The response of the corneal endothelium to intraocular surgery

The corneal endothelium is affected by age, disease, and intraocular surgery. With age, the endothelial cell density decreases linearly, the hexagonal pattern is less common, and there is an increased variation in cell size and shape. There are primary and secondary endotheliopathies in elderly patients which further compromise the endothelial reserve. Intraocular surgery causes cell loss in the superior cornea which requires a transformation and migration of endothelial cells from the central and inferior cornea. Although a stable endothelial mosaic is reestablished in most corneas, some maintain a bizarre endothelial appearance which is correlated with continued cell loss. Intraocular surgery causes an acute cell loss as well as a chronic cell loss which is greater than the normal attrition due to aging. There are many variables in predicting future corneal edema; longitudinal observation of endothelial cell loss may be the best prognosticator.