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
- 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