Search Results (63)

Objectives: To evaluate the impact of different corneal storage containers—with and without corneal holders—on endothelial cell density (ECD) and endothelial cell loss (ECL) during organ culture, following a temporary shortage of Böhnke Donor Corneal Holders at a German eye bank. Methods: A retrospective analysis was conducted on 383 human donor corneas cultured in six types of containers between January and September 2024 at the Eye Bank of Rhineland-Palatinate. ECD was measured at 6.0 ± 1.2 days (ECD1) and again at 14.9 ± 4.4 days (ECD2) after retrieval using standardized organ culture protocols with an inverted light microscope. Group 1 (G1) used the standard 50 mL Corning^® flask with the Böhnke corneal holder. Groups 2–6 used alternative containers, with or without corneal holders. ECL was defined as the difference between ECD2 and ECD1. Results: Mean overall ECD1 was 2478.3 ± 843.4 cells/mm². G1 showed ECD1 < 2000 cells/mm² in 29% of corneas and low ECL (−1%). The 60 mL Ratiolab^® flask with Cornea-Claw^® was the best alternative, showing the lowest incidence of ECD1 < 2000 cells/mm² (7%) and no ECL. Containers without corneal holders, particularly the 100 mL Sterilin™ and 15 mL Cryogenic Tube^®, had significantly higher rates of ECD1 < 2000 (40% and 75%) and greater ECL (9% and 14%). Conclusions: Container design, especially volume and the presence of corneal holders, significantly influences endothelial preservation. Especially a lack of corneal holders led to unacceptable endothelial cell loss. Eye banks should prioritize appropriate flask configurations to minimize tissue deterioration, particularly during supply shortages. Full article

Background/Objectives: Although methylphenidate is a first-line pharmacological agent in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD), its long-term effects on ocular tissues, particularly the corneal endothelium, remain poorly understood. Given the cornea’s metabolic sensitivity, subclinical changes may occur even in the absence of overt ophthalmologic symptoms. This study aims to evaluate the impact of six-month methylphenidate treatment on corneal endothelial morphology and intraocular pressure (IOP) in pediatric patients with ADHD. Methods: This prospective observational study included 100 treatment-naive children with ADHD and 100 age- and sex-matched healthy controls. All participants underwent comprehensive ophthalmologic assessment at baseline. In the ADHD group, follow-up evaluations were performed after six months of methylphenidate therapy. Endothelial cell density (ECD), average cell area (AVE), standard deviation (SD), coefficient of variation (CV), hexagonality index (6A), central corneal thickness (CCT), and IOP were measured using specular microscopy and corneal topography. ADHD symptom severity was evaluated using the Turgay DSM-IV-Based Rating Scale. Results: Significant reductions in ECD and increases in CCT, CV, AVE, and SD were observed following treatment (p < 0.001). IOP also showed a statistically significant increase while remaining within normal physiological limits. Weak but significant correlations were found between inattention scores and ECD (r = 0.222), and between inattention and corneal volume (r = −0.248). Conclusions: Chronic methylphenidate use may be associated with measurable changes in corneal endothelial microstructure and IOP in children with ADHD. These findings highlight the need for routine ophthalmologic monitoring during stimulant therapy and underscore the importance of further large-scale, long-term studies exploring the neuro-ophthalmologic implications of pediatric psychopharmacological treatment. Full article

