endothelium protection in phacoemulsification h.r. ziai md

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  • Endothelium Protection In Phacoemulsification H.R. Ziai MD
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  • What Is The Endothelium?
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  • Histology Monolayer Hexagonal Isomorphic Non proliferating Produces BM Descemet 's M.
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  • Physiology Pump leak ATP ase Maintains stromal partially dehydrated, needs for corneal clarity Not proliferats, But covers damaged area with side extention 0.6% attrition rate per year
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  • Endothelial Cell Evaluation 1.Direct observation - Specular microscopy - Confocal technique 2.Indirect evaluation - Corneal thickness - Corneal clarity
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  • Indirect evaluation Corneal thickness Corneal clarity
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  • - Endothelium, maintains a stromal water content of 78% and an average corneal thickness of 0.52mm water content > 78% Edema clarity - clarity evaluation is a clinical one
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  • Cornal thickness can be measured by : -Ultrasound ( pachy mettry ) -Topography -OCT
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  • How to Protect Endothelium ? Preoperative Intraoperative Post operative
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  • Preoperative Carefully examination is critical for diagnosis preexisting endothelial abnormalities like FED, PPMD, .. complain of blurred vision at morning is suggestive for FED
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  • Fuch's endothelial dystrophy AD Guttae (guttata): The earliest clinical sign Thickening of Descemet's membrane Stromal edema Endothelial edema
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  • Guttata alone without corneal edema and blurring of vision, may be seen in normal eye, Uveitis, glaucoma and trauma.
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  • So: any guttata, need's more evaluation, Pachymetry: >600 Red Flag Specular microscopy: cell density
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  • LECTUER 03114476010 392