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. 2025 Apr 29.
doi: 10.1007/s00417-025-06846-1. Online ahead of print.

Intracellular dark endothelial spots: A new imaging biomarker for the development of bullous keratopathy after cataract surgery

Taiyo Shijo  1 , Yukari Yagi-Yaguchi  1 , Osama Ibrahim  1 , Hirotsugu Kasamatsu  1 , Yurina Mori-Ogiwara  1 , Daisuke Tomida  1 , Hisashi Noma  2 , Dogru Murat  1 , Takefumi Yamaguchi  3
Affiliations

Intracellular dark endothelial spots: A new imaging biomarker for the development of bullous keratopathy after cataract surgery

Taiyo Shijo et al. Graefes Arch Clin Exp Ophthalmol. .

Abstract

Purpose: Intracellular dark endothelial spots (IDES) on specular microscopy indicate corneal endothelial stress, and can be an imaging biomarker for subsequent endothelial cell density (ECD) loss after endothelial keratoplasty. This study evaluated the risk factors for the development of bullous keratopathy (BK) by comparing low ECD patients with or without IDES before cataract surgery.

Methods: This retrospective study included 106 consecutive patients who underwent cataract surgery with a preoperative ECD of less than 1000 cells/mm2. The patients were divided into 2 groups according to presence of IDES. The medical charts were retrospectively reviewed for preoperative central corneal thickness (CCT), ECD, anterior chamber depth (ACD), presence of IDES, presence of guttae, grade of nuclear sclerosis, intraoperative posterior capsule rupture (PCR) and development of BK after cataract surgery. The clinical factors were compared in patients with or without IDES and the risk factors for BK after cataract surgery were evaluated.

Results: The mean preoperative ECD was 687 ± 124 cells/mm2. IDES were observed in 41 eyes (38.7%). IDES were significantly more common in eyes with shallow ACD than in those with deep ACD (P = 0.033). Twenty-two eyes (20.8%) developed BK after cataract surgery. IDES were significantly associated with the development of BK (31.7%) compared to those without BK (13.9%, P = 0.03). CCT, nuclear sclerosis, PCR, and IDES were identified as significant risk factors for postoperative BK (P < 0.0083).

Conclusion: IDES can be used as a new imaging biomarker that suggests a potential risk for development of BK in patients with shallow anterior chamber who are to undergo cataract surgery.

Keywords: Bullous keratopathy; Cataract surgery; Endothelial cell density; Intracellular dark endothelial spot; Specular microscopy.

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Conflict of interest statement

Declarations. Ethical approval: This study was approved by the Institutional Ethics Review Board of Tokyo Dental College Ichikawa General Hospital (Institution Review Board No.: I- 22 - 06R and I 2414-2502). All the procedures conformed to the tenets of the Declaration of Helsinki and the Japanese Guidelines for Life Science and Medical Research. Conflict of interest disclosures: None. Financial interests: No financial disclosures. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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