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Opala A, Kołodziejski Ł, Grabska-Liberek I. Impact of Well-Controlled Type 2 Diabetes on Corneal Endothelium Following Cataract Surgery: A Prospective Longitudinal Analysis. J Clin Med 2025; 14:3603. [PMID: 40429600 PMCID: PMC12112250 DOI: 10.3390/jcm14103603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 05/02/2025] [Accepted: 05/12/2025] [Indexed: 05/29/2025] Open
Abstract
Background: The aim of this study was to evaluate corneal endothelial changes following phacoemulsification cataract surgery with intraocular lens implantation in patients with type 2 diabetes (study group) and without diabetes (control group). The study aimed to determine the extent of endothelial cell damage and the regenerative capacity of the cornea in patients with well-controlled diabetes. Methods: This study compared corneal endothelial parameters in 80 eyes (80 patients) with well-controlled type 2 diabetes and 80 eyes (80 patients) without diabetes, all of whom underwent uneventful phacoemulsification cataract surgery. Patients were examined preoperatively and at 14 days, 3 months, and 6-8 months postoperatively. Endothelial cell density (ECD), percentage of hexagonal cells (%HEX), cell size variability (CV), and central corneal thickness (CCT) were assessed using a specular microscope. Visual acuity, intraocular pressure (IOP), and cumulative dissipated energy (CDE) during phacoemulsification were also measured. Results: The study and control groups were matched for age and sex. Preoperatively, patients with type 2 diabetes had significantly lower endothelial cell density (2480.76 ± 303.48 cells/mm2) compared to the control group (2629.64 ± 304.73 cells/mm2, p = 0.002). Visual acuity was also significantly lower in the study group (0.44 ± 0.18) than in the control group (0.50 ± 0.19, p = 0.049). No significant preoperative differences were observed in IOP, CV, %HEX, or CCT. Postoperatively, both groups experienced ECD decline: -18.44%, -18.77%, and -19.05% in the study group and -15.12%, -16.42%, and -16.73% in the control group at 14 days, 3 months, and 6-8 months, respectively. Differences between groups were not statistically significant (p = 0.285). A significant %HEX decrease was observed in both groups at all time points, with a greater decline in the study group at 14 days and 3 months. CV significantly increased in both groups at 14 days and 3 months postoperatively, but no significant difference was found between groups. A significant increase in CCT was observed at 14 days and 3 months postoperatively, with a greater increase in the study group at 14 days. Preoperative visual acuity negatively correlated with CDE in both groups. Additionally, CDE negatively correlated with ECD at all time points. Conclusions: Endothelial cell density is lower in patients with well-controlled type 2 diabetes than in non-diabetic individuals. Both groups are at risk of endothelial cell loss during phacoemulsification. Despite good glycemic control and comparable preoperative endothelial morphology, the cornea in diabetic patients is more vulnerable to damage, with a prolonged regeneration process. The impaired regenerative capacity of the corneal endothelium suggests the need for additional precautions during cataract surgery in diabetic patients. Despite ECD decline and delayed endothelial regeneration, the functional status of the cornea, as indicated by visual acuity and CCT, remains stable. The adequate corneal endothelial cell reserve in well-controlled type 2 diabetes patients allows for cataract surgery without significant corneal complications.
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Affiliation(s)
- Aleksandra Opala
- Department of Ophthalmology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
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Akansha, Yadav RS. Comparative assessment of the corneal endothelium following phacoemulsification surgery in patients with type II diabetes and nondiabetes. Saudi J Ophthalmol 2025; 39:77-83. [PMID: 40182979 PMCID: PMC11964349 DOI: 10.4103/sjopt.sjopt_226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2025] Open
Abstract
PURPOSE The purpose is to assess the corneal endothelial changes after phacoemulsification surgery in diabetic patients and compare with those of nondiabetic subjects. METHODS The study compared the corneal endothelial changes in diabetics and nondiabetics after phacoemulsification surgery. The study population included 40 patients with diabetes mellitus with good glycemic control and 40 nondiabetic patients who underwent uneventful phacoemulsification surgery. Central corneal endothelial cell density (ECD), central corneal thickness (CCT), and percentage of hexagonality percentage coefficient of variation (%CV) were measured preoperatively and postoperatively (at 4 and 12 weeks) using a specular microscope. RESULTS Mean ECD loss (%) was measured as 9.85% and 8.41% at 4 weeks and 12 weeks postoperatively in the diabetic group while ECD loss percentage was 7.09% and 5.74% in the control group at the same time intervals, respectively. Furthermore, a significant difference was noted on comparing mean ECD measurements between the two groups at the postsurgical visits (4 weeks and 12 weeks). While the CCT was found to be similar in both diabetic and nondiabetic patients, increase was observed in the values of (%CV in both the groups at postoperative 4 weeks' and 12 weeks' follow-up. The values of both %CV and percentage hexagonality showed statistically significant differences between the diabetic and nondiabetic group before surgery and at 4 weeks' and 12 weeks' postoperative examinations. CONCLUSION The patients with diabetes suffered greater endothelial damage despite good glycemic control as compared to nondiabetic patients which indicates the necessity of far more care to protect cornea endothelium in patients with diabetes.
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Affiliation(s)
- Akansha
- Department of Ophthalmology, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Ramyash S. Yadav
- Department of Ophthalmology, BRD Medical College, Gorakhpur, Uttar Pradesh, India
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Wang S, Wu T, Zhang Y, Liu Y, Qin X. Effect of size of capsulorhexis on the outcome of cataract surgery: a protocol for systematic review and individual participant data meta-analysis. BMJ Open 2024; 14:e092002. [PMID: 39806673 PMCID: PMC11667307 DOI: 10.1136/bmjopen-2024-092002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 11/19/2024] [Indexed: 01/16/2025] Open
Abstract
INTRODUCTION In the era of functional intraocular lens (IOL) implantation, it is crucial to investigate the influence of different capsulorhexis sizes (including the diameter of the capsulorhexis, area of the anterior capsule opening, anterior capsule coverage, centration and circularity of the capsulorhexis) on the postoperative outcomes (eg, visual acuity, capsule shrinkage, IOL stability and intraocular pressure) in patients undergoing cataract surgery. This is particularly important in patients with high myopia or diabetes mellitus. The proposed protocol aims to enhance the transparency of our research and offer references for future studies. METHODS AND ANALYSIS A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and China Science and Technology Journal Database is performed from inception to 4 July 2024. Data of individual participants will be collected from relevant clinical trials, both completed and ongoing. The collected data will be analysed using multilevel regression models to examine the association between capsulorhexis size and surgical outcomes. Potential demographic and clinical factors that may influence the results of cataract surgery, including postoperative visual acuity and IOL rotational stability, will also be explored. Any future modification to this protocol will include the date and rationale for the change. ETHICS AND DISSEMINATION Ethical approval is not required because the study does not involve individual patients. The study results are to be disseminated via professional journals as well as academic media. TRIAL REGISTRATION NUMBER CRD42023459903.
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Affiliation(s)
- Songhong Wang
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Tiexi Wu
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yue Zhang
- Department of Operating Room, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Yue Liu
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xuejiao Qin
- Department of Ophthalmology, The Second Hospital of Shandong University, Jinan, Shandong, China
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Li G, Sommi A, Klawe J, Ahmad S. Demographic and Systemic Risk Factors for Persistent Corneal Edema Following Cataract Surgery in Patients With and Without Diabetes. Am J Ophthalmol 2024; 266:182-189. [PMID: 38801875 DOI: 10.1016/j.ajo.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To identify risk factors associated with the development of corneal edema (CE) and the need for corneal transplantation following cataract surgery. DESIGN Retrospective cohort study. METHODS SETTING Nation-wide sample of Medicare beneficiaries from 2011-2015. STUDY POPULATION Medicare beneficiaries aged over 65 years who received cataract surgery between 2011-2014 with at least 1 year of continuous follow-up. Data was retrieved from the Denominator and Physician Supplier Part B file from the Center for Medicare and Medicaid Services. MAIN OUTCOME(S) AND MEASURE(S) The main outcome was the association between demographic characteristics (e.g., age, sex, race/ethnicity) and systemic factors including diabetes status, hypertension, and tobacco use on the incidence of CE and the subsequent need for corneal transplantation following cataract surgery. RESULTS Among 187,746 beneficiaries, 67,734 had diabetes and 120,012 did not. Beneficiaries with diabetes were more likely to develop CE compared to those without (Odds ratio [OR] 1.19, 95% Confidence Interval [CI] [1.02-1.40]). Compared to those aged 65-74, beneficiaries aged 75-84 and over 85 were more likely to develop CE (OR 1.29 [1.09-1.52]) and OR 1.96 [1.55-2.46], respectively). Asian (OR 2.42 [1.66-3.40]), Hispanic (OR 2.60 [1.73-3.74]), and North American Native (OR 3.59 [1.78-6.39]) race was associated with increased likelihood of developing CE. North American Native beneficiaries had higher risk of requiring corneal transplantation compared to White beneficiaries (OR 9.30 [2.26-25.31]). Female sex decreased likelihood of requiring corneal transplantation post-operatively (OR 0.56 [0.36-0.87]). Amongst those with diabetes, the presence of proliferative diabetic retinopathy increased the likelihood of developing CE (OR 1.94 [1.05-3.39]). CONCLUSION Older age, diabetes, and non-White race elevate the risk of CE following cataract surgery, with race incurring the highest risk. Further research is needed to understand the factors underlying the significantly increased risk of CE in racial and ethnic minorities within the United States.
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Affiliation(s)
- Gavin Li
- From the Icahn School of Medicine at Mount Sinai, Department of Ophthalmology (G.L., A.S., J.K., S.A.), New York, New York, USA
| | - Arvind Sommi
- From the Icahn School of Medicine at Mount Sinai, Department of Ophthalmology (G.L., A.S., J.K., S.A.), New York, New York, USA
| | - Janek Klawe
- From the Icahn School of Medicine at Mount Sinai, Department of Ophthalmology (G.L., A.S., J.K., S.A.), New York, New York, USA
| | - Sumayya Ahmad
- From the Icahn School of Medicine at Mount Sinai, Department of Ophthalmology (G.L., A.S., J.K., S.A.), New York, New York, USA.
