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 Morphology Examples
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).
A comprehensive anterior segment exam must include corneal endothelial evaluation.Jonathan D. Solomon, MD
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