Potential Factors of Corneal Endothelial Cells for Progression in Children with Uveitis

Objective. To observe the morphological changes and abnormal structure of corneal endothelial cells in children with uveitis, to analyze the related factors affecting the morphological changes of corneal endothelial cells, and to explore the clinical application of a corneal endothelial microscope in children with uveitis. Methods. The corneal endothelial cells of 70 patients with uveitis were photographed with the Topcon SP-3000 noncontact corneal endothelial microscope, and the corneal endothelial cell density (CD), average cell area (AVE), coefficient of variation of the cell area (CV), and percentage of hexagonal cells (PHC) were measured with the IMAGEnet system. Twenty-eight patients (56 eyes) with monocular uveitis were selected, with the affected eyes (28 eyes) as the experimental group and the contralateral healthy eyes (28 eyes) as the control group. The corneal endothelial cell parameters between the two groups were statistically analyzed. The parameters of corneal endothelial cells in 70 children with uveitis were compared, and the effects of the course of the disease, inflammatory cells in the anterior chamber, and posterior corneal deposition (KP) on the parameters of corneal endothelial cells were analyzed. Results. There are four abnormal forms of the corneal endothelium in children with uveitis: enlarged cell area gap, irregular cell shape, blurred intercellular space, and cell loss. KP showed irregular high reflective white spots in the corneal endothelial microscope images, surrounded by dark areas, and existed in all the eyes with dusty KP found in slit lamp examination and a small number of eyes without obvious KP. Comparing the corneal endothelial cell parameters between the experimental group and the control group, it was found that the corneal endothelial CD and PHC of the former were lower than those of the latter, and the difference was statistically significant ( P < 0.001 and P = 0.018 , respectively). The AVE and CA of the former were higher than those of the latter ( P = 0.013 and P = 0.046 , respectively). The corneal endothelial cell density of the eyes with a course of the disease of more than 1 year was lower than that of the eyes with a course of the disease less than 1 year, the coefficient of variation of the corneal endothelial cell area of the eyes with KP was higher than that of the eyes without KP, and the difference was statistically significant ( P = 0.003 and P = 0.030 , respectively). Conclusion. Corneal endothelial microscopy is one of the important methods for the detection of uveitis with high sensitivity. The change of morphological parameters of corneal endothelial cells is one of the important indexes to assist in the diagnosis of uveitis and can be further promoted in ophthalmological examination.

Association between aqueous humor cytokines and postoperative corneal endothelial cell loss after Descemet stripping automated endothelial keratoplasty

This study measured the intraoperative anterior aqueous humor concentrations of various cytokines during corneal endothelial transplantation and searched for relationships between these concentrations and postoperative corneal endothelial cell (CEC) depletion. We recruited 30 consecutive patients who underwent corneal endothelial transplantation with Descemet’s stripping automated endothelial keratoplasty (DSAEK) at Tohoku University Hospital between February 2014 and July 2017. During surgery, we obtained aqueous humor samples and later measured the concentrations of 27 cytokines with a Multiplex Bead Assay (Bio-Plex Pro). We counted CECs 1, 6 and 12 months after surgery, and used Spearman’s rank correlation coefficient to identify relationships between CEC depletion and the concentrations of detected cytokines. The loss of CECs 1–6 months after surgery was significantly correlated with IL-7, IP-10, MIP-1a and MIP-1b concentrations (-0.67, -0.48, -0.39, and -0.45, respectively, all P <0.01). CEC loss 1–12 months after surgery was significantly correlated with IL-1b, IL-7, IP-10 and RANTES concentrations (-0.46, -0.52, -0.48, and -0.43, respectively). Multiple regression analysis showed that IL-7 concentration was significantly associated with CEC loss 1–6 months after surgery (b = -0.65, P < 0.01) and IP-10 concentration was associated with CEC loss 1–12 months after surgery (β = -0.38, P < 0.05). These results suggest that not only inflammatory cytokines but also IL-7, a cytokine related to lymphocytes, may be involved in the depletion of CECs after DSAEK, particularly depletion that occurs relatively early.

Nocardia Endophthalmitis- Prophylactic Prevention with an Innovative Approach

Background: Nocardia is a common cause of endophthalmitis in southern India. It is an aggressive disease with a poor prognosis. Objective: This study was conducted using an amikacin antibiotic in the drip irrigation of balanced saline solution (BSS) during the surgery to prophylactically study the occurrence of Nocardia endophthalmitis and any subsequent toxic effects of the antibiotics used. Methods: Prospective study period was of 6 months, starting from July to December-2018. Preoperative and postoperative specular counts and macular thickness using Ocular Coherence Tomography (OCT) were compared with any incidence of Nocardia endophthalmitis. A total of 500 patients operated for manual SICS were randomly assigned into 2 groups. The first group of 250 patients received antibiotic amikacin added to the Balanced Saline Solution (BSS) irrigating solution throughout the course of the surgery. The second control group received no antibiotics. Manual SICS was performed on all 500 patients by a single surgeon and was found to be uneventful. Pre- and postoperative corneal endothelial cell density and mean macular thickness using OCT were taken and recorded of all the patients, respectively, and data obtained were statistically compared. Results: No incidence of Nocardia endophthalmitis among the cataract surgeries operated was found. There was no drug-related toxicity to the cornea or macula. Furthermore, no incidence of Nocardia endophthalmitis has been reported since 2018 after using antibiotics. Conclusion: A simple routine of adding amikacin in the drip prophylactically during the course of surgery helped us prevent Nocardia endophthalmitis with no side effects. Also, it will be an innovative technique that is economically feasible and effective in regions where Nocardia endophthalmitis is prevalent.