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Mahmoud MSED, Omar IAN, AttaAllah HR. Evaluation of the corneal thickness and endothelial changes following uncomplicated phacoemulsification in diabetic and non-diabetic patients with pseudo-exfoliation syndrome by specular microscopy. Int Ophthalmol 2023; 43:4773-4780. [PMID: 37721703 DOI: 10.1007/s10792-023-02877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX. METHODS This prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT. RESULTS By the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction. CONCLUSION Patients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications. STUDY REGISTRATION NUMBER The study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168).
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Affiliation(s)
| | | | - Heba Radi AttaAllah
- Ophthalmology Department, Faculty of Medicine, Minia University Hospital, Minia, Egypt.
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Briceno-Lopez C, Burguera-Giménez N, García-Domene MC, Díez-Ajenjo MA, Peris-Martínez C, Luque MJ. Corneal Edema after Cataract Surgery. J Clin Med 2023; 12:6751. [PMID: 37959216 PMCID: PMC10647590 DOI: 10.3390/jcm12216751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
This systematic review investigates the prevalence and underlying causes of corneal edema following cataract surgery employing manual phacoemulsification. A comprehensive search encompassing databases such as PubMed, Embase, ProQuest, Cochrane Library, and Scopus was conducted, focusing on variables encompassing cataract surgery and corneal edema. Two independent reviewers systematically extracted pertinent data from 103 articles, consisting of 62 theoretical studies and 41 clinical trials. These studies delved into various aspects related to corneal edema after cataract surgery, including endothelial cell loss, pachymetry measurements, visual performance, surgical techniques, supplies, medications, and assessments of endothelial and epithelial barriers. This review, encompassing an extensive analysis of 3060 records, revealed significant correlations between corneal edema and endothelial cell loss during phacoemulsification surgery. Factors such as patient age, cataract grade, and mechanical stress were identified as contributors to endothelial cell loss. Furthermore, pachymetry and optical coherence tomography emerged as valuable diagnostic tools for assessing corneal edema. In conclusion, this systematic review underscores the link between corneal edema and endothelial cell loss in manual phacoemulsification cataract surgery. It highlights the relevance of factors like patient demographics and diagnostic modalities. However, further research is essential to unravel the complexities of refractive changes and the underlying mechanisms.
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Affiliation(s)
- Celeste Briceno-Lopez
- Department of Optics and Optometry and Vision Sciences, Faculty of Physics, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain; (N.B.-G.); (M.C.G.-D.); (M.A.D.-A.); (M.J.L.)
- Cátedra Alcon—FOM—UVEG, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain
| | - Neus Burguera-Giménez
- Department of Optics and Optometry and Vision Sciences, Faculty of Physics, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain; (N.B.-G.); (M.C.G.-D.); (M.A.D.-A.); (M.J.L.)
- Cátedra Alcon—FOM—UVEG, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain
| | - M. Carmen García-Domene
- Department of Optics and Optometry and Vision Sciences, Faculty of Physics, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain; (N.B.-G.); (M.C.G.-D.); (M.A.D.-A.); (M.J.L.)
- Cátedra Alcon—FOM—UVEG, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain
| | - M. Amparo Díez-Ajenjo
- Department of Optics and Optometry and Vision Sciences, Faculty of Physics, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain; (N.B.-G.); (M.C.G.-D.); (M.A.D.-A.); (M.J.L.)
- Cátedra Alcon—FOM—UVEG, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain
| | - Cristina Peris-Martínez
- Anterior Segment and Cornea and External Eye Diseases Unit, Fundación de Oftalmología Médica, Av. Pío Baroja 12, E-46015 Valencia, Spain;
- Surgery Department, Faculty of Medicine, Universitat de València, Av. Blasco Ibáñez 15, E-46010 Valencia, Spain
| | - M. José Luque
- Department of Optics and Optometry and Vision Sciences, Faculty of Physics, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain; (N.B.-G.); (M.C.G.-D.); (M.A.D.-A.); (M.J.L.)
- Cátedra Alcon—FOM—UVEG, Universitat de València, Dr. Moliner 50, E-46100 Burjassot, Spain
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Cruz JCG, Moreno CB, Soares PVBDS, Moscovici BK, Colombo-Barboza GN, Colombo-Barboza LR, Colombo-Barboza MN. Comparison of endothelial cell loss in diabetic patients after conventional phacoemulsification and femtosecond laser-assisted cataract surgery. BMC Ophthalmol 2023; 23:181. [PMID: 37101284 PMCID: PMC10131353 DOI: 10.1186/s12886-023-02923-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. METHODS A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. RESULTS After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81-592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62-1803.23). CONCLUSIONS Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. TRIAL REGISTRATION It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.
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Affiliation(s)
- João Carlos Gonçalves Cruz
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil.
| | - Celso Busnelo Moreno
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
| | | | - Bernardo Kaplan Moscovici
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Guilherme Novoa Colombo-Barboza
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Luiz Roberto Colombo-Barboza
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Faculdade de Ciências Médicas de Santos (UNILUS), Santos, Brazil
| | - Marcello Novoa Colombo-Barboza
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
- Faculdade de Ciências Médicas de Santos (UNILUS), Santos, Brazil
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Chen TM, Lasarev MR, Eaton JS. Retrospective investigation of perioperative risk factors for immediate postoperative corneal erosions in dogs undergoing phacoemulsification. Vet Ophthalmol 2022; 26:191-204. [DOI: 10.1111/vop.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/15/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Tiffany Mei Chen
- Department of Surgical Sciences, School of Veterinary Medicine University of Wisconsin Madison USA
| | - Michael R. Lasarev
- Biostatistics and Medical Informatics, School of Medicine and Public Health University of Wisconsin Madison USA
| | - Joshua Seth Eaton
- Department of Surgical Sciences, School of Veterinary Medicine University of Wisconsin Madison USA
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Moshirfar M, Webster CR, Ronquillo YC. Phakic intraocular lenses: an update and review for the treatment of myopia and myopic astigmatism in the United States. Curr Opin Ophthalmol 2022; 33:453-463. [PMID: 35916572 DOI: 10.1097/icu.0000000000000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To review all phakic intraocular lenses (pIOLs) available in the United States for the correction of myopia or myopic astigmatism and offer a clinical approach to their proper use, postoperative follow-up, and analysis of visual and adverse outcomes. RECENT FINDINGS In March 2022, the FDA approved the EVO/EVO+ Visian ICL for widespread use, adding this lens to the two others available (Verisyse, Visian ICL). Cataract formation, endothelial cell loss (ECL) and surgical reintervention remain the most common adverse events. There are discrepancies between studies on ECL following implantation with pIOLs, although trends can be deduced with meta-analysis. Posterior Chamber-pIOLs (PC-pIOLs), especially the EVO/EVO+, have an overall lower mean adverse effect and subjective patient symptom profile when compared to Iris Fixated-pIOLS (IF-pIOLs). Advancements in PC-pIOL sizing have provided a noticeable difference in visual and safety outcomes. SUMMARY All pIOLs available in the United States provide high-quality visual correction of moderate to high myopia and/or myopia with astigmatism. Proper follow-up for ECL and cataract formation is warranted.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City
- Utah Lions Eye Bank, Murray, Utah
| | - Court R Webster
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
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Sanchis-Gimeno JA, Hasrod N, Calvo-Maroto AM, Nalla S, Cerviño A. Effect of diabetes mellitus on quantitative corneal anatomy – A systemic review. AFRICAN VISION AND EYE HEALTH 2022. [DOI: 10.4102/aveh.v81i1.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Corneal changes occur as a direct consequence of diabetes mellitus (DM). The central corneal thickness (CCT) is a useful parameter that provides information about the status of the metabolism of the cornea and can therefore help monitor the progression of DM.Aim: The aim of this study was to determine the impact of DM on CCT and its correlation with diabetes duration and glycated haemoglobin (HbA1c) levels.Methods: The systematic review was undertaken to answer: (1) What effect does DM have on CCT values? (2) What effect does DM duration have on CCT values? (3) What effect does HbA1c levels have on CCT values? The Web of Science was used to conduct a computerised search for articles of CCT values in DM.Results: A total of 38 articles that met the criteria for inclusion were included in this systemic review. The researchers found 27 articles that observed increased CCT values in DM patients compared with control subjects. There were six studies in which increased CCT values were related to DM duration and 12 studies in which DM duration did not alter CCT values. Also, eight studies showed that CCT values increased with glycated haemoglobin levels, and 12 studies did not observe this.Conclusion: Diabetes mellitus patients usually present with increased CCT values although there is no unanimity about the effect of DM duration and increased HbA1c levels (poor glycaemic control) in the CCT values of DM patients.
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Chaurasia RK, Khasnavis A, Mittal J. Comparison of corneal endothelial changes following phacoemulsification in diabetic and non-diabetic patients. Indian J Ophthalmol 2022; 70:1208-1213. [PMID: 35326017 PMCID: PMC9240528 DOI: 10.4103/ijo.ijo_1955_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: To study corneal endothelial changes post phacoemulsification in diabetic and non-diabetic patients. Methods: A comparative, prospective, observational study was conducted on 100 diabetic and 100 non-diabetics who underwent phacoemulsification. All patients were operated by the same surgeon by using the phaco chop technique to exclude any surgeon-related bias. Endothelial cell count, CCT, and coefficient of variance (CV) were measured with a specular microscope along with BCVA preoperatively and at 1 week, 4 weeks, and 3 months postoperatively. For statistical analysis, data were analyzed by using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA). Data were summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Chi square test, independent sample T test, and paired T test were used to compare the data. P ≤ 0.05 was considered statistically significant. Results: Postoperatively at 1 week, 4-week, and 3 months follow-up intervals, the mean endothelial cell count and coefficient of variance were significantly higher, and the mean percentage of hexagonal cells was significantly lower in non diabetic as compared to the diabetic group. A significant difference in mean central corneal thickness of the two groups was observed at 1-week and 4-weeks postoperative intervals; at both these intervals, the mean value was significantly higher in non diabetic as compared to the non-diabetic group. However, at 3-months post-operative interval, the difference between the two groups was not significant statistically. Mean BCVA values were significantly higher in diabetic as compared to the diabetic group at all three follow-up intervals. Conclusion: The findings of the present study show that endothelial cell characteristics are adversely affected in diabetic eyes as compared to non-diabetic patients undergoing phacoemulsification; this might also have an effect on the visual outcomes.
