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Pu Y, Zhang W, Zhang X, Xia L, Yang P. Corneal Endothelial Changes in Chinese Patients with Fuchs' Uveitis Syndrome. Ocul Immunol Inflamm 2025; 33:439-445. [PMID: 39432374 DOI: 10.1080/09273948.2024.2417187] [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: 05/24/2024] [Revised: 09/30/2024] [Accepted: 10/11/2024] [Indexed: 10/23/2024]
Abstract
PURPOSE To analyze the changes of corneal endothelial cells in Chinese patients with unilateral Fuchs' uveitis syndrome (FUS) and investigate the factors relevant to these changes. METHODS Bilateral specular microscopic examination was performed in 459 Chinese patients with unilateral FUS from April 2008 to April 2023. The affected eyes constituted the study group, while the contralateral eyes served as controls. RESULTS The median values of endothelial cell density (ECD), cell count, total cell size, and hexagonality were significantly lower in the FUS eyes compared to the control eyes (p < 0.001). The median values of average cell size, maximum cell size, SD of cell size, and CV were significantly higher in the FUS eyes compared to the control eyes (p < 0.001). Central ECD showed a negative correlation with age (r = -0.339; p < 0.001), maximum IOP (r = -0.127; p = 0.006), and the interval since symptom onset (r = -0.172; p < 0.001). The ECD was lower in eyes with ocular hypertension compared to those without ocular hypertension (p < 0.001). Eyes with KPs distributed on the central corneal endothelium had a significantly lower ECD than those with KPs distributed diffusely or KPs distributed triangularly on the inferior corneal endothelium (p = 0.006). CONCLUSION Our findings suggest decreased ECD, increased cell size, and morphological alterations in the affected eyes of Chinese patients with FUS. The reduction in ECD is correlated with age, elevated IOP, the interval since symptom onset, and the distribution of KPs.
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Affiliation(s)
- Yanlin Pu
- The First Affliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Wanyun Zhang
- The First Affliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xinle Zhang
- The First Affliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lan Xia
- The First Affliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
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Ibanez-Esparza MO, González-Salinas R, Concha-Del-Río LE, Navarro-López P. Findings in Corneal Endothelium by Confocal and Specular Microscopy in Patients with Fuchs Uveitis Syndrome Undergoing Phacoemulsification. Ocul Immunol Inflamm 2025; 33:432-438. [PMID: 39446716 DOI: 10.1080/09273948.2024.2416531] [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: 02/08/2024] [Revised: 10/04/2024] [Accepted: 10/08/2024] [Indexed: 10/26/2024]
Abstract
PURPOSE To compare corneal endothelial changes in patients with Fuchs Uveitis Syndrome (FUS) undergoing phacoemulsification surgery using confocal and specular microscopy. METHODS We included 14 patients with unilateral FUS and cataracts who underwent phacoemulsification surgery in a Mexican referral center for inflammatory eye diseases. Preoperative confocal and specular microscopies were conducted, establishing baseline images for subsequent analyses. Surgery on the FUS eye was performed by a single surgeon and an intraocular lens was implanted in all cases. Both specular and confocal microscopy were repeated 6 months after FUS eye surgery and compared with baseline images. We used Image J to do a manual segmentation of KP and determine their density for further analysis hence developing a new tool for confocal microscopy image analysis. RESULTS All patients underwent uneventful phacoemulsification surgery in the FUS eye. There was no significant change in endothelial cell density (ECD) from 2257 (±508.2) cells/mm2 preoperatively to 2214 (±535.1) cells/mm2 postoperatively (p = 0.809). Confocal microscopy revealed a decrease in Keratic Precipitate Density (KPD) from a median of 1413 (±2809.7) KPs/mm2 preoperatively to a median of 685.5 (1527.9) KPs/mm2 postoperatively (p = 0.036). CONCLUSIONS Phacoemulsification surgery in patients with FUS produces no significant loss of endothelial cells and morphological changes that can be detected by confocal and specular microscopy. We found a reduction in KPD 6 months after surgery on confocal microscopy. Additionally, our manual segmentation technique for KPs utilizing Image J offers a novel and practical approach for confocal microscopy image analysis.
