The cornea, often referred to as the “black eye”, is the first barrier between the eye and the outside world. A healthy and clear cornea is very important to people. The corneal endothelium is a single layer of hexagonal cells located in the innermost part of the cornea. The human corneal endothelium cannot regenerate and is highly susceptible to damage from various physical and chemical factors such as hypoxia, ageing, metabolic disorders, inflammatory attack and intraocular surgery.
Recently, a 78-year-old man was nearly blind due to the low number of corneal endothelium in his left eye and the difficulty in getting treatment for cataract surgery. Finally, the old man underwent cataract extraction combined with IOL implantation at Suzhou Eye and Vision Hospital. Two hours after the surgery, the old man’s vision was restored to 0.4 and he was able to see again.
It is understood that this elderly patient has suffered from diabetes for 27 years and hypertension for 5 years. In the past 10 years, the old man felt that his eyes were getting blurry. The patient was found to have diabetic cataracts in both eyes, but preoperative examination revealed that the patient’s corneal endothelial cell count was only over 700/mm2, and the doctor refused to perform cataract surgery for the elderly for fear of corneal complications. In March this year, the old man approached Li Guoxing, the vice president of cataract specialists at Suzhou Eye and Vision Hospital.
During the preoperative examination, Li Guoxing found that the corneal endothelium of the patient’s left eye had only 778 cells/mm2, while under normal circumstances, the density of corneal endothelial cells in the human body should decrease at a rate of 0.5-1% per year with aging. If the number of endothelial cells decreases to less than 1000/mm2, it will become a relative contraindication to cataract surgery. Li Guoxing said it would be difficult to perform cataract surgery for patients with low corneal endothelial cell counts.
This is because the surgery itself will cause some damage to the corneal endothelium, leading to a further decrease in the number of endothelial cells, resulting in corneal edema and even large vesicular keratopathy. After the surgery, patients will have symptoms such as eye pain, photophobia and tearing, which may eventually lead to blindness and later treatment such as corneal transplantation or eye removal surgery may be required.
When cataract patients go to the hospital for eye examinations, pay attention to the cornea. Through corneal endothelial count examination, it is easy for doctors to observe the morphology, data processing and analysis of corneal endothelial cells, assess corneal function, and thus determine the surgical plan, while choosing a relatively safe surgical procedure, which can avoid unnecessary complications. At the same time, endothelial count examination can be very helpful for the diagnosis of some corneal diseases, the evaluation of certain diseases on the cornea, and guidance on the selection of corneal contact lens materials and wearing methods.