Biomicroscopical observations on corneal endothelium in pseudophakia

The principle and technique of Maurice's method of microscopy of the corneal endothelium at high magnificant is discussed. An instrument is now available for clinical use (clinical specular microscope). The experience of the authors in patients with an intraocular lens is reported. A rather high deficit of endothelial cells was found in a series of 26 children and young adults, that had suffered injury from 2 to 11 years previously. An average immediate endothelial cell loss of only 6-7% was found in extracapsular cataract extraction with simultaneous implantation of a 2-loop or 4-loop intraocular lens. A striking difference was found between the two eyes of bilateral pseudophakic patients when one eye had undergone intracapsular surgery and the other eye extracapsular surgery. It had to be concluded that barrier deprivation of the intracapsular aphakic eye leads to continuing endothelial cell loss other than through ageing. Subclinical and clinical late corneal dystrophy therefore belong to the "barrier deprivation syndrome" together with retino-vascular accidents (macular and optic disc oedema) and vitreous degeneration.