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Affiliation(s)
- Miguel O Ibanez-Esparza
- Inflammatory Eye Diseases Clinic, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - Roberto González-Salinas
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - Luz-Elena Concha-Del-Río
- Inflammatory Eye Diseases Clinic, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - Patricia Navarro-López
- Inflammatory Eye Diseases Clinic, Asociación para Evitar la Ceguera en México, IAP, Mexico City, Mexico
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Mejía-Salgado G, Muñoz-Vargas PT, Cifuentes-González C, Flórez-Esparza G, Paquentín-Jiménez R, Castro-Monreal MÁ, Medina-Galindo N, Hernández-Herrera GN, Concha-del-Río LE, de-la-Torre A. Quantitative changes in the corneal endothelium and central corneal thickness during anterior chamber inflammation: A systematic review and meta-analysis. PLoS One 2024; 19:e0296784. [PMID: 38181008 PMCID: PMC10769021 DOI: 10.1371/journal.pone.0296784] [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: 06/16/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE To establish the effects of anterior chamber inflammation (ACI) on the corneal endothelium parameters and central corneal thickness (CCT). METHODS We conducted a comprehensive literature review using medical databases (PubMed, EMBASE, VHL, and medRxiv) on March 8, 2023, for studies that included patients with ACI who had undergone specular microscopy or pachymetry. Case series with >10 patients, cross-sectional, case-control, and cohort studies were included. The risk of bias was assessed using CLARITY tools and validated scales such as those by Hassan Murad et al. and Hoy et al. A narrative synthesis and a quantitative standardized mean difference meta-analysis, I2 heterogeneity assessment, and publication bias tests were conducted. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethical committee (DVO005 2277- CV1712). RESULTS Thirty-four studies, encompassing 1,388 eyes with ACI, were included. Compared with healthy controls, overall, ACI eyes show significant mean differences in endothelial parameters (endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX)) (P < 0.05). In the subgroup analysis compared with healthy controls, both active and chronic-recurrent ACI demonstrated a reduced ECD. An increased CV was observed in active, inactive, and chronic-recurrent ACI. Lower HEX was evident in inactive, acute, and chronic-recurrent ACI, while both active and acute ACI exhibited high CCT. CONCLUSION ACI leads to significant alterations in endothelial parameters and CCT. The primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Further studies are needed to explore the impact of ACI etiology on the endothelium, potential biases in IOP measurements during acute ACI episodes, and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI.
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Affiliation(s)
- Germán Mejía-Salgado
- Institute of Translational Medicine (IMT), Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Institute of Translational Medicine (IMT), Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Paula Tatiana Muñoz-Vargas
- Postgraduate Master’s Program in Epidemiology Universidad CES, Medellín, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
| | - Carlos Cifuentes-González
- Institute of Translational Medicine (IMT), Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Postgraduate Master’s Program in Epidemiology Universidad CES, Medellín, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
| | - Gabriela Flórez-Esparza
- Institute of Translational Medicine (IMT), Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rebeca Paquentín-Jiménez
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Miguel Ángel Castro-Monreal
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Naomi Medina-Galindo
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Gilma Norella Hernández-Herrera
- Postgraduate Master’s Program in Epidemiology Universidad CES, Medellín, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
| | - Luz Elena Concha-del-Río
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Alejandra de-la-Torre
- Institute of Translational Medicine (IMT), Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
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Cheng YY, Wang CY, Zheng YF, Ren MY. Hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome: A case report. World J Clin Cases 2022; 10:13081-13087. [PMID: 36568999 PMCID: PMC9782945 DOI: 10.12998/wjcc.v10.i35.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hammered silver appearance of the corneal endothelium is considered a characteristic change in iridocorneal-endothelial syndrome. Herein we report an interesting case of hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome (FUS). CASE SUMMARY A 49-year-old man with progressive vision loss in the right eye for one year was admitted to our hospital. The clinical manifestations of the patient's right eye were mild conjunctival hyperemia, scattered stellate keratic precipitates on the corneal endothelium, normal depth anterior chamber, 2+ cellular reaction in the aqueous humor, diffuse iris depigmentation, absence of synechia, Koeppe nodules, opalescent lens, and vitreous opacity. FUS and a complicated cataract were diagnosed based on the typical clinical manifestations. The corneal endothelial changes were recorded in detail by slit-lamp examination, specular microscopy, and in vivo confocal microscopy before cataract extraction, revealing a hammered silver appearance of the corneal endothelium in the affected eye, a wide-band dark area, as well as irregular corneal endothelial protuberances and dark bodies of various sizes. Subsequently, the patient underwent phacoemulsification combined with intraocular lens implantation, and his postoperative visual acuity recovered to 1.0. CONCLUSION Hammered silver appearance of the corneal endothelium in FUS, which is considered a more serious manifestation of endothelial damage, is rare and may be caused by many irregular protrusions in the corneal endothelium.