Background: This prospective observational study was conducted to systematically assess immediate changes occurring (within one hour) in corneal endothelial cell morphology and anterior segment parameters following Nd:YAG laser posterior capsulotomy in pseudophakic patients and to analyze the correlation between these changes and laser energy parameters. Methods: A single-arm, within-subject pre–post design was employed to evaluate corneal endothelial morphology (cell density, count, area, coefficient of variation and hexagonal percentage) and anterior chamber parameters (depth, angle, volume) before and one hour after the procedure using specular microscopy and Pentacam analysis. Patient demographics (age), clinical parameters (best corrected visual acuity and intraocular pressure), postoperative-YAG laser interval, and laser energy parameters (energy per shot, pulse count, and total applied energy) were also documented. Results: Thirty-two pseudophakic patients (mean age 56.3 ± 19.2 years) underwent Nd:YAG laser posterior capsulotomy with mean energy per shot of 3.15 ± 1.07 mJ and pulse count of 34.3 ± 20.4. Specular microscopy revealed significant post-procedural decreases in endothelial cell density (2184.05 to 2057.2 cells/mm²; p = 0.006) and increases in average cell area (529.25 ± 242.72 to 587.75 ± 281.09 µm²; p = 0.004) and minimum cell area (199.3 ± 170.62 to 248.35 ± 202.7 µm²; p = 0.035). Corneal topography also decreased significantly in the anterior chamber angle (40.07 ± 10.34 to 35.42 ± 6.78 degrees; p = 0.048), with positive correlations between energy per shot and endothelial cell density (r = 0.557; p = 0.011) and average cell area (r = 0.544; p = 0.013). Conclusions: This study demonstrates that Nd:YAG laser capsulotomy causes immediate, energy-dependent alterations in corneal endothelial density and anterior chamber parameters within one hour post-procedurally. The identification of energy per shot as a key determinant represents a preliminary observation for optimizing laser parameters and reducing potential complications in pseudophakic patients. Full article

Polyhexamethylene guanidine phosphate (PHMG-p), a widely used disinfectant component in household humidifiers, has been implicated in various health issues, including pulmonary toxicity. Many people use humidifiers to improve dry eye disease (DED). The current study was performed to elucidate the effect of PHMG-p on eye dryness in a rat model using metabolomics. Male Sprague Dawley rats were exposed to PHMG-p (0.1% and 0.3%) following a previously established DED induction model using scopolamine hydrobromide and desiccation stress. Ocular surface damage was assessed using corneal fluorescein staining, tear volume measurement, and tear break-up time (TBUT). Plasma and urine samples were analyzed using ¹H-NMR-based metabolomics to identify metabolic alterations associated with PHMG-P-p exposure and DED pathogenesis. PHMG-p exposure exacerbated DED symptoms, as evidenced by a significant reduction in tear volume, shorter TBUT, and increased corneal damage compared to the control group. Metabolomic profiling identified distinct metabolic changes in PHMG-p-exposed groups, including alterations in glutamate, glycine, citrate, and succinate metabolism. These metabolic changes correlated with increased levels of inflammatory cytokines such as IL-1β, IL-6, and TNF-α in the corneal and lacrimal gland tissues. Our findings suggest that PHMG-p exposure contributes to DED pathophysiology by inducing metabolic disturbances and inflammatory responses in the ocular surface. This study highlights the need for further investigation into the potential risks of PHMG-p exposure on ocular health and provides novel insights into the metabolic underpinnings of DED. Full article

Objectives: This study aimed to evaluate the safety and efficacy of the eight-chop technique in cataract surgery in patients with pseudoexfoliation (PEX) syndrome and assess the intraoperative parameters, changes in corneal endothelial cells, intraocular pressure (IOP), and intraoperative complications. Methods: This technique was applied in patients with and without PEX syndrome. Preoperative and postoperative assessments were conducted on best-corrected visual acuity, IOP, corneal endothelial cell density (CECD), coefficient of variation, percentage of hexagonal cells, and central corneal thickness. Intraoperative recordings included operative time, phaco time, aspiration time, cumulative dissipated energy (CDE), and fluid of volume used. Results: We analyzed 150 eyes from 150 patients (mean age, 75.5 ± 5.7 years; 59 men, 91 women). In the PEX group, operative time, phaco time, aspiration time, CDE, and volume of fluid used were 6.7 min, 17.4 s, 85.2 s, 6.91 µJ, and 33.4 mL, respectively, demonstrating favorable surgical metrics. On the other hand, in the control group, operative time, phaco time, aspiration time, CDE, and volume of fluid used were 4.5 min, 14.3 s, 64.0 s, 5.83 µJ, and 25.5 mL, respectively. In addition, CECD losses were 3.7% at week 7 and 2.7% at week 19 in the PEX group and 2.7% and 1.6%, respectively, in the control group. Significant decreases were observed at 7 and 19 weeks postoperatively in the PEX and control groups. No eye in the PEX group required a capsular tension ring due to zonular dialysis. Conclusions: The eight-chop technique in cataract surgery demonstrates excellent intraoperative parameters in patients with PEX, is effective against zonular weakness, and does not require the use of a capsular tension ring. This technique will aid in establishing personalized treatment strategies and improve cataract management and treatment. Full article

