optical coherence tomography (OCT). Results The study cohort consisted of 83 eyes of 83 individuals: a group of 44 participants with T2DM, and a control group of 39 obese participants with no history of diabetes. Comparing measurements on the two groups, participants with T2DM had lower values with statistical significance for retinal nerve fiber layer (RNFL) nasal superior thickness (p = 0.010) and three corneal nerve (CN) parameters: fiber length (p = 0.025), total branch density (p = 0.013), and fiber area (p = 0.009). There was a borderline significant difference in CN fiber width (p = 0.051) and RNFL nasal inferior thickness (p = 0.056). No other significant differences were observed in the IVCCM and OCT parameters. No statistically significant correlation was found between CN and RNFL parameters. Conclusions Progression from a pre-diabetic obese state to a T2DM condition might entail a loss or diminishment of certain corneal nerve fibers or retinal nerve fibers, but not necessarily a loss of both corneal and retinal nerve fibers simultaneously. Using IVCCM and OCT together enables monitoring of both corneal and retinal health of the eye.

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Descemet’s Membrane Endothelial Keratoplasty for Pseudoexfoliation Syndrome: A Case Series

10.21203/rs.2.229/v3 ◽

2019 ◽

Author(s):

Saho Tase ◽

Toshiki Shimizu ◽

Takahiko Hayashi ◽

Hitoshi Tabuchi ◽

Koji Niimi ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Corneal Thickness ◽

Reduction Rate ◽

Case Series ◽

Corneal Dystrophy ◽

Pseudoexfoliation Syndrome ◽

Endothelial Keratoplasty ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane

Abstract Bachground: To evaluate the clinical outcomes and features of Descemet’s membrane endothelial keratoplasty (DMEK) for eyes with pseudoexfoliation syndrome (PEX). Methods: In this retrospective study, 37 DMEK cases were reviewed from available medical records. Patients who exhibited endothelial dysfunction derived from PEX or Fuchs endothelial corneal dystrophy (FECD) and successfully underwent cataract surgery about four weeks before DMEK were enrolled. The best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and incidence of intra-operative/post-operative complications of DMEK were analyzed. Results: This study included 14 eyes of 14 patients (PEX: n=6, FECD: n=8). There was no primary graft failure. In the PEX group, BSCVA improved from 0.67 ± 0.28 at the preoperative point to 0.43 ± 0.14 at 1 month, 0.27 ± 0.10 at 3 months, and 0.19 ± 0.08 at 6 months after DMEK. The donor corneal ECD was 2,704 ± 225 cells/mm2 at the preoperative point and decreased to 1,691 ± 498 cells/mm2 at 1 month, 1,425 ± 366 cells/mm2 at 3 months, and 1,281 ± 340 cells/mm2 (52.7 ± 11.7% less than ECD of the donor graft) at 6 months after DMEK. None of the patients required rebubbling. When compared with the FECD group, no statistical difference was observed in CCT (p=0.821); BSCVA (p=0.001) and the reduction rate of ECD (p=0.010) were relatively worse. Conclusions: DMEK is effective for the treatment of endothelial dysfunction due to PEX.

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Descemet’s Membrane Endothelial Keratoplasty for Pseudoexfoliation Syndrome: A Case Series

10.21203/rs.2.229/v2 ◽

2019 ◽

Author(s):

Saho Tase ◽

Toshiki Shimizu ◽

Takahiko Hayashi ◽

Hitoshi Tabuchi ◽

Koji Niimi ◽

...

Keyword(s):

Endothelial Dysfunction ◽

Corneal Thickness ◽

Reduction Rate ◽

Case Series ◽

Corneal Dystrophy ◽

Pseudoexfoliation Syndrome ◽

Endothelial Keratoplasty ◽

Descemet’S Membrane Endothelial Keratoplasty ◽

Descemet's Membrane ◽

Descemet’S Membrane

Abstract Background: To evaluate the clinical outcomes and features of Descemet’s membrane endothelial keratoplasty (DMEK) for eyes with pseudoexfoliation syndrome (PEX). Methods: In this retrospective study, 37 DMEK cases were reviewed from available medical records. Patients who exhibited endothelial dysfunction derived from PEX or Fuchs’ endothelial corneal dystrophy (FECD) and successfully underwent cataract surgery approximately four weeks before DMEK were enrolled. The best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD), and incidence of intra-operative/post-operative complications of DMEK were analyzed. Results: This study included 14 eyes of 14 patients (PEX: n=6, FECD: n=8). There was no primary graft failure. In the PEX group, BSCVA improved from 0.67 ± 0.28 preoperatively to 0.43 ± 0.14 at 1 month, 0.27 ± 0.10 at 3 months, and 0.19 ± 0.08 at 6 months after DMEK. The donor corneal ECD was 2,704 ± 225 cells/mm2 preoperatively and decreased to 1,691 ± 498 cells/mm2 at 1 month, 1,425 ± 366 cells/mm2 at 3 months, and 1,281 ± 340 cells/mm2 (52.7 ± 11.7% less than ECD of the donor graft) at 6 months after DMEK. None of the patients required rebubbling. When compared with the FECD group, no statistical difference was observed in CCT (p=0.821); BSCVA (p=0.001) and the reduction rate of ECD (p=0.010) were comparatively worse. Conclusions: DMEK is effective for the treatment of endothelial dysfunction due to PEX.

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