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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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