Corneal Endothelium Endothelium Cells Are Destroyed by Disease Or Trauma, Thelial Cells Per Year
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Integrating the Best Davis EyeCare Technology Associates Specular Microscopy is a new tech- nique to monitor corneal cell loss due to damage from extended con- tact lens wear, surgery, or the ag- ing process. It is also an excellent tool for: educating patients, screening for corneal disease (fuchs-guttata, kerataconus, Corneal trauma, dry eye, glaucoma, diabe- tes and certain medications etc.) and observing the damaging ef- Endothelium fects of contact lens wear. Often we can avoid more serious complica- tions of con- tact lens wear by under- standing the condition of the cornea. In early stages simply ad- justing the wearing time or chang- ing to a different contact lens ma- terial avoids future issues. In our elderly population our cell counts diminish and with a specular mi- croscope we can monitor and treat Davis EyeCare Associates the aging cornea much more effec- tively. This is an essential tool in managing our contact lens patients 4663 West 95th Street www.daviseyecare.com and is very important in assessing Oak Lawn Il 60453 potential risks for cataracts and Phone: 708-636-0600 4663 West 95th Street refractive surgery. Oak Lawn IL 60453 Fax: 708-636-0606 708-636-0600 E-mail: www.daviseyecare.com mal aging, the central cornea loses 100 to 500 endo- Corneal Endothelium endothelium cells are destroyed by disease or trauma, thelial cells per year. When these cells die, they they are lost forever. slough off the posterior surface of the cornea into the We are pleased to offer Konan Microscopy to the anterior chamber, creating a gap in the endothelial Common ocular conditions, such as glaucoma, uveitis management of your eyecare. Specular Microscopy mosaic that compromises both the barrier and pump and Fuchs endothelial dystrophy, may produce measures the density of corneal endothelial cells functions of the endothelium. To repair the gap, the changes in the structure and function of the corneal that are important in maintaining corneal clarity endothelium relies on cellular migration and cellular and successful contact lens wear. It is a concise endothelium that result in corneal edema and visual fusion. In this wound repair mechanism, the endothe- way to assess cell loss or damage due to extended impairment. Additionally, contact lens wear and in- lial cells adjacent to the defect move to fill in the contact lens wear, surgery, and the aging process – traocular surgery, may compromise the endothelium space vacated by the sloughed cell. The endothelial unobtainable with biomicroscopy and corneal to- and cause corneal edema. An accu- pography. It is also an excellent tool for screening cells either stretch and slide into a different position, rate diagnosis of endothelial dis- for corneal disease and observing the damaging or they fuse together to re-establish complete cover- ease may be the key in not only effects of contact lens wearing and to access the age of the posterior surface of the cornea. This move- proper treatment. determining cause of corneal ment of the endothelial cells creates a variation in edema, but also developing a treat- cell size known as polymegethism. Maintaining both Normal Cornea: ment plan. The cornea consists of three major layers. The outer the barrier and pump function requires a certain most layer, which protects Guttata are areas of thickening of the endothelial number of endothelial cells to cover the posterior the entire cornea is called cells that do not function normally and are common surface of the cornea. The minimum number of cells, the Epithlium. This ac- with increasing age. In Fuch’s dystrophy a large num- or critical cell density, averages between 300 and counts for 10% of the ber of Guttata appear along with reduced cell density. 500 cells/mm. If the number of cells fall below this whole cornea. The middle This eventually causes cornea swelling (edema) that critical number the clear cornea will become opaque. layer is called the stroma can causes reduced vision, light sensitivity, and even- and is 90% of the cornea. tually pain. Holes appear in the Davis EyeCare will observe your corneal endothelium The Endothelium is the cornea endothelium as black spots. by testing with the Specular Microscope and find out extremely thin, innermost Because the endothelium does not your risk for the cornea becoming adversely effected layer of the cornea. regenerate adjacent cells fill in the from ocular surgery or extended wear contact lenses. gaps made by the holes and Corneal Endothelium: change the size and shapes of the In the normal cornea’s the endothelium are com- remaining cells. There is no medical treatment that can promote posed of six sided regularly wound healing or regeneration of the corneal endo- shaped cell in a honeycomb pat- If the cells have too much variation thelium. In early stages of corneal edema, symptoms tern without gaps. The responsi- in size it is called Polymegathism. If the cells have to of blurred vision and ocular pain predominate, due to edema and blistering (bullae) of the corneal epithe- bility of the endothelial cells are much variation in shape it is called Pleomorphism. essential in keeping the cornea lium. Partial treatment of these symptoms can some- clear. Normally water and nutri- These changes in size and shape of corneal endothe- times be obtained through the instillation of topical ents flow freely from the inside lial cells represent inefficient corneal hypertonic saline drops, use of bandage soft contact of the eye into the cornea. The endothelium’s job is function resulting in the cornea taking lenses, and/or application of anterior stromal micro- to pump excess fluid out of the cornea back into the in water and becoming hazy with re- puncture. In cases in which irreversible corneal endo- eye. Without this pumping action, the cornea would duced vision. Complete coverage of the thelial failure develops, severe corneal edema hazyness occurs, and the only effective remedy is swell with water, becoming hazy and ultimately posterior corneal surface is required to replacement of the diseased corneal endothelium opaque. In a healthy eye, a perfect balance is main- maintain the barrier function of the tained between the fluid moving into the cornea through the surgical approach of corneal transplanta- and fluid being pumped out of the cornea. Once the corneal endothelium. Because of nor- tion. .