Radiation-induced keratoconjunctivitis sicca (KCS) is a significant late complication in dogs receiving radiation therapy for intranasal tumors, particularly with hypofractionated intensity-modulated radiation therapy (IMRT). This retrospective case-control study was performed to identify anatomical and dosimetric risk factors for KCS in 15 canine patients treated with IMRT delivered in 4–6 weekly fractions of 8 Gy. Orbital structures were retrospectively contoured, and dose–volume metrics (D50) were calculated. Receiver operating characteristic (ROC) curve analysis and odds ratios were used to evaluate the associations between radiation dose and KCS development. Six dogs (33%) developed KCS within three months post-treatment. Statistically significant dose differences were observed between affected and unaffected eyes for the eyeball, cornea, and retina. ROC analyses identified dose thresholds predictive of KCS: 13.8 Gy (eyeball), 14.9 Gy (cornea), and 17.0 Gy (retina), with the retina showing the highest odds ratio (28.33). To ensure clinical relevance, KCS was diagnosed based on decreased tear production combined with corneal damage to ensure clinical relevance. This study proposes dose thresholds for ocular structures that may guide treatment planning and reduce the risk of KCS in canine patients undergoing IMRT. Further prospective studies are warranted to validate these thresholds and explore mitigation strategies for high-risk cases. Full article

Background/Objectives: To analyze corneal endothelial changes and intraocular pressure (IOP) after phacoemulsification combined with the eight-chop technique and intraoperative parameters in patients with diabetes mellitus. Methods: The eyes of patients with cataracts who underwent phacoemulsification were analyzed in this study. Based on their hemoglobin A1c levels, patients were divided into two groups. The eight-chop technique was used for cataract surgery. The operative time, the phaco time, the aspiration time, the cumulative energy dissipated, and the volume of fluid used were determined. Best corrected visual acuity, IOP, corneal endothelial cell density (CECD), central corneal thickness (CCT), coefficient of variation (CV), and percentage of hexagonal cells (PHC) were recorded before and after surgery. Results: Overall, 181 eyes of 138 patients with cataracts were evaluated. In the diabetes group, the CECD loss rates were 5.1%, 3.9%, and 2.1% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. In the control group, the CECD loss rates were 2.8%, 2.6%, and 1.2% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. Significant differences in the percentage decrease in CECD were observed between the two groups at 7 and 19 weeks postoperatively. Significant differences in the CV and PHC were observed preoperatively and postoperatively between the diabetes and control groups (p < 0.01 or p = 0.01, 0.02). Significant differences were also observed between CV and PHC preoperatively, at 19 weeks, and 1 year postoperatively in the diabetes and control groups (p < 0.01). At 1 year postoperatively, IOP reduction rates were 8.0% and 11.2% in the diabetes and control groups, respectively. Conclusions: CECD loss was minimal with the eight-chop technique; however, the diabetes group showed a higher percentage decrease than the control group up to 19 weeks postoperatively. In addition, although IOP decreased in both groups after surgery, the percentage decrease was significantly different at 1 year postoperatively. This study suggests that the corneal endothelial cells of diabetic eyes may be more fragile than those of normal eyes and that the long-term postoperative IOP-lowering effect may be attenuated. These findings will contribute to advances in personalized treatment strategies for patients with diabetes. Full article