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Affiliation(s)
- Rajendra Kumar Chaurasia
- Department of Ophthalmology, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpita Khasnavis
- Department of Ophthalmology, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jimmy Mittal
- Department of Ophthalmology, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
PURPOSE OF REVIEW Given the epidemiology and demographic trends of diabetes mellitus and cataracts, ophthalmologists are likely to encounter patients with both comorbidities at an increasing frequency. Patients with diabetes represent a higher risk population than healthy patients for cataract surgery. In this review, we discuss key risks and risk-mitigation practices when performing cataract surgery on these patients. RECENT FINDINGS Patients with diabetes continue to represent a high-risk surgical population: Nagar et al. suggest a dose-dependent relationship may exist between number of intravitreal injections and likelihood of posterior capsular rupture. However, novel treatments are improving outcomes for patients with diabetes. Several studies have reported intracameral phenylephrine/ketorolac may reduce the incidence of post-operative cystoid macular edema while others have discussed the efficacy of pre-treatment and post-treatment with intravitreal bevacizumab on improving cataract surgery outcomes in patients with diabetic retinopathy. Pre-operatively, ophthalmologists should perform an enhanced evaluation, consider timing and lens selection decisions, and complete any appropriate pre-operative treatment. Peri-operatively, surgeons should be aware of pupillary dilation adjustments, combination surgery options, and potential complications. Post-operatively, clinicians should address pseudophakic cystoid macular edema, diabetic macular edema, diabetic retinopathy, and posterior capsular opacification.
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Affiliation(s)
| | - Christina A Mamalis
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA
| | - Sumitra S Khandelwal
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX, 77030, USA.
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13
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Kang KH, Song MY, Kim KY, Hwang KY, Kwon YA, Koh K. Corneal Endothelial Cell Changes After Femtosecond Laser-Assisted Cataract Surgery in Diabetic and Nondiabetic Patients. Eye Contact Lens 2021; 47:664-669. [PMID: 34294644 DOI: 10.1097/icl.0000000000000823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare corneal endothelial cell changes after femtosecond laser-assisted cataract surgery (FLACS) in diabetic and nondiabetic patients. METHODS This retrospective study included patients with cataract who underwent FLACS performed by a single surgeon between August 2018 and November 2020. Changes in corneal endothelial cell density (ECD), hexagonality, coefficient of variation in cell size (CV), and central corneal thickness (CCT) at baseline and at the 1-month and 3-month postoperative follow-ups were investigated by dividing the patients into diabetic and nondiabetic groups. RESULTS We included 75 patients (60% men, mean age: 57.7±11.4 years, range: 27-80 years) in the analysis: 31 diabetic patients (64% men, mean age: 58.7±11.9 years, range: 27-79 years) and 44 nondiabetic patients (56% men, mean age: 57.1±11.3 years, range: 34-80 years). No differences were observed between the two groups as regards preoperative and intraoperative parameters, the mean postoperative ECD, hexagonality, and CV. At 1 month postoperatively, the CCT was significantly greater in the diabetic group (P=0.034); however, at 3 months, there was no significant difference between the two groups (P=0.927). CONCLUSIONS Changes in postoperative corneal endothelial cells were comparable between patients with and without diabetes after FLACS. Femtosecond laser-assisted cataract surgery seems to cause less damage to the corneal endothelium in diabetic patients because it uses less phacoemulsification energy.
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Affiliation(s)
- Kyoung Hae Kang
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Republic of Korea
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14
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Joo JH, Kim TG. Comparison of corneal endothelial cell changes after phacoemulsification between type 2 diabetic and nondiabetic patients. Medicine (Baltimore) 2021; 100:e27141. [PMID: 34477167 PMCID: PMC8415947 DOI: 10.1097/md.0000000000027141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/18/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study is to compare the endothelial cell density (ECD) and morphology between diabetic mellitus (DM) and nondiabetic patients at 1 year after phacoemulsification in operated eyes and nonoperated eyes.Evaluation was performed in 28 patients (56 eyes) with type 2 diabetes and 37 patients (74 eyes) without diabetes who underwent 1-year interval cataract surgery. Using a noncontact specular microscope and Scheimpflug rotating camera, corneal parameters were analyzed before and 1 year after surgery. Subgroups analysis was performed based on a disease duration 10 years and HbA1c concentration 7% and Pearson correlation analysis was performed.The mean change in ECD at 1 year after surgery was 13.28% in the DM group and 11.40% in the control group. In the fellow nonoperated eyes, the mean change was 4.47% and 3.63% in the DM and control groups, respectively. There was no significant difference in postoperative ECD, coefficient of variance, hexagonality, and central corneal thickness between 2 groups. In the subgroup analysis, the long disease duration DM group (≥10 years) had a significantly greater ECD loss than the control and short disease duration DM groups (<10 years). Blood urea nitrogen (BUN) showed a significant correlation with postoperative ECD change (r = -0.474, P = .011).The diabetic group with a longer disease duration showed significantly greater ECD decrease compared to the nondiabetic group and BUN correlated with ECD changes after phacoemulsification. Postoperative ECD loss may be high if the disease duration is long or if the BUN level is high.
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15
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The Effect of Mesenchymal Stem Cell Secretome on Corneal Endothelial Cell Preservation in an Oxidative Injury Model. Cornea 2021; 39:1426-1430. [PMID: 32732699 DOI: 10.1097/ico.0000000000002442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To describe a reproducible oxidative injury model in ex vivo porcine corneas and to investigate the effects of corneal mesenchymal stem cell (Co-MSC) secretome and specific factors on the preservation of corneal endothelium after oxidative injury. METHODS Porcine corneas underwent vital staining with trypan blue and alizarin red with different concentration and time points. Ex vivo porcine corneas were exposed (endothelial side) to varied concentrations of hydrogen peroxide. After injury, 3 groups of 5 corneas underwent treatment with secretome from either a wild-type (WT) murine Co-MSC, a pigment epithelium derived factor (PEDF) knock out (K/O) murine Co-MSC, or basal media for 4 hours at 37°C. The viability of the endothelium was evaluated using the optimized vital staining protocol. RESULTS The optimal vital staining was achieved with 0.4% trypan blue for 60 seconds and 0.5% alizarin red for 90 seconds. The optimal oxidative injury (for consistency and level of damage) was obtained with 1% hydrogen peroxide for 15 seconds. Treatment with both WT Co-MSC and PEDF K/O Co-MSC secretome significantly reduced the endothelial damage compared with control (17.2% ± 10.0%, 33.5% ± 11.6%, and 68% ± 17%, respectively, P < 0.01). The WT Co-MSC secretome was significantly more effective compared with PEDF K/O Co-MSC secretome (P < 0.05). CONCLUSIONS A reproducible model of vital staining and oxidative injury is described for studying porcine corneal endothelial survival. Our results demonstrate a beneficial role of a corneal MSC secretome in reducing oxidative damage to the corneal endothelium. In addition, it suggests a potential role for PEDF in this process.
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Chowdhury B, Bhadra S, Mittal P, Shyam K. Corneal endothelial morphology and central corneal thickness in type 2 diabetes mellitus patients. Indian J Ophthalmol 2021; 69:1718-1724. [PMID: 34146014 PMCID: PMC8374766 DOI: 10.4103/ijo.ijo_3120_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose This study aimed to examine the corneal endothelial morphology and thickness in patients with Type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched nondiabetic controls. Methods This hospital-based cross-sectional observational study was conducted in the ophthalmology department of a tertiary hospital consisting of 262 patients (131 with T2DM as cases and 131 without diabetes who served as controls). All patients underwent a comprehensive ocular examination including visual acuity, slit-lamp biomicroscopy, intraocular pressure measurement. Central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variance (CV), and percentage of hexagonal cells (HEX) were compared between the cases and controls. Predictors of corneal endothelial dysfunctions were analyzed. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 17.0. Chi-square test, Fisher's exact test, and Spearman's rho correlation analysis were used as appropriate. Results Patients with T2DM showed poorer visual acuity and higher intraocular pressure. As compared to controls, patients with T2DM had thicker CCT, lesser ECD, decreased HEX, and higher CV but the differences were statistically nonsignificant. HbA1c levels showed a significant positive correlation with CCT and CV and a negative correlation with ECD. Macroalbuminuria and higher albumin creatinine ratio was associated with an increase in CV in patients with T2DM. Conclusion Our study showed that poorly controlled patients with T2DM and those with macroalbuminuria have corneal endothelial abnormalities.
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Affiliation(s)
- Bithi Chowdhury
- Department of Ophthalmology, Hindu Rao Hospital, New Delhi, India
| | - Sangeeta Bhadra
- Department of Ophthalmology, Hindu Rao Hospital, New Delhi, India
| | - Pramod Mittal
- Department of Medicine, Hindu Rao Hospital, New Delhi, India
| | - Kishore Shyam
- Department of Medicine, Hindu Rao Hospital, New Delhi, India
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The effects of type 2 diabetes mellitus on the corneal endothelium and central corneal thickness. Sci Rep 2021; 11:8324. [PMID: 33859349 PMCID: PMC8050290 DOI: 10.1038/s41598-021-87896-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/30/2021] [Indexed: 12/04/2022] Open
Abstract
Aim of this study is to evaluate the differences in corneal endothelial cell morphology and corneal thickness in patients with and without type 2 diabetes related to age, disease duration, and HbA1c percentage. This retrospective cross-sectional study included 511 (1022 eyes) type 2 diabetes patients and 900 (1799 eyes) non-diabetic patients. The endothelial cell density (ECD), variation in endothelial cell size (CV), percentage of hexagonal cells, and central corneal thickness (CCT) were analyzed using a noncontact specular microscope and a Pentacam Scheimpflug camera. We also examined the correlation between the corneal parameters and the duration of diabetes. For total ages, the subjects with type 2 diabetes showed significantly lower ECD, hexagonality, higher CV, and thicker CCT than the control group. This difference was more pronounced in patients with long-standing DM (≥ 10 years) and high HbA1c (≥ 7%). When stratified by age group, from the 60 s group, corneal endothelial cell parameters showed a statistically significant difference between DM and control groups. The duration of diabetes was inversely correlated with ECD (r = − 0.167; p = 0.000). These findings suggest that diabetes affects corneal endothelial cell in older age and those with long-standing DM and higher HbA1c. Regular corneal endothelial examinations are required in diabetic patients.
