Endothelium Protection In Phacoemulsification H.R. Ziai MD

What Is The Endothelium?

Histology Monolayer Hexagonal Isomorphic Non proliferating Produces BM Descemet 's M.

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

Endothelial Cell Evaluation 1.Direct observation - Specular microscopy - Confocal technique 2.Indirect evaluation - Corneal thickness - Corneal clarity

Indirect evaluation Corneal thickness Corneal clarity

- 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

Cornal thickness can be measured by : -Ultrasound ( pachy mettry ) -Topography -OCT

How to Protect Endothelium ? Preoperative Intraoperative Post operative

Preoperative Carefully examination is critical for diagnosis preexisting endothelial abnormalities like FED, PPMD, ….. complain of blurred vision at morning is suggestive for FED

Fuch's endothelial dystrophy AD Guttae (guttata): The earliest clinical sign Thickening of Descemet's membrane Stromal edema Endothelial edema

Guttata alone without corneal edema and blurring of vision, may be seen in normal eye, Uveitis, glaucoma and trauma.

So: any guttata, need's more evaluation, Pachymetry: >600μ  Red Flag Specular microscopy: cell density<1000 cell/mm2  Red Flag High polymegethism (coefficient of variation greater than 0.40) mean cell area (MCA) SD MCA high pleomorphism(proportion of nonhexagonal cells greater than 50%)

ضمن عرض پوزش بدلیل حجم بالای LECTUER ادامه اسلایدها امکان پذیر نمیباشد در صورت نیاز به ادامه لطفا به واحد سمعی و بصری مرکز آموزشی درمانی فیض مراجعه و یا با شماره تلفن داخلی 392 تماس حاصل نمائید با تشکر