Background/Objectives: Dry eye disease (DED) is a multifactorial inflammatory disease that disrupts the ocular surface, causing tear film instability, epithelial damage, and chronic inflammation. Mesenchymal stem cell-derived exosomes (MSC-exos) are promising therapeutics with immunomodulatory and regenerative properties. This study investigates the therapeutic effects of umbilical cord MSC-derived exosomes (UCMSC-exos) in a severe dry eye model, induced by a surgical resection of the infra-orbital (ILG) and extra-orbital lacrimal gland (ELG) in rats. Methods: Clinical evaluations, including tear volume measurement, slit lamp biomicroscopy, fluorescein staining, and spectral domain optical coherence tomography (SD-OCT), were performed to assess corneal neovascularization, corneal abrasion, and epithelial/stromal thickness. Histopathological analysis, immunohistochemistry, and mRNA gene expression were conducted to evaluate corneal tissue changes and inflammatory marker expression. Results: The results show that the treatment group exhibited significantly reduced corneal neovascularization compared to the control group (p = 0.030). During the first month, the Exo group also had a significantly lower corneal fluorescein staining area (p = 0.032), suggesting accelerated wound healing. SD-OCT analysis revealed that the corneal epithelial thickness in the treatment group was closer to normal levels compared to the control group (p = 0.02 and p = 0.006, respectively). UCMSC-exos treatment also modulated the expression of α-SMA and apoptosis in the cornea. Additionally, the gene expression of inflammatory cytokines (IL-1β and TNF-α) were downregulated. Conclusions: These findings suggest that MSC-exosome therapy offers a novel, cell-free regenerative approach for managing severe DED, modulating inflammatory response. Full article

Objectives: Intraocular lens dislocation is a well-recognized complication of cataract surgery, necessitating secondary interventions such as retropupillary iris-claw IOL implantation. While effective, this procedure requires larger incisions that may induce significant astigmatism. This study aimed to (1) evaluate anterior chamber changes following retropupillary ICIOL implantation and (2) compare surgically induced astigmatism between corneal and scleral incision techniques. Methods: In this prospective cohort study, patients with IOL dislocation underwent 25-gauge pars plana vitrectomy with ICIOL implantation. Anterior chamber depth, volume, and angle configuration were measured across 12 meridians preoperatively, at 1–1.5 months (short-term), and 5–6 months (long-term). Surgically induced astigmatism was compared between the corneal and scleral incision groups. Statistical analysis included Shapiro–Wilk, Mann–Whitney U, and repeated-measures ANOVA tests. Results: This prospective study included 40 patients (22 females, 18 males) with a mean age of 76.3 ± 5.38 years (range 65–86). Significant reductions in ACD and ACV occurred postoperatively (p < 0.05), with partial recovery at long-term follow up. Surgically induced astigmatism was markedly higher with corneal incisions versus scleral approaches (p < 0.01 short term; p < 0.05 long term). Anterior chamber angle changes varied by meridian but stabilized by 6 months. Conclusions: Retropupillary ICIOL implantation induces predictable anterior segment remodeling, with scleral incisions offering superior refractive stability. Surgical planning should prioritize scleral techniques to minimize surgically induced astigmatism while maintaining anatomical efficacy. Future innovations in IOL design may further reduce incision-related complications. Full article

This study aimed to evaluate the effectiveness of an innovative platform (the Bilateral Corneal Symmetry 3-D Analyzer—BiCSA) and a novel corneal symmetry index (the Volume Between Spheres—VBS) in differentiating normal corneas from those with keratoconus. Pentacam imaging data from 30 healthy corneas and 30 keratoconus cases were analyzed. BiCSA was utilized to determine the VBS for each case. Statistical analyses included comparing mean VBS values between groups and assessing sensitivity, specificity, and positive predictive values (PPVs). Keratoconus patients exhibited significantly higher VBS scores compared to healthy controls, particularly within the central 4.0 mm zone (11.4 versus 6.3). Using a VBS threshold of 11.3 in the central zone identified 40% of keratoconus cases (40% sensitivity), but 100% of cases surpassing the threshold were keratoconus (100% PPV). Lowering the threshold to 10.4 increased case detection to 90% while maintaining a high PPV (84.2%). These findings suggest that VBS, particularly when focused on the central 4.0 mm zone, can be a valuable tool for early keratoconus screening and identifying potential corneal abnormalities requiring further clinical evaluation. No healthy control corneas in this study exceeded a VBS threshold of 11.4 at 4 mm, indicating that values above this warrant further investigation. Full article