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18
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Albietz JM, Lenton LM. Standardised antibacterial Manuka honey in the management of persistent post‐operative corneal oedema: a case series. Clin Exp Optom 2021; 98:464-72. [PMID: 26390910 DOI: 10.1111/cxo.12295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 02/20/2015] [Accepted: 03/06/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Julie M Albietz
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lee M Lenton
- Vision Eye Institute, Brisbane, Queensland, Australia
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19
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Elmekawey H, Abdelaziz M, El Baradey M, Kotb M. Epithelial Remodeling Following Phacoemulsification in Diabetic Patients Using Anterior-Segment Optical Coherence Tomography: A Comparative Study. Clin Ophthalmol 2020; 14:2515-2523. [PMID: 32921979 PMCID: PMC7457868 DOI: 10.2147/opth.s266464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To compare the effect of phacoemulsification on corneal epithelial thickness in diabetic and nondiabetic cataract patients. Methods Fifty eyes with cataracts were enrolled in a prospective comparative interventional study. They were divided into two groups: group A (diabetics) and group B (nondiabetics) and underwent uneventful phacoemulsification. Epithelial thickness was assessed in the central, paracentral, and peripheral cornea on the first day and at 1 week, 1 month, and 3 months postoperatively using spectral-domain ocular coherence tomography. Results A significant increase in the first-day postoperative central epithelial thickness was noticed in both groups (57.16±3.5 µm and 55.96±2.81 µm in groups A and B, respectively), with increased baseline epithelial thickness of 3.8±2.1 µm and 3.4±2.14 µm in groups A and B, respectively (P<0.001). A significant decrease in epithelial thickness was noticed in both groups after 1 week (−2.40±3.1 µm and −2.76±2.71 µm in group A and B, respectively). No further significant change was noticed in the nondiabetic group at 1 month; however, significant reductions in for central epithelial thickness were found in the diabetic group up to the first month (−0.80±1.9 µm, P=0.05). Central corneal thickness followed the same pattern of change as the epithelium. A nonsignificant delay in visual acuity improvement was noticed in diabetic patients. Conclusion Phacoemulsification induces a temporary increase in corneal and epithelial thickness that should resolve by the first week postoperatively. However, diabetic patients had slower epithelial recovery that took up to 1 month, which could be reflected in delayed visual recovery with no effect on the final visual outcome.
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Affiliation(s)
- Hany Elmekawey
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magda Abdelaziz
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed El Baradey
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Kotb
- Ophthalmology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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20
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Beato JN, Esteves-Leandro J, Reis D, Falcão M, Rosas V, Carneiro Â, Falcão Reis F. Evaluation of Corneal Structure and Endothelial Morphological Characteristics in Type 2 Diabetic and Non-Diabetic Patients. Clin Ophthalmol 2020; 14:1993-1999. [PMID: 32764865 PMCID: PMC7369306 DOI: 10.2147/opth.s256244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare corneal structure and endothelial morphological features between patients with type 2 diabetes mellitus (DM) and non-diabetic patients; and determine if the DM duration, glycated hemoglobin (HbA1c) levels, and diabetic retinopathy (DR) stage affect corneal morphological properties. Patients and Methods Sixty diabetic patients and 47 age- and sex-matched controls were enrolled in this cross-sectional study. DM group was analyzed according disease duration, HbA1c levels, and presence of retinopathy. Endothelial cell density (ECD) and morphology (average and coefficient of variation [CV] of cell size, percentage of hexagonal cells) were recorded using non-contact specular microscopy. Central corneal thickness (CCT) and corneal volume were measured by scheimpflug tomography. Univariate and multivariate linear regression analyses were performed to evaluate the relationship between demographical, clinical, and ocular variables with CCT and ECD. Results There were no statistically significant differences in the endothelium cell density or morphology between DM and non-DM groups (p>0.05). Also, there was no statistical difference between groups for CCT or corneal volume (p>0.05). Multivariate linear regression analysis showed that older age (p=0.028) was significantly associated with lower ECD; CCT was found to be significantly greater in males (p<0.001) and positively associated with corneal volume (p<0.001). Conclusion The present study did not find any statistically significant differences between the corneal structural and endothelial characteristics of diabetic and non-diabetic subjects; other demographical parameters, such as age and gender, seem to be more determinant for the corneal properties.
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Affiliation(s)
- João N Beato
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - David Reis
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vítor Rosas
- Department of Ophthalmology, São João Hospital, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão Reis
- Department of Ophthalmology, São João Hospital, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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21
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Viberg A, Samolov B, Claesson Armitage M, Behndig A, Byström B. Incidence of corneal transplantation after phacoemulsification in patients with corneal guttata: a registry-based cohort study. J Cataract Refract Surg 2020; 46:961-966. [DOI: 10.1097/j.jcrs.0000000000000207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Pont C, Ascaso FJ, Grzybowski A, Huerva V. Corneal endothelial cell density during diabetes mellitus and ocular diabetes complications treatment. J Fr Ophtalmol 2020; 43:794-798. [PMID: 32616318 DOI: 10.1016/j.jfo.2019.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/17/2022]
Abstract
Diabetes mellitus may affect the cornea at various levels. Ocular surface changes and dry eye had been studied. Researchers are concerned that medical treatment of diabetes or retinal complications may result in endothelial damage and cell loss. This report summarizes the possibility of endothelial cell loss in diabetic patients. A decrease in endothelial cell density (ECD) in diabetic patients has been reported. In addition, corneal thickness may increase in diabetic patients. Significant endothelial cell loss has been demonstrated in long-term disease and in cases of poor metabolic control. No association between the use of oral hypoglycemics and ECD has been reported. There is also no evidence of an association between the use of insulin and corneal endothelial damage. No difference in ECD among the various degrees of retinopathy or with a history of photocoagulation has been shown. Regarding the studies comparing diabetic and non-diabetic patients undergoing cataract surgery, in all cases, the decrease in ECD is higher in diabetic patients than that seen in non-diabetic patients. However, there is no evidence of increased endothelial damage in diabetics compared to non-diabetics during vitreo-retinal surgery in phakic eyes. No significant changes in corneal endothelium after intravitreal anti-VEGF injections have been referenced.
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Affiliation(s)
- C Pont
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198 Lleida, Spain
| | - F J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Aragón Health Research Institute (IIS Aragon), Zaragoza, Spain; Aragon Institute of Engineering Research (13A), University of Zaragoza, Zaragoza, Spain
| | - A Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - V Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Avda. Alcade Rovira Roure 80, 25198 Lleida, Spain; University of Lleida (UdL), Lleida, Spain; IRB Lleida, Lleida, Spain.
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23
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Papadakou P, Chatziralli I, Papathanassiou M, Lambadiari V, Siganos CS, Theodossiadis P, Kozobolis V. The Effect of Diabetes Mellitus on Corneal Endothelial Cells and Central Corneal Thickness: A Case-Control Study. Ophthalmic Res 2020; 63:550-554. [PMID: 32172250 DOI: 10.1159/000507197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the characteristics of corneal endothelial cells and central corneal thickness (CCT) in patients with diabetes mellitus (DM), comparing them with those of healthy subjects (controls) and to determine potential factors affecting the corneal parameters in patients with DM. METHODS Participants in this study were 72 patients with DM and 88 healthy controls. Diabetic patients were further classified into groups depending on the severity of diabetic retinopathy (no retinopathy, mild, moderate, severe non-proliferative diabetic retinopathy, and proliferative diabetic retinopathy). All participants underwent non-contact specular microscopy to evaluate corneal endothelium parameters and CCT, while factors affecting endothelial cell density and CCT in patients with DM were also analyzed. RESULTS Patients with DM presented significantly decreased endothelial cell density compared to controls (2,297.9 ± 311.3 and 2,518.3 ± 243.7 cells/mm2, respectively; p < 0.001), while the two groups did not differ significantly in any other measured corneal parameter. In the diabetic group, the multivariate analysis showed a significant association between decreased endothelial cell density and increased HbA1c (p < 0.001), longer DM duration (p = 0.003), and more severe diabetic retinopathy status (p = 0.008). CONCLUSION DM seems to affect the corneal endothelium, since endothelial cell density was decreased in the diabetic group, while duration of disease, HbA1c levels, and severity of retinopathy were significantly associated with changes in endothelial cell density and should be taken into account.
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Affiliation(s)
- Panagiota Papadakou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece,
| | | | - Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Vassilios Kozobolis
- Eye Institute of Thrace, Democritus University of Thrace, Alexandroupolis, Greece
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24
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Kunzmann BC, Wenzel DA, Bartz‐Schmidt KU, Spitzer MS, Schultheiss M. Effects of ultrasound energy on the porcine corneal endothelium - Establishment of a phacoemulsification damage model. Acta Ophthalmol 2020; 98:e155-e160. [PMID: 31469490 DOI: 10.1111/aos.14235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to establish a standardized in vitro phacoemulsification damage model for future investigations of the effects of phacoemulsification, surgical devices, protective ophthalmic viscoelastic devices (OVDs), irrigation solutions and other aspects related to cataract phacoemulsification surgery on the corneal endothelium using porcine eyes. METHODS Thirty-four porcine eyes were randomly assigned to three groups (phacoemulsification (n = 13), irrigation (n = 9), control (n = 12)). A total of 5 min of ultrasound energy with intermittent irrigation/aspiration was applied in the eyes of the phacoemulsification group. The eyes of the irrigation group received the identical treatment, but without the application of ultrasound energy. The control group was left untreated. All eyes were then prepared to split corneal buttons followed by 15 days of cultivation. Endothelial cell density (ECD) was assessed blinded on day 15. RESULTS Endothelial cell density declined significantly more until day 15 in the phacoemulsification group (2567 ± 317/267 cells/mm² (median ± 25%/75%-quartiles), -32.5 ± 7.0/6.4%) compared to the irrigation (3450 ± 350/383 cells/mm², -11.8 ± 5.3/2.6%; p < 0.001) and the control group (3650 ± 288/258 cells/mm², -10.2 ± 3.2/4.6%; p < 0.001). CONCLUSION The phacoemulsification damage model presented in this study is sensitive to phacoemulsification energy and may reliably be used to investigate various factors involved in phacoemulsification with regard to their influence on corneal endothelial cells. This method is able to replace animal experiments or in vitro cell culture experiments that often do not translate well to the in vivo situation in humans.
