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The Cornea

 

The corneal endothelium is a single layer of cells whose function is to maintain the balance of fluid (aqueous) within the cornea by means of a barrier effect, and to remove excess aqueous from the cornea by means of a pumping mechanism. A properly functioning endothelium maintains the correct clarity and shape of the corneal required for clear vision. When endothelial cells are lost or damaged, the remaining cells grow in size and change shape to fill in the gaps in order to maintain structural integrity. If too many cells are lost or damaged, the pumping mechanism may be negatively affected, resulting in corneal edema which may lead to partial or complete loss of vision.

Cell Density & Morphology Changes

 

Endothelial cells may be lost due to traumatic injury, damage during eye surgery (corneal incisions, phaco-energy), laser surgery, intraocular lenses, pharmaceutical agents contained in eye drops, or simply through the aging process. The number of cells along with the variance of the sizes and shapes of the endothelial cells serve as quantitative and qualitative indicators of the health of the cornea. With the prevalence of corneal and anterior segment surgeries, implantable eye devices, and contact lenses, the value of monitoring the corneal endothelium has never been higher. Konan’s specular microscope makes it possible to observe the endothelium at high magnification and provides a detailed assessment of the cornea. This important information helps define the best mode of surgery or therapy for a given patient.

Normal Endothelial Cell Density (ECD)
Normal ECD declines with age.
Low ECD

Low ECD is a risk factor for cataract and corneal surgeries that can be missed without the use of specular microscopy.

Pleomorphism
 

Change from optimum hexagonal cell geometry to variable / compromised cell shapes.

Polymegethism
 

Change from uniform cell sizes to variable cell sizes is an indication of distress to the endothelium.

Normal ECD with Polymegethism and Pleomorphism
 

Here the ECD is typical, but there are also large changes in morphology with high variance in cell area / sizes (pleomorphism) and a large number of non-hexagonal cell shapes (4, 5, 7 sided cells, i.e. pleomorphism).

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