Accelerated corneal endothelial cell loss in two patients with granulomatosis with polyangiitis following phacoemulsification

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Abstract

Background

Generally, the loss rate of human endothelial cells (HCEC) in routine cataract surgery is 8.5%. When the corneal endothelial cells density (ECD) drops, the HCEC may decompensate to keep cornea dehydration which leads to corneal edema. Granulomatosis with polyangiitis (GPA) is an uncommon autoimmune disease involving multiple organs including eyes such as conjunctivitis, scleritis, uveitis, and corneal ulcer. In this study, we report two cases of GPA whose corneal ECD decreased significantly after phacoemulsification cataract surgery.

Case presentation

In the first case of 69-year-old male with GPA, the ECD dropped 39.6% (OD) four months after phacoemulsification and 38.1% (OS) six months postoperatively respectively. At the final follow-up, the residual ECD was only 55% in the right eye in the 49 ^th month, and 56% remained in the left eye in the 39 ^th month. In the second case of 54-year old female, left ECD dropped 63.9% at the 4 ^th month after surgery and 69.6% ECD remained at the 15 ^th month postoperatively while similar ECD of right eye before and after left eye surgery.

Conclusion

Extensive preoperative ophthalmic evaluation and meticulous postoperative inflammation control should be applied to prevent severe loss of HCEC in GPA patients.

Related collections

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Steroid-induced posterior subcapsular cataracts (PSCs) exhibit three main distinctive characteristics: (i) association only with steroids possessing glucocorticoid activity, (ii) involvement of aberrant migrating lens epithelial cells, and (iii) a central posterior location. The first characteristic suggests a key role for glucocorticoid receptor activation and subsequent changes to the transcription of specific genes. Glucocorticoid receptor activation is associated in many cell types with proliferation, suppressed differentiation, a reduced susceptibility to apoptosis, altered transmembrane transport, and enhancement of reactive oxygen species activity. Glucocorticoids may be capable of inducing changes to the transcription of genes in lens epithelial cells that are related to many of these cellular processes. This review examines the various mechanisms that have been proposed to account for the development of PSC in the context of recent DNA array studies. Additionally, given that the glucocorticoid receptor can also engender wide-ranging indirect activities, glucocorticoids could also indirectly affect the lens through the responses of other cells within the ocular compartment and/or through effects on cells at more remote locations. These indirect mechanisms, which, for example, could be mediated through alterations to the intraocular levels of growth factors that normally orchestrate lens development and maintain lens homeostasis, are also discussed. Although the mechanism of steroid cataract induction remains unknown, glucocorticoid-induced gene transcription events in lens epithelial cells, and also other intraocular or systemic cells, likely interact to generate steroid cataracts. Finally, although evidence for glucocorticoid-protein adduct formation in the lens is inconclusive, the generation of such adducts cannot yet be discounted as a contributing factor and must necessarily be retained in discussions of the etiology of steroid cataract.

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Author and article information

Contributors

Fang-Chi Hsiao: mtfredh@gmail.com

Hung-Ta Chen: b8001045@yahoo.com.tw

Kuan-Jen Chen: cgr999@gamil.com

Yi-Jen Hsueh: t6612@seed.net.tw

Yaa-Jyuhn James Meir: hercats1@gmail.com

Tsai-Te Lu: ttlu@mx.nthu.edu.tw

Chao-Min Cheng: chaomin@mx.nthu.edu.tw

Wei-Chi Wu: weichi666@gmail.com

Hung-Chi Chen:

ORCID: http://orcid.org/0000-0002-1117-7878

mr3756@cgmh.org.tw

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 7 December 2020

Publication date PMC-release: 7 December 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 480

Affiliations

[1 ]GRID grid.413801.f, ISNI 0000 0001 0711 0593, Department of Ophthalmology, , Chang Gung Memorial Hospital, ; No. 5, Fuxing Street, Guishan District, Linkou, Taoyuan, 33305 Taiwan

[2 ]GRID grid.145695.a, Department of Medicine, , Chang Gung University College of Medicine, ; Taoyuan, Taiwan

[3 ]Department of Internal Medicine, Taipei City Hospital- Heping Branch, Taipei, Taiwan

[4 ]Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan

[5 ]GRID grid.145695.a, Department of Biomedical Sciences, , Chang Gung University College of Medicine, ; Taiyuan, Taiwan

[6 ]GRID grid.38348.34, ISNI 0000 0004 0532 0580, Institute of Biomedical Engineering, , National Tsing Hua University, ; Hsinchu, Taiwan

Author information

Hung-Chi Chen http://orcid.org/0000-0002-1117-7878

Article

Publisher ID: 1752

DOI: 10.1186/s12886-020-01752-y

PMC ID: 7720459

SO-VID: 653c2bd1-5fe6-4f1c-bb6b-bbaa4b359b6a

License:

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