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Affiliation(s)
- Berenike C. Kunzmann
- University Eye Hospital Centre for Ophthalmology University Hospital Tübingen Tübingen Germany
| | - Daniel A. Wenzel
- Department of Ophthalmology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Karl U. Bartz‐Schmidt
- University Eye Hospital Centre for Ophthalmology University Hospital Tübingen Tübingen Germany
| | - Martin S. Spitzer
- Department of Ophthalmology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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25
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Possible Sampling Error in Corneal Specular Microscopy: Can Central Endothelial Data Generated by Specular Microscope Represent the Real Clinical Condition of the Whole Cornea? Cornea 2020; 39:779-781. [DOI: 10.1097/ico.0000000000002290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Goldstein AS, Janson BJ, Skeie JM, Ling JJ, Greiner MA. The effects of diabetes mellitus on the corneal endothelium: A review. Surv Ophthalmol 2020; 65:438-450. [PMID: 31926185 DOI: 10.1016/j.survophthal.2019.12.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 12/19/2022]
Abstract
The corneal endothelium plays a critical role in maintaining corneal clarity. There is an expected decline in cell density with age and disease, and maintaining the health of this cell layer is important as corneal endothelial cells generally are amitotic in vivo. Diabetes mellitus is a highly prevalent disease that damages the corneal endothelium. Diabetes causes structural and functional impairments in the corneal endothelium that decrease cellular reserve in response to stress. These effects have implications to consider for diabetic patients undergoing anterior segment surgery, and for corneal surgeons who use diabetic donor tissue and treat diabetic patients. In this review, we discuss the specifics of how diabetes mellitus impacts the corneal endothelium including alterations in cell morphology, cell density, ultrastructure, pump and barrier function, cataract surgery outcomes, and corneal transplant outcomes with attention to the use of diabetic donor tissue and diabetic transplant recipients.
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Affiliation(s)
- Andrew S Goldstein
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ben J Janson
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jessica M Skeie
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jennifer J Ling
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mark A Greiner
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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Fernandes SI, Nagpal S. Corneal thickness and endothelial cell density in children with type 1 diabetes mellitus. Oman J Ophthalmol 2020; 12:186-190. [PMID: 31902995 PMCID: PMC6826602 DOI: 10.4103/ojo.ojo_21_2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND: The aim of this study was to detect the effect of diabetes on the corneal endothelium in patients of Type 1 diabetes in the pediatric age group and to compare them with age-matched controls. Further, it was proposed to establish any correlation between these changes and risk factors of diabetes, viz., age, duration of diabetes, and hemoglobin A1c (HbA1c) values. MATERIALS AND METHODS: This was a prospective cross-sectional study. Fifty children with Type 1 diabetes, between the ages of 7 and 17 years (average, 12.16 ± 2.63 years), and fifty healthy age-matched controls (average 12.28- ±3.00 years) were examined. The central corneal thickness (CCT) and endothelial cell density (CD) were assessed by the Topcon SP-1P specular microscope. The duration of diabetes (average, 3.91 ± 1.65 years) and the HbA1c values (average, 10.92 ± 2.28) were also noted. RESULTS: The average CCT in the diabetics was 525.16 ± 33.14 μ and in the controls 513.44 ± 29.46 μ. This was significantly higher (P = 0.015). The average endothelial CD in the diabetics was 3039.64 ± 292.84 cells/mm2 and in the nondiabetics 3360.41 ± 268.04 cells/mm2. This was significantly lower (P < 0.001). A significant correlation was found between the endothelial CD and age of the diabetic patients (P = 0.008). However, there was no significant correlation between the endothelial CD and the CCT with either duration of diabetes or HbA1c. CONCLUSIONS: A significant decrease in the endothelial CD and increase in the CCT occurs in children and adolescents with Type 1 diabetes. With the age of the diabetic patients, the endothelial CD significantly reduces. However, duration of diabetes and HbA1c do not affect these values.
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Affiliation(s)
- Sheldon Ignatius Fernandes
- Department of Ophthalmology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Shubha Nagpal
- Department of Ophthalmology, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
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Khalid M, Hanif MK, Islam QU, Mehboob MA. Change in corneal endothelial cell density after phacoemulsification in patients with type II diabetes mellitus. Pak J Med Sci 2019; 35:1366-1369. [PMID: 31489008 PMCID: PMC6717492 DOI: 10.12669/pjms.35.5.596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: To compare the mean change in Corneal Endothelial cell Density (CED), from baseline (pre-operative value), two months after phacoemulsification cataract surgery between type II diabetic patients and non-diabetic patients. Methods: This prospective stratified controlled study was conducted at PNS Shifa Hospital, Karachi. 80 eyes of 72 type II diabetic patients and 80 eyes of 77 non diabetic controls, having Nuclear Opalescence (NO) grades 2 and 3 on slit lamp examination underwent phacoemulsification surgery. CED was measured in cells/mm2, of concerned eye of each subject preoperatively and 2 months post operatively using specular microscope. The difference in mean CED change between the two groups after surgery was analyzed. Results: Mean age of study population was 61.41± 6.76 years. Out of study population, 92 (57.5%) were males and 68 (42.5%) were females. There was a statistically significant difference between both groups in terms of mean post-operative CED, mean change in CED and mean frequency change in CED (p <0.05). There was no statistically significant difference between both groups in age, gender, laterality of eyes and mean pre-operative CED, (p >0.05). Difference of pre-operative CED from post-operative CED in each group was statistically significant. Conclusion: There is a significant difference between diabetic population and normal population in terms of corneal endothelial loss after uneventful phacoemulsification cataract surgery.
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Affiliation(s)
- Muhammad Khalid
- Dr. Muhammad Khalid, MBBS. Department of Ophthalmology, PNS SHIFA, Karachi, Pakistan
| | - Muhammad Kashif Hanif
- Dr. Muhammad Kashif Hanif, FCPS. Department of Ophthalmology, PNS SHIFA, Karachi, Pakistan
| | - Qamar Ul Islam
- Dr. Qamar ul Islam, FCPS. Department of Ophthalmology, PNS SHIFA, Karachi, Pakistan
| | - Muhammad Asim Mehboob
- Dr. Muhammad Asim Mehboob, FCPS. Department of Ophthalmology, PNS SHIFA, Karachi, Pakistan
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Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications. J Clin Med 2019; 8:jcm8050716. [PMID: 31137510 PMCID: PMC6572121 DOI: 10.3390/jcm8050716] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023] Open
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial-stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.
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Khokhar S, Sen S, Dhull C. Active-fluidics-based torsional phacoemulsification in diabetic eyes: A prospective interventional study. Indian J Ophthalmol 2019; 67:619-624. [PMID: 31007221 PMCID: PMC6498917 DOI: 10.4103/ijo.ijo_1146_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/03/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare the outcomes of active-fluidics based torsional phacoemulsification in diabetics and nondiabetics using a balanced tip. Methods Two hundred and forty-eight patients undergoing senile cataract surgery using torsional phacoemulsification on an active-fluidics-based platform from December 2016 to August 2017 were included in this prospective, nonrandomized, interventional cohort study; of the 248 patients, 54 were controlled diabetics and 194 were nondiabetics. Intraoperative parameters such as cumulative dissipated energy (CDE), total ultrasound time, torsion usage time, torsion amplitude, aspiration time, and fluid usage were documented and compared. Endothelial cell loss (ECL) and central corneal thickness (CCT) were evaluated at 1 month postoperatively. Results Diabetics and nondiabetics did not differ in CDE, total ultrasound time, torsion amplitude, aspiration time, fluid usage, endothelial cell count, and CCT. ECL on Day 1 (10.2 ± 8.0%) and Day 30 (11.05 ± 8.3%) were significantly higher in diabetics (P = 0.025 and P = 0.045, respectively). There was an increase in CCT on Day 1 (P = 0.018), which settled by Day 30. Grade 4 cataracts in diabetics had significantly higher CCT at Day 1 (P = 0.032) and Day 30 (P = 0.007). In the diabetic subgroup, Grades 3 and 4 cataracts required lower CDE (P < 0.001) and Grade 4 cataracts showed higher ECL than others till 1 month of follow-up (P < 0.05). Conclusion Intraoperative and postoperative parameters after torsional phacoemulsification are comparable in diabetics and nondiabetics. Endothelial changes and pachymetry may be related to the grade of cataract in diabetics.
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Affiliation(s)
- Sudarshan Khokhar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sagnik Sen
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Chirakshi Dhull
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Maadane A, Boutahar H, Bourakba S, Sekhsoukh R. [Corneal endothelial evaluation of diabetic patients after phacoemulsification]. J Fr Ophtalmol 2019; 42:381-386. [PMID: 30926269 DOI: 10.1016/j.jfo.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine whether phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients compared to non-diabetic patients. MATERIALS AND METHODS This study compared the endothelial status in 32 diabetics with good glycemic control and 32 non-diabetic patients before and after uneventful phacoemulsification. Central corneal thickness (CCT), central corneal endothelial cell density (CD), hexagonal cell percentage (HEX), and percent coefficient of variation (% CV) were measured using a specular microscope. RESULTS Data were matched by age and sex. Diabetics showed a significantly higher loss of endothelial cells compared to non-diabetics. After 3 months, there was a decline of 165 endothelial cells (SD 97) in the diabetic group and 114 (SD 45) in the control group. This was statistically significant (P=0.0065). In addition, diabetics showed a slower recovery trend of endothelial healing as evidenced by a lower CV variation. The CV change was 4.7 in the control group and 3.2 in the diabetic group, which was statistically significant (P=0.023). A significant correlation was found between the energy used and the change in endothelial count as well as the CV in both groups. CONCLUSION Despite good glycemic control, diabetics have significantly more endothelial damage compared to non-diabetics with a similar nuclear classification and phacoemulsification energy used. This justifies a more careful use of phacoemulsification energy in diabetics.