Objectives: In this study, the correlation between anterior chamber depth (ACD) and corneal endothelial cell density (CECD) loss was evaluated, and an assessment was made of the safety and efficacy of the eight-chop technique in cataract surgery for patients with shallow anterior chamber (SAC) depth. Methods: The technique was applied to patients with SAC and normal ACD, defined as <3 mm and ≥3 mm, respectively. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), CECD, coefficient of variation, percentage of hexagonal cells, and central corneal thickness were assessed pre- and postoperatively. Operative time, phaco time, aspiration time, cumulative dissipated energy (CDE), and volume of fluid used were recorded intraoperatively. Results: A total of 180 eyes from 99 patients (mean age, 74.8 ± 5.1 years; 28 men, 71 women) were analyzed. In the SAC group, the mean operative time, phaco time, aspiration time, CDE, and volume of fluid used were 4.7 min, 15.4 s, 65.6 s, 5.87, and 26.6 mL, respectively, demonstrating favorable surgical metrics. CECD loss was 1.3% at 7 weeks, 1.1% at 19 weeks, and 0.9% at 1 year, with no significant decrease after surgery in the SAC group. No correlation was observed between CECD loss and ACD in either group. Conclusions: These findings suggest that the eight-chop technique is a minimally invasive and effective approach that preserves corneal endothelial integrity, even in patients with SAC depth. Full article

Objectives: To estimate the efficacy of the eight-chop technique in phacoemulsification surgeries for patients with hard nucleus cataracts by investigating the reduction of corneal endothelial cell density (CECD) after phacoemulsification and intraoperative parameters. Methods: Patients were categorized into three groups (Grade IV, IV plus, and V) according to the hardness of their lens nuclei. Surgeries were performed using the eight-chop technique. Key intraoperative metrics (operative time, phaco time, aspiration time, cumulative dissipated energy [CDE], and fluid volume used) were measured. Pre- and postoperative assessments included corrected-distance visual acuity, intraocular pressure (IOP), central corneal thickness, variation in the size of the endothelial cells, percentage of hexagonal cells, and CECD. Results: Overall, 89 eyes from 67 patients with cataracts were evaluated. The mean operative time, phaco time, aspiration time, CDE, and fluid volume used across Grades IV, IV plus, and V were 10.5 min, 38.9 s, 135.6 s, 19.2, and 53.0 mL, respectively. At 19 weeks postoperatively, the CECD decreased by 0.2%, 6.8%, and 9.6% for Grades IV, IV plus, and V, respectively, with an average decrease of 3.7%. Significant reductions in postoperative IOP were observed across all groups compared with preoperative IOP (p < 0.01). Loss of CECD significantly correlated with phaco time, CDE, and fluid volume (p = 0.027, p < 0.01, and 0.034, respectively). Conclusions: The eight-chop technique in phacoemulsification for hard nucleus cataracts resulted in minimal CECD loss. It may provide an effective surgical solution for patients with hard nucleus cataracts. Full article

We aimed to determine the effects of night-shift work on corneal parameters in thirty-five healthy individuals (24–59 years) in a retrospective cohort study. Among them, 12 hospital nurses regularly worked two shifts, spending a third of their nights awake, whereas 23 age-matched controls never worked shifts and slept regularly. Measurements were performed at least five times within 12 h. We analyzed the keratometric parameters of the corneal front (F) and back (B) surfaces, including the refractive power in the flattest and steepest axes (K1, K2), astigmatism (Astig); and corneal pachymetry (Pachy) at the thinnest corneal point and pupil center, volume relative to the 10 mm corneal diagonal (Vol D10); and surface variance index (ISV). A multilevel mixed-effects linear regression adjusted for age was applied to 905 measurements. All parameters exhibited significant periodic fluctuations (p ≤ 0.005). The two groups also showed significantly different periodic fluctuations (p ≤ 0.008), except in K1B and AstigB. K1/K2 (F and B), AstigF, Pachy, and ISV differed significantly (p < 0.0001). Surprisingly, prolonged night shift work did not increase the ISV, and no evidence of age-related corneal thinning was observed. Long-term night-shift exposures change various corneal parameters, reflecting both concomitant and adaptive effects. This study highlights the impact of consistent sleep deprivation on corneal properties, warranting further research into understanding the long-term effects of night-shift work. Full article

