Progressive corneal endothelial cell changes in anterior segment disease

We have demonstrated marked changes in the corneal endothelium in some groups of patients with ocular anterior segment disease including chronic cyclitis, both heterochromic and classical, pseudoexfoliation of the lens capsule, and anterior segment pigment dispersal syndrome. The most striking changes occurred in heterochromic cyclitis with reduced endothelial cell counts (p less than 0.01) and altered cellular morphology. In almost all eyes with cyclitis endothelial belbs were seen. In eyes with unilateral pseudoexfoliation of the lens capsule there was a lower endothelial cell count with pleomorphism and polymegathism, the changes being somewhat more marked with raised intraocular pressure (p less than 0.01). In anterior segment pigment dispersal syndrome there was an even smaller reduction in count (p less than 0.05) with mild changes in morphology. Factors producing endothelial cell changes included hypoperfusion of the iris with microneovascularization of the iris stroma, intercellular bleb formation with oedema of the corneal endothelium, and raised intraocular pressure. A normal iris circulation is important to the integrity of the corneal endothelium.