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Affiliation(s)
- Yan-Yan Cheng
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
| | - Cong-Ying Wang
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
| | - Yan-Fang Zheng
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
| | - Ming-Yu Ren
- Department of Glaucoma, Hebei Eye Hospital, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Key Laboratory of Ophthalmology, Xingtai 054000, Hebei Province, China
- Department of Glaucoma, Hebei Provincial Clinical Research Center for Eye Diseases, Xingtai 054000, Hebei Province, China
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Anterior segment structures in dark iris Chinese patients with unilateral Fuchs' uveitis syndrome. Int Ophthalmol 2022; 42:2939-2947. [PMID: 35366140 PMCID: PMC9420092 DOI: 10.1007/s10792-022-02282-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
Purpose To compare binocular anterior segment structures in Chinese patients with dark iris and unilateral Fuchs’ uveitis syndrome (FUS). Methods This was a cross-sectional study including 34 phakic eyes (17 patients) with unilateral FUS. Anterior segment parameters were measured by rotating Scheimpflug imaging camera, noncontact specular microscopy, and anterior segment optical coherence tomography. Results Corneal volume was higher in FUS eyes compared to unaffected eyes (p < 0.05). The iridocorneal angles were larger in FUS eyes compared to contralateral eyes (p < 0.05). Mean endothelial cell density (ECD) was lower, and the coefficient of variation in endothelial cell size and average cell area of endothelial cells (ACA) were higher, in FUS eyes (p < 0.05). Mean densitometry values of the midstromal cornea (zones with a diameter of 0–2, 2–6, or 10–12 mm), posterior (0–2, 2–6, 10–12, or 0–12 mm), or total thickness (0–2 or 2–6 mm) were higher in FUS eyes compared with unaffected eyes (p < 0.05). ECD, percentage of hexagonal cells, and ACA were strongly related to densitometry values of the midstromal and posterior cornea in the FUS eyes (p < 0.05). Smoothness index of iris was lager in affected eyes (p < 0.05). Conclusion In Chinese patients with unilateral FUS, loss of endothelial cells, wider iridocorneal angle, thicker cornea, higher corneal densitometry of midstromal and posterior layer, and smoother iris were observed in affected eyes compared to contralateral eyes. These data can help to elucidate anterior segment characteristics of unilateral FUS in this population.
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Abstract
Specular microscopy is a noninvasive diagnostic tool that allows for in vivo evaluation of corneal endothelium in health and various diseased states. Endothelial imaging helps in the diagnosis and management of several endothelial disorders. The review focuses on the principles of specular microscopy, limitations of endothelial imaging, and its interpretation in common conditions seen in the clinical practice. A thorough PubMed search was done using the keywords specular microscopy, corneal endothelium, and endothelial imaging.
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Affiliation(s)
- Sunita Chaurasia
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Murugesan Vanathi
- Cornea, Cataract and Refractive Surgery Service, RP Centre, AIIMS, New Delhi, India
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Srirampur A. Comments on: Corneal endothelium in unilateral Fuchs heterochromic iridocyclitis. Indian J Ophthalmol 2020; 68:2057. [PMID: 32823480 PMCID: PMC7690525 DOI: 10.4103/ijo.ijo_1072_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Arjun Srirampur
- Department of Cataract and Refractive Surgery, Anand Eye Institute, Hyderabad, Telangana, India
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