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Affiliation(s)
- A Maadane
- Service d'ophtalmologie, CHU Mohammed VI, BP 4806, 60049 Oujda, Maroc; Laboratoire d'épidémiologie, recherche clinique et santé publique, faculté de médecine, université Mohammed Premier, Oujda, Maroc.
| | - H Boutahar
- Service d'ophtalmologie, CHU Mohammed VI, BP 4806, 60049 Oujda, Maroc
| | - S Bourakba
- Service d'ophtalmologie, CHU Mohammed VI, BP 4806, 60049 Oujda, Maroc
| | - R Sekhsoukh
- Service d'ophtalmologie, CHU Mohammed VI, BP 4806, 60049 Oujda, Maroc
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Kiziltoprak H, Tekin K, Inanc M, Goker YS. Cataract in diabetes mellitus. World J Diabetes 2019; 10:140-153. [PMID: 30891150 PMCID: PMC6422859 DOI: 10.4239/wjd.v10.i3.140] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic systemic disease that has increases in prevalence over time. DM can affect all ocular structures, with cataract being the most common ocular complication. Cataract is the leading cause of blindness worldwide. Due to several mechanisms, there is an increased incidence of cataract formation in the diabetic population. Advancements in technology have now made cataract surgery a common and safe procedure. However, the diabetic population is still at risk of vision-threatening complications, such as diabetic macular edema (ME), postoperative ME, diabetic retinopathy progression, and posterior capsular opacification.
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Affiliation(s)
- Hasan Kiziltoprak
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van 65400, Ercis, Turkey
| | - Yasin Sakir Goker
- Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara 06240, Turkey
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Muto T, Machida S. Effect of intravitreal aflibercept on corneal endothelial cells: a 6-month follow-up study. Clin Ophthalmol 2019; 13:373-381. [PMID: 30858687 PMCID: PMC6387600 DOI: 10.2147/opth.s177506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose To determine the effect of intravitreal aflibercept injection on the corneal endothelium in patients with diabetic or cystoid macular edema caused by retinal vein occlusion. Material and methods Forty-six eyes of 44 consecutive patients (27 men, 17 women; age range: 55-88 years) were evaluated. All participants initially received a single intravitreal injection of aflibercept (2 mg in 0.05 mL), followed by pro re nata use and underwent central corneal specular microscopy before the injection and at 1, 3 and 6 months after the first injection during a 6-month follow-up period. The endothelial cell density (ECD), average cell size (AVG), standard deviation of cell size (SD), coefficient of variation of cell size (CoV), maximum of cell size (MAX), minimum of cell size (MIN) and percentage of hexagonal cells (Hex%) were analyzed and the central corneal thickness (CCT) was measured. Results No significant differences in the ECD, AVG, SD, CoV, MIN, Hex% and CCT were observed between measurements obtained before and 1, 3 and 6 months after the first injection. However, the MAX measured before injection differed significantly from the values measured at 1, 3 and 6 months after the first injection (P=0.033). An average of 1.43±0.58 intravitreal aflibercept injections were administered per patient. Conclusion These study findings indicate that the intravitreal administration of aflibercept (2 mg) might very slightly alter the corneal endothelium within 6 months of the first injection.
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Affiliation(s)
- Tetsuya Muto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan,
| | - Shigeki Machida
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan,
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Kelkar A, Kelkar J, Mehta H, Amoaku W. Cataract surgery in diabetes mellitus: A systematic review. Indian J Ophthalmol 2018; 66:1401-1410. [PMID: 30249823 PMCID: PMC6173035 DOI: 10.4103/ijo.ijo_1158_17] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/01/2018] [Indexed: 12/20/2022] Open
Abstract
India is considered the diabetes capital of the world, and a significant proportion of patients undergoing cataract surgery are diabetic. Considering this, we reviewed the principles and guidelines of managing cataract in patients with diabetes. The preoperative, intraoperative, and postoperative factors are of paramount importance in the management of diabetic cataract patients. Particularly, the early recognition and treatment of diabetic retinopathy or maculopathy before cataract surgery influence the final visual outcome and play a major role in perioperative decision-making. Better understanding of various factors responsible for favorable outcome of cataract surgery in diabetic patients may guide us in better overalll management of these patients and optimizing the results.
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Affiliation(s)
- Aditya Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Hetal Mehta
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Winfried Amoaku
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, University of Nottingham, Nott Inghamshire, UK
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dell'Omo R, Cifariello F, De Turris S, Romano V, Di Renzo F, Di Taranto D, Coclite G, Agnifili L, Mastropasqua L, Costagliola C. Confocal microscopy of corneal nerve plexus as an early marker of eye involvement in patients with type 2 diabetes. Diabetes Res Clin Pract 2018; 142:393-400. [PMID: 29935212 DOI: 10.1016/j.diabres.2018.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/24/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To measure the thickness and length of corneal nerves and the peri-papillary retinal nerve fiber layer (RNFL) thickness in patients recently diagnosed with diabetes mellitus (DM). METHODS Twenty-two eyes of 22 patients recently diagnosed with type 2 DM and 22 eyes of 22 healthy individuals were consecutively enrolled. Central corneal sensitivity was measured using a Cochet-Bonnet esthesiometer, and corneal nerve length (CNL) and thickness (CNT) were evaluated through in vivo confocal microscopy. The confocal images were examined using software that could semi-automatically trace the corneal nerve pathway. Spectral domain optical coherence tomography (SD-OCT) was performed to quantify the overall and sectorial RNFL thickness. RESULTS Mean DM duration was 3.5 ± 1.7 months, whereas the mean glycemia and HbA1c levels were 180.5 ± 73.13 mg/dl and 8.6 ± 1.7% (65.2 ± 19.7 mmol/mol), respectively. Corneal sensation threshold was significantly lower in the DM group compared to control group (p = 0.003). CNL and CNT were reduced in the DM group (p = 0.043 and p = 0.004, respectively). Significant correlations were found between CNT and HbA1c levels (p = 0.04; r = -0.47), and between CNT and the corneal sensation threshold (p = 0.04; r = 0.69). RNFL thickness was significantly reduced in the temporal quadrants, but no correlation was found with CNT and CNL changes (p > 0.05). CONCLUSIONS CNL and CNT changes are evident even in the early stages of DM, and RNFL reduction was recorded in the temporal quadrants. These findings indicate that, in the eye with diabetes, neuropathy may represent an early marker of the disease.
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Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy; Casa di Cura «Villa Maria», Campobasso, Italy
| | | | - Serena De Turris
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy.
| | | | - Federico Di Renzo
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Davide Di Taranto
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Giovanni Coclite
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Luca Agnifili
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy; Casa di Cura «Villa Maria», Campobasso, Italy
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Bamdad S, Bolkheir A, Sedaghat MR, Motamed M. Changes in corneal thickness and corneal endothelial cell density after phacoemulsification cataract surgery: a double-blind randomized trial. Electron Physician 2018; 10:6616-6623. [PMID: 29881523 PMCID: PMC5984015 DOI: 10.19082/6616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/27/2017] [Indexed: 11/16/2022] Open
Abstract
Background Age-related cataract is a leading cause of visual impairment, considered a global health burden, it is responsible for over 47% of blindness worldwide. Surgical intervention is usually the treatment of choice and phacoemulsification cataract surgery with implantation of an intraocular lens is the most common procedure, which may have several complications. Objectives To determine the effects of phacoemulsification surgery on corneal endothelial cell density and corneal thickness in patients undergoing cataract surgery. Methods The present study was conducted on patients diagnosed with immature senile cataract requiring surgical intervention from November 2013 to 2014 in Khatam al Anbia Hospital (a tertiary ophthalmology center). Physical examination included best-corrected visual acuity using the Snellen chart, refraction, slit-lamp bio-microscopy for anterior chamber evaluation, keratometry, Goldman tonometry, gonioscopy, and dilated indirect ophthalmoscopy, pachymetry, specular microscopy and biometry. Surgery was performed by similar method and technique in all patients. The change in the corneal endothelial cell count or density and central corneal thickness (CCT) number were compared preoperatively and one day, one week, one month, and three months post–operatively. Results A total of 92 eyes of 85 patients (43 females and 42 males with mean age of 62.1±12.2 years) were studied. Patients’ visual acuity improved (log MAR: 1±0.5 preoperatively to 0.45±0.34 post-operatively) (p=0.001). There was 11.4% endothelial cell loss (ECL) and significant decrease in ECC (from 2,791.15±99.86 to 2,472.87±472.14) (p=0.04). The central corneal thickness increased significantly (from 530.47±2.60 to 540.91±36.07). Diabetic patients (12.9%) had a statistically significant higher ECL rate after phacoemulsification (14.6% versus 8.7% respectively, p=0.002). Conclusion Phacoemulsification resulted in significant corneal endothelial damage, which is particularly important in patients with a borderline reservoir of endothelial cell, such as diabetic patients, which highlights the necessity of refining the current surgical methods and instruments to minimize the endothelial damage. Trial registration The trial was registered in the Thai clinical trial registry (http://www.clinicaltrials.in.th) with the ID: TCTR20171122001. Funding The study was supported by a research grant of Mashhad University of Medical Sciences.
