3. Endothelium Protection In Phacoemulsification H.R. Ziai MD

4. What Is The Endothelium?

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

9. 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

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

17. Indirect evaluation Corneal thickness Corneal clarity

18. - 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

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

20. How to Protect Endothelium ? Preoperative Intraoperative Post operative

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

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

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

30. 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%)

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