Corneal endothelium

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Corneal endothelium
Vertical section of human cornea from near the margin. (Corneal endothelium is #5, labeled at bottom right.)
Details
Identifiers
Latin	epithelium posterius corneae
MeSH	D004728
TA98	A15.2.02.022
FMA	312267
Anatomical terminology [edit on Wikidata]

The corneal endothelium is a single layer of endothelial cells on the inner surface of the cornea. It faces the chamber formed between the cornea and the iris.

The corneal endothelium are specialized, flattened, mitochondria-rich

The corneal endothelium is embryologically derived from the neural crest. The postnatal total endothelial cellularity of the cornea (approximately 300,000 cells per cornea) is achieved as early as the second trimester of gestation. Thereafter the endothelial cell density (but not the absolute number of cells) rapidly declines, as the fetal cornea grows in surface area,^[1] achieving a final adult density of approximately 2400 - 3200 cells/mm². The number of endothelial cells in the fully developed cornea decreases with age up until early adulthood, stabilizing around 50 years of age.^[2]

The normal corneal endothelium is a single layer of uniformly sized cells with a predominantly hexagonal shape. This honeycomb tiling scheme yields the greatest efficiency, in terms of total perimeter, of packing the posterior corneal surface with cells of a given area. The corneal endothelium is attached to the rest of the cornea through Descemet's membrane, which is an acellular layer composed mostly of collagen IV.^{[citation needed]}

Physiology

The principal physiological function of the corneal endothelium is to allow leakage of solutes and nutrients from the aqueous humor to the more superficial layers of the cornea while at the same time pumping water in the opposite direction, from the stroma to the aqueous. This dual function of the corneal endothelium is described by the "pump-leak hypothesis." Since the cornea is avascular, which renders it optimally transparent, the nutrition of the corneal epithelium, stromal keratocytes, and corneal endothelium must occur via diffusion of glucose and other solutes from the aqueous humor, across the corneal endothelium. The corneal endothelium then transports water from the stromal-facing surface to the aqueous-facing surface by an interrelated series of active and passive ion exchangers. Critical to this energy-driven process is the role of

A rare disease called X-linked endothelial corneal dystrophy was described in 2006.

Treatment for endothelial disease

There is no medical treatment that can promote wound healing or regeneration of the corneal endothelium. In early stages of corneal edema, symptoms of blurred vision and episodic ocular pain predominate, due to edema and blistering (bullae) of the corneal epithelium. Partial palliation of these symptoms can sometimes be obtained through the instillation of topical hypertonic saline drops, use of bandage soft contact lenses, and/or application of anterior stromal micropuncture. In cases in which irreversible corneal endothelial failure develops, severe corneal edema ensues, and the only effective remedy is replacement of the diseased corneal endothelium through the surgical approach of corneal transplantation.

Historically, penetrating keratoplasty, or full thickness corneal transplantation, was the treatment of choice for irreversible endothelial failure. More recently, new corneal transplant techniques have been developed to enable more selective replacement of the diseased corneal endothelium. This approach, termed endokeratoplasty, is most appropriate for disease processes that exclusively or predominantly involve the corneal endothelium. Penetrating keratoplasty is preferred when the disease process involves irreversible damage not just to the corneal endothelium, but to other layers of the cornea as well. Compared to full-thickness keratoplasty, endokeratoplasty techniques are associated with shorter recovery times, improved visual results, and greater resistance to wound rupture. Although instrumentation and surgical techniques for endokeratoplasty are still in evolution, one commonly performed form of endokeratoplasty at present is Descemet's Stripping (Automated) Endothelial Keratoplasty (DSEK [or DSAEK]). In this form of endokeratoplasty, the diseased host endothelium and associated Descemet's membrane are removed from the central cornea, and in their place a specially harvested layer of healthy donor tissue is grafted. This layer consists of posterior stroma, Descemet's membrane, and endothelium that has been dissected from cadaveric donor corneal tissue, typically using a mechanized (or "automated") instrument.

Investigational methods of corneal endothelial surgical replacement include Descemet's Membrane Endothelial Keratoplasty (DMEK), in which the donor tissue consists only of Descemet's membrane and endothelium, and corneal endothelial cell replacement therapy, in which in vitro cultivated endothelial cells are transplanted.^[3][4] These techniques, although still in an early developmental stage, aim to improve the selectivity of the transplantation approach by eliminating the presence of posterior stromal tissue from the grafted tissue.

References