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Affiliation(s)
- Shahram Bamdad
- M.D., Associate Professor of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Bolkheir
- M.D., Resident of Ophthalmology, Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Sedaghat
- M.D., Professor of Ophthalmology, Department of Ophthalmology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Motamed
- M.D., Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Sahu PK, Das GK, Agrawal S, Kumar S, Kumar N. Comparative Evaluation of Corneal Endothelium in Diabetic Patients Undergoing Phacoemulsification. Middle East Afr J Ophthalmol 2018; 24:195-201. [PMID: 29422754 PMCID: PMC5793451 DOI: 10.4103/meajo.meajo_212_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To determine if phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetics. MATERIALS AND METHODS This study compared the endothelial status in 60 diabetics with good glycemic control and 60 nondiabetics before and after uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality and percentage coefficient of variation (%CV) were measured using a specular microscope. RESULTS Data were age and sex matched. Diabetics showed significantly higher loss in endothelial cell count as compared to nondiabetics. At the end of 3 months, there was a decline of 157 endothelial cell (standard deviation [SD] 90) in the diabetic group and 121 (SD 50) in the control group. This was statistically significant (P = 0.008). Furthermore, the diabetics showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the %CV. The change in %CV was 4.5 in the control group and 3.1 in diabetic group which was statistically significant (P = 0.016). Significant correlation was found between energy used and change in endothelial count as well as %CV in nondiabetics only. CONCLUSION In spite of good glycemic control, diabetics have significantly more endothelial damage in comparison to nondiabetics with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in diabetics.
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Affiliation(s)
- Pramod Kumar Sahu
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Gopal Krushna Das
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Sumeet Agrawal
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Sabitabh Kumar
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Nitish Kumar
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
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38
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Tang Y, Chen X, Zhang X, Tang Q, Liu S, Yao K. Clinical evaluation of corneal changes after phacoemulsification in diabetic and non-diabetic cataract patients, a systematic review and meta-analysis. Sci Rep 2017; 7:14128. [PMID: 29074989 PMCID: PMC5658349 DOI: 10.1038/s41598-017-14656-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 10/13/2017] [Indexed: 01/26/2023] Open
Abstract
Corneal endothelium morphological abnormalities result in fluid imbalance, stromal swelling, and loss of transparency, thus impairing visual function. Recently, growing number of studies have focused on diabetic corneal abnormalities after cataract surgery and its comparison with non-diabetic patients, the results remain conflicting. Thus, to evaluate the effect of phacoemulsification on the corneal properties in diabetic and non-diabetic patients, prospective studies were comprehensively searched through PubMed, EMBASE, and Cochrane databases updated to Jan 2017. A meta-analysis of the 13 identified studies was performed using weighted mean difference (WMD) and 95% confidence interval (CI). For the dynamic changes between preoperative and postoperative values, significant differences were identified between the two groups in endothelial cell density (ECD) and hexagon cells (HC%) at 1 day, 1 week, 1 month, and 3 months postoperatively, in central corneal thickness (CCT) at 1 month postoperatively, and in coefficient variation (CV) at 1 week and 1 month postoperatively. However, no significant differences were observed in CCT at 1 day, 1 week and 3 months postoperatively or in CV at 1 day and 3 months postoperatively. Diabetic corneas are more vulnerable to stress and trauma, resulting in greater morphological abnormalities and longer recovery time.
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Affiliation(s)
- Yizhen Tang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, P.R. China
| | - Xinyi Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, P.R. China
| | - Xiaobo Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, P.R. China
| | - Qiaomei Tang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, P.R. China
| | - Siyu Liu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, P.R. China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China. .,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, P.R. China.
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Sahu PK, Das GK, Agrawal S, Kumar S. Comparative Evaluation of Corneal Endothelium in Patients with Diabetes Undergoing Phacoemulsification. Middle East Afr J Ophthalmol 2017; 24:74-80. [PMID: 28936050 PMCID: PMC5598306 DOI: 10.4103/meajo.meajo_242_15] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of this study is to determine if phacoemulsification with posterior chamber foldable intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetic controls. MATERIALS AND METHODS This study compared the corneal endothelial status in sixty patients with diabetes with good glycemic control and sixty nondiabetic controls before and after (1 week, 1 month, 2 month, and 3 month) uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality, and coefficient of variation were measured using a noncontact specular microscope. Central corneal thickness was taken as a surrogate marker for endothelium functional status. RESULTS Data were age and sex matched. Patients with diabetes showed significantly higher loss in endothelial cell count as compared to nondiabetic controls. Furthermore, the patients with diabetes showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the coefficient of variation. Significant correlation was found between energy used and change in endothelial count as well as coefficient of variation in nondiabetics only. CONCLUSION In spite of good glycemic control, patients with diabetes have significantly more endothelial damage in comparison to nondiabetic controls with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in patient with diabetes.
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Affiliation(s)
- Pramod K Sahu
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Gopal K Das
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Sumeet Agrawal
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
| | - Sabitabh Kumar
- Department of Ophthalmology, UCMS and GTB Hospital, New Delhi, India
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Age-Stratified Analysis of Diabetes and Pseudophakia Effects on Corneal Endothelial Cell Density: A Retrospective Eye Bank Study. Cornea 2017; 36:367-371. [PMID: 27984364 DOI: 10.1097/ico.0000000000001107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To perform an age-stratified analysis of the effect of diabetes and pseudophakia on corneal endothelial cell density (ECD). METHODS This is a comparative analysis of donor characteristics from data supplied by the Lions Eye Institute for Transplant and Research on tissue harvested from July 1, 2007, through May 23, 2014. The mixed-effects model was used to compare age-adjusted mean corneal ECD between donors with and without diabetes. RESULTS A total of 20,026 nondiabetic donor eyes and 13,617 diabetic donor eyes were included in this study. ECD was 2604 cells per square millimeter in nondiabetic corneas and 2576 cells per square millimeter in diabetic corneas (P < 0.001). Among phakic patients, diabetic ECD was significantly less in the middle-age subgroups: -33 cells per square millimeter in the 21-to-40-year-old subgroup (P = 0.048) and -25 cells per square millimeter in the 41-to-60-year-old subgroup (P = 0.009). Among pseudophakic patients, diabetic ECD was significantly less only in the subgroup 61 years or older: -56 cells per square millimeter (P = 0.026). The magnitude of difference in ECD between phakic and pseudophakic donors was greater in patients with diabetes in the subgroup 61 years or older (P < 0.001). CONCLUSIONS Donor eyes with a history of diabetes had a slightly lower ECD (-29 cells/mm) than eyes without a history of diabetes. Although this statistical relationship is consistent with our pathophysiologic understanding of diabetes and the corneal endothelium, such a minor difference in ECD would be expected to have minimal clinical impact on overall corneal endothelial function.
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Goyal S, Hardin J, Uwaydat SH, Ellabban AA, Warner DB, Sallam AB. Review and update of cataract surgery in the diabetic eye. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1351296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sunali Goyal
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Cornea and External Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua Hardin
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sami H. Uwaydat
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Retina, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - David B. Warner
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Cornea and External Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Retina, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Diabetic complications in the cornea. Vision Res 2017; 139:138-152. [PMID: 28404521 DOI: 10.1016/j.visres.2017.03.002] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 12/15/2022]
Abstract
Diabetic corneal alterations, such as delayed epithelial wound healing, edema, recurrent erosions, neuropathy/loss of sensitivity, and tear film changes are frequent but underdiagnosed complications of both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus. The disease affects corneal epithelium, corneal nerves, tear film, and to a lesser extent, endothelium, and also conjunctiva. These abnormalities may appear or become exacerbated following trauma, as well as various surgeries including retinal, cataract or refractive. The focus of the review is on mechanisms of diabetic corneal abnormalities, available animal, tissue and organ culture models, and emerging treatments. Changes of basement membrane structure and wound healing rates, the role of various proteinases, advanced glycation end products (AGEs), abnormal growth and motility factors (including opioid, epidermal, and hepatocyte growth factors) are analyzed. Experimental therapeutics under development, including topical naltrexone, insulin, inhibitors of aldose reductase, and AGEs, as well as emerging gene and cell therapies are discussed in detail.
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Kim BJ, Lee JH, Kim SW. Change of Corneal Epithelial and Stromal Thickness after Cataract Surgery through Scleral Tunnel Incision. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.11.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bong Jun Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Hyuck Lee
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea
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Vázquez N, Chacón M, Rodríguez-Barrientos CA, Merayo-Lloves J, Naveiras M, Baamonde B, Alfonso JF, Zambrano-Andazol I, Riestra AC, Meana Á. Human Bone Derived Collagen for the Development of an Artificial Corneal Endothelial Graft. In Vivo Results in a Rabbit Model. PLoS One 2016; 11:e0167578. [PMID: 27907157 PMCID: PMC5131948 DOI: 10.1371/journal.pone.0167578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022] Open
Abstract
Corneal keratoplasty (penetrating or lamellar) using cadaveric human tissue, is nowadays the main treatment for corneal endotelial dysfunctions. However, there is a worldwide shortage of donor corneas available for transplantation and about 53% of the world's population have no access to corneal transplantation. Generating a complete cornea by tissue engineering is still a tough goal, but an endothelial lamellar graft might be an easier task. In this study, we developed a tissue engineered corneal endothelium by culturing human corneal endothelial cells on a human purified type I collagen membrane. Human corneal endothelial cells were cultured from corneal rims after corneal penetrating keratoplasty and type I collagen was isolated from remnant cancellous bone chips. Isolated type I collagen was analyzed by western blot, liquid chromatography -mass spectrometry and quantified using the exponentially modified protein abundance index. Later on, collagen solution was casted at room temperature obtaining an optically transparent and mechanically manageable membrane that supports the growth of human and rabbit corneal endothelial cells which expressed characteristic markers of corneal endothelium: zonula ocluddens-1 and Na+/K+ ATPase. To evaluate the therapeutic efficiency of our artificial endothelial grafts, human purified type I collagen membranes cultured with rabbit corneal endothelial cells were transplanted in New Zealand white rabbits that were kept under a minimal immunosuppression regimen. Transplanted corneas maintained transparency for as long as 6 weeks without obvious edema or immune rejection and maintaining the same endothelial markers that in a healthy cornea. In conclusion, it is possible to develop an artificial human corneal endothelial graft using remnant tissues that are not employed in transplant procedures. This artificial endothelial graft can restore the integrality of corneal endothelium in an experimental model of endothelial dysfunction. This strategy could supply extra endothelial tissue and compensate the deficit of cadaveric grafts for corneal endothelial transplantation.