Background/Objectives: A novel ophthalmic formulation, XanterDES, containing 0.2% xanthan gum and 0.025% desonide sodium phosphate (DES), was developed to alleviate ocular surface discomfort and irritation. This study aimed to evaluate its pharmacodynamic properties and to characterize its rheological behavior and mucoadhesive characteristics, compared to another formulation containing 0.2% hyaluronic acid and 0.001% hydrocortisone (HYD). Methods: A rabbit (New Zealand White) model of LPS-induced uveitis was used to test different concentrations of DES on ocular markers of inflammation. The efficacy of XanterDES and HYD on induced dry eye was evaluated by assessing tear volume and corneal damage in C57BL/6 mice exposed to a controlled environmental chamber. The rheological and mucoadhesive properties of XanterDES and HYD were assessed using a HAAKE RheoStress RS600 rheometer and a TA-XT2 texture analyzer, respectively. Results: In the uveitis model, unlike DES 0.25%, a low concentration of 0.025% DES showed a significant inhibitory activity localized to the eye surface and effectively reduced corneal edema. In the dry eye model, XanterDES demonstrated superior efficacy compared to HYD, effectively preventing both tear volume reduction and corneal damage. XanterDES also demonstrated pseudoplastic and enhanced mucoadhesive properties compared to HYD. Conclusions: The ancillary anti-inflammatory effects of a low dose of DES combined with the biophysical properties of xanthan gum are supportive of a favorable therapeutic profile, promoting the maintenance or restoration of ocular surface homeostasis while minimizing the risk of adverse effects typically associated with standard-dose corticosteroids. The comparison with another low-dose corticosteroid highlights the superiority of XanterDES in pharmacodynamic and biophysical performance. Full article

Background/Objectives: This study aimed to evaluate the therapeutic effects of combined 5% lifitegrast (LF) and tocopherol (TCP) eye drops in a murine experimental dry eye (EDE) model. Methods: Female C57BL/6 were divided into seven groups: untreated controls, EDE control, EDE + 0.05% cyclosporin A (CsA), EDE + tocopherol (TCP), EDE + 5% LF, EDE + 5% LF + TCP (once daily), and EDE + 5% LF + TCP (twice daily). Clinical parameters (tear volume, tear break-up time (TBUT), corneal fluorescein staining score (CFSS), tear film lipid layer grade (TFLLG)) were assessed on days 7 and 14. Goblet cell density in the conjunctiva, CD4+ IFN-γ+ T cells, interleukin levels, reactive oxygen species (ROS) levels, and corneal apoptotic cells were analyzed on day 14. Results: Monotherapy with 0.05% CsA and LF showed improvements in all clinical parameters compared to the EDE control (p < 0.05). Combination therapy groups demonstrated superior improvements in clinical parameters compared to the EDE control, 0.05% CsA, and 5% LF groups. CD4+ IFN-γ+ T cell percentages and ROS levels in the cornea and conjunctiva were markedly reduced in the combination groups compared with the 0.05% CsA and 5% LF groups (p < 0.01). Furthermore, corneal apoptotic cells significantly decreased in the combination groups compared to the 0.05% CsA and TCP groups (p < 0.05). Conclusions: Combined 5% LF and TCP eye drops improved tear film parameters and reduced inflammatory and oxidative stress markers. The combination therapy can mitigate ocular surface damage by managing inflammation and oxidative stress in dry eye. Full article