Quantitative Changes in the Corneal Endothelium and Central Corneal Thickness During Anterior Chamber Inflammation: a Systematic Review and Meta-analysis

Germán Mejía-Salgado, Paula Tatiana Muñoz-Vargas, Carlos Cifuentes-González, Gabriela Flórez-Esparza, Rebeca Paquentín-Jiménez, Miguel Ángel Castro-Monreal, Naomi Medina-Galindo, Gilma Norella Hernández-Herrera, Luz Elena Concha-del-Río, Alejandra de-la-Torre


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 corneal endothelium is the posterior monolayer of the cornea, which appears as a honeycomb-like mosaic when viewed from the rear side. Its primary function is maintaining corneal clarity by ensuring it remains relatively deturgesced [1]. Human endothelial cells show no mitotic activity in vivo; however, humans are born with a significant reserve cell density of approximately 3,500 cells/mm2, decreasing gradually at approximately 0.6% per year. As endothelial cells get damaged, they lose their mosaic shape, which changes their size (polymegatism) and their characteristic hexagonal shape (pleomorphism) [2].

Materials and method

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature review and meta-analysis (S1 File) [15]. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethics committee (DVO005 2277-CV1712).


The initial search yielded 347 studies (Pubmed 177, Embase 144, VHL 4, and medRxiv 22). After the studies were reviewed, 78 duplicate ones were removed. 215 studies were removed during the paired review phase of abstract and title and 6 during the full-text review because they did not meet the inclusion criteria. Furthermore, 11 studies were discarded because the full text could not be retrieved; 3 studies were excluded due to a high risk of bias identified. In total, 34 studies were included in our systematic review; 25 were cross-sectional, 7 were case series, 1 was a cohort, and 1 was a case-control study. For the meta-analyses, the number of studies varied depending on data availability for each analysis.


Several studies have examined how ACI affects corneal endothelial parameters and CCT. Some of the studies indicate that the presence of ACI is associated with significantly low ECD and HEX and high CV and CCT [5,22,24]; however, other studies have found no such differences [10,41,45]. The wide variations in the findings and the lack of information underscore the importance of this systematic review and meta-analysis for clarifying the effects of ACI on the endothelium and CCT.


Patients with ACI typically exhibit reduced ECD and HEX and elevated CV and CCT; primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Our results highlight potential inaccuracies in IOP measurements during acute ACI episodes and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI. Further studies are essential for understanding the influence of etiology of ACI on the endothelium and evaluating the heightened risks associated with intraocular procedures in patients with ACI compared to those without.


We thank Universidad del Rosario for the language editing of the manuscript.

Citation: Mejia-Salgado G, Munoz-Vargas PT, Cifuentes-Gonzalez C, Florez-Esparza G, Paquentin-Jimenez R, Castro-Monreal MÁ, et al. (2024) Quantitative changes in corneal endothelium and central corneal thickness during anterior chamber inflammation: A systematic review and meta-analysis. PLoS ONE 19(1): e0296784.

Editor: Andrzej Grzybowski, University of Warmia, POLAND

Received: June 16, 2023; Accepted: December 19, 2023; Published: January 5, 2024

Copyright: © 2024 Mejía-Salgado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.


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