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Affiliation(s)
- Natalia Vázquez
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | - Manuel Chacón
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | | | | | - Miguel Naveiras
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | - Begoña Baamonde
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
- Hospital Universitario Central de Asturias (Spain)
| | - Jose F. Alfonso
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | | | - Ana C. Riestra
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | - Álvaro Meana
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
- CIBER on rare disease–CIBERer. Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz–IIS-FJD (Spain)
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Tsaousis KT, Panagiotou DZ, Kostopoulou E, Vlatsios V, Stampouli D. Corneal oedema after phacoemulsification in the early postoperative period: A qualitative comparative case-control study between diabetics and non-diabetics. Ann Med Surg (Lond) 2015; 5:67-71. [PMID: 26865977 PMCID: PMC4710706 DOI: 10.1016/j.amsu.2015.12.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/16/2015] [Accepted: 12/17/2015] [Indexed: 02/08/2023] Open
Abstract
Background The occurrence and severity of corneal oedema after phacoemulsification is dependent on the integrity of corneal endothelial cells. The function of these cells is affected by diabetes mellitus and consequently the behaviour of the cornea in diabetic patients is of special interest. Aim To compare the frequency of corneal oedema in two age-matched groups of diabetics and non diabetic patients that underwent cataract surgery in the Ophthalmology Department of Xanthi General Hospital in Greece. Methods A retrospective case control study was conducted in a retrospective fashion. Patients in the control and study groups were assessed regarding the severity of corneal oedema at three postoperative visits: days 1, 3–7, 10–14 after the operation. Ultrasound energy consumed during phacoemulsification was also a parameter of interest and possible correlations with the pre-existent cataract severity and the subsequent incidence of corneal oedema were investigated. Results The difference in the incidence of severe corneal oedema between the study and control group was statistically significant: (4.5% non diabetics vs 14.3% diabetics). The consumed ultrasound energy did not define final clinical outcome. Conclusions The existence of diabetes mellitus type 2 appears to be a significant risk factor for the development of persistent corneal oedema. The results of our study led to the modification of the algorithm for postoperative follow-up of patients of this remote area of Greece.
Ultrasound energy is not the only defining factor for the development of corneal oedema. Persistent corneal oedema is more frequent in diabetic patients 2 weeks postoperatively. Modern Greek public health system requires modifications in clinical governance issues.
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Affiliation(s)
- Konstantinos T Tsaousis
- Department of Ophthalmology, General Hospital of Xanthi, Greece; 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece
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Vislisel JM, Liaboe CA, Wagoner MD, Goins KM, Sutphin JE, Schmidt GA, Zimmerman MB, Greiner MA. Graft survival of diabetic versus nondiabetic donor tissue after initial keratoplasty. Cornea 2015; 34:370-4. [PMID: 25642643 DOI: 10.1097/ico.0000000000000378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare corneal graft survival using tissue from diabetic and nondiabetic donors in patients undergoing initial Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP). METHODS A retrospective chart review of pseudophakic eyes that underwent DSAEK or PKP was performed. The primary outcome measure was graft failure. Cox proportional hazard regression and Kaplan-Meier survival analyses were used to compare diabetic versus nondiabetic donor tissue for all keratoplasty cases. RESULTS A total of 183 eyes (136 DSAEK, 47 PKP) were included in the statistical analysis. Among 24 procedures performed using diabetic donor tissue, there were 4 cases (16.7%) of graft failure (3 DSAEK, 1 PKP), and among 159 procedures performed using nondiabetic donor tissue, there were 18 cases (11.3%) of graft failure (12 DSAEK, 6 PKP). Cox proportional hazard ratio of graft failure for all cases comparing diabetic with nondiabetic donor tissue was 1.69, but this difference was not statistically significant (95% confidence interval, 0.56-5.06; P = 0.348). There were no significant differences in Kaplan-Meier curves comparing diabetic with nondiabetic donor tissue for all cases (P = 0.380). Statistical analysis of graft failure by donor diabetes status within each procedure type was not possible because of the small number of graft failure events involving diabetic tissue. CONCLUSIONS We found similar rates of graft failure in all keratoplasty cases when comparing tissue from diabetic and nondiabetic donors, but further investigation is needed to determine whether diabetic donor tissue results in different graft failure rates after DSAEK compared with PKP.
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Affiliation(s)
- Jesse M Vislisel
- *Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City, IA; †Iowa Lions Eye Bank, Coralville, IA; ‡Department of Ophthalmology, Kansas University Medical Center, Kansas City, KS; and §Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA
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Calabuig-Goena M, López-Miguel A, Marqués-Fernández V, Coco-Martín MB, Iglesias-Cortiñas D, Maldonado MJ. Early Changes in Corneal Epithelial Thickness after Cataract Surgery--Pilot Study. Curr Eye Res 2015; 41:311-7. [PMID: 25803625 DOI: 10.3109/02713683.2015.1014565] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess early variations in central and paracentral corneal epithelial and non-epithelial thicknesses after uneventful clear corneal incision phacoemulsification. MATERIALS AND METHODS Twenty patients with a senile cataract underwent coaxial phacoemulsification through a 2.75-mm-wide corneal incision created at 180° in a prospective cohort pilot study. Corneal sublayer thickness measurements were obtained with Fourier-domain optical coherence tomography (FD-OCT, Cirrus HD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA) before and after 1 week and 1 month postoperatively. Central measurements were performed in the middle of the FD-OCT scan and in the 3-mm corneal diameter (paracentral 180° and 0° locations). Epithelial, non-epithelial and total corneal pachymetry were measured at the central and paracentral locations. RESULTS No significant changes in epithelial thickness were seen 1 week postoperatively. However, 1 month postoperatively, the central, 180°, and 0° paracentral epithelial thicknesses (52.7 ± 3.8, 53.1 ± 5.4, and 52.7 ± 5.3 µm, respectively) decreased significantly (p < 0.01) compared to preoperatively (57.2 ± 4.8, 58.0 ± 5.7, 56.6 ± 5.3 µm, respectively). The 1-week central, 180°, and 0° paracentral non-epithelial corneal thicknesses (515.5 ± 39.6, 534.3 ± 45.6, and 521.3 ± 36.9 µm) were significantly (p < 0.01) higher than preoperatively (486.2 ± 34.7, 498.2 ± 33.8, 497.5 ± 32.3 µm, respectively). The non-epithelial corneal thickness increase was significantly (p = 0.02) greater after 1 week in the central (29.3 ± 17.2 µm) and the 180° paracentral (36.1 ± 28.7 µm) locations than at the 0° paracentral location (23.8 ± 16.5 µm). CONCLUSIONS Immediate postoperative corneal edema following phacoemulsification irregularly affects the cornea at the sublayer level. The initial central and paracentral non-epithelial thickening is compensated by subsequent central and paracentral epithelial thinning. These initial changes occurred more markedly closest to the main incision over the entrance pupil, which may have visual implications.
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Affiliation(s)
- María Calabuig-Goena
- a IOBA, Universidad de Valladolid , Valladolid , Spain and.,b Departamento de Oftalmología , Hospital Universitario Rio Hortega , Valladolid , Spain
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Lass JH, Riddlesworth TD, Gal RL, Kollman C, Benetz BA, Price FW, Sugar A, Terry MA, Soper M, Beck RW. The effect of donor diabetes history on graft failure and endothelial cell density 10 years after penetrating keratoplasty. Ophthalmology 2015; 122:448-56. [PMID: 25439611 PMCID: PMC4339512 DOI: 10.1016/j.ophtha.2014.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/04/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To examine the long-term effect of donor diabetes history on graft failure and endothelial cell density (ECD) after penetrating keratoplasty (PK) in the Cornea Donor Study. DESIGN Multicenter, prospective, double-masked, controlled clinical trial. PARTICIPANTS One thousand ninety subjects undergoing PK for a moderate risk condition, principally Fuchs' dystrophy or pseudophakic or aphakic corneal edema, were enrolled by 105 surgeons from 80 clinical sites in the United States. METHODS Corneas from donors 12 to 75 years of age were assigned by 43 eye banks to participants without respect to recipient factors. Donor and recipient diabetes status was determined from existing medical records. Images of the central endothelium were obtained before surgery (baseline) and at intervals for 10 years after surgery and were analyzed by a central image analysis reading center to determine ECD. MAIN OUTCOME MEASURES Time to graft failure (regraft or cloudy cornea for 3 consecutive months) and ECD. RESULTS There was no statistically significant association of donor diabetes history with 10-year graft failure, baseline ECD, 10-year ECD, or ECD values longitudinally over time in unadjusted analyses, nor after adjusting for donor age and other significant covariates. The 10-year graft failure rate was 23% in the 199 patients receiving a cornea from a donor with diabetes versus 26% in the 891 patients receiving a cornea from a donor without diabetes (95% confidence interval for the difference, -10% to 6%; unadjusted P=0.60). Baseline ECD (P=0.71), 10-year ECD (P>0.99), and changes in ECD over 10 years (P=0.86) were similar comparing donor groups with and without diabetes. CONCLUSIONS The study results do not suggest an association between donor diabetes and PK outcome. However, the assessment of donor diabetes was imprecise and based on historical data only. The increasing frequency of diabetes in the aging population in the United States affects the donor pool. Thus, the impact of donor diabetes on long-term endothelial health after PK or endothelial keratoplasty, or both, warrants further study with more precise measures of diabetes and its complications.
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Affiliation(s)
- Jonathan H Lass
- Case Western Reserve University, Department of Ophthalmology and Visual Sciences, and University Hospitals Eye Institute, Cleveland, Ohio.
| | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | | | - Beth A Benetz
- Case Western Reserve University, Department of Ophthalmology and Visual Sciences, and University Hospitals Eye Institute, Cleveland, Ohio
| | | | - Alan Sugar
- W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | | | - Mark Soper
- Indiana Lions Eye Bank, Indianapolis, Indiana
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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Do JR, Oh JH, Chuck RS, Park CY. Transient corneal edema is a predictive factor for pseudophakic cystoid macular edema after uncomplicated cataract surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2015; 29:14-22. [PMID: 25646056 PMCID: PMC4309864 DOI: 10.3341/kjo.2015.29.1.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.
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Affiliation(s)
- Jae Rock Do
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jong-Hyun Oh
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Choul Yong Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea
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