title: Long term changes in human corneal endothelium following toxic endothelial cell destruction: a specular microscopic and fluorophotometric study.
abstract: OBJECTIVE
  To investigate the long term relation between corneal thickness, endothelial morphometric variables, and endothelial permeability in patients with endothelial cell counts under 900 cells/mm2 as a result of endothelial cell destruction after cataract surgery.
  
  
  METHODS
  Eighteen patients developed the so called toxic endothelial cell destruction (TECD) syndrome following routine cataract surgery because of the intracameral injection of a toxic detergent residue. Ten patients with a mean (SEM) initial cell loss of 72% (2%) were followed for 4 years. Data were obtained at 6 months and 4 years postoperatively and compared between TECD eyes and contralateral control eyes.
  
  
  RESULTS
  Mean (SEM) endothelial cell density of the TECD eyes increased from 642 (41) cells/mm2 to 849 (50) cells/mm2 at 4 years postoperatively (p = 0.005). There was no difference in coefficient of variation or percentage hexagonals between 6 months and 4 years postoperatively. Mean (SD) corneal thickness of the TECD eyes and control eyes was similar, 0.51 (0.02) mm and 0.49 (0.01) mm, respectively (p = 0.65). Mean (SD) endothelial permeability was also similar for TECD eyes and control eyes (4.3 (0.9) x 10(-4) cm/min and 4.4 (0.6) x 10(-4) cm/min, respectively (p = 0.57). There was no correlation between endothelial cell density, coefficient of variation, or percentage of hexagonal cells and endothelial permeability in the TECD eyes. In three patients a permanent corneal decompensation occurred.
  
  
  CONCLUSIONS
  Four years after TECD corneal endothelial wound healing is stable and the barrier function has been restored.
authors.affiliation: Department of Ophthalmology, University of Maastricht, Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Nuyts
authors.forename: N
authors.initials: N
authors.lastname: Boot
authors.forename: J A
authors.initials: JA
authors.lastname: van Best
authors.forename: H F
authors.initials: HF
authors.lastname: Edelhauser
authors.forename: A C
authors.initials: AC
authors.lastname: Breebaart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002387:Cataract Extraction / Q000009:adverse effects*; D003316:Corneal Diseases / Q000209:etiology* / Q000473:pathology; D003902:Detergents / Q000009:adverse effects*; D004728:Endothelium, Corneal / Q000187:drug effects / Q000473:pathology*; D005260:Female; D005452:Fluoresceins / Q000493:pharmacokinetics; D015590:Fluorophotometry; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D010539:Permeability
chemical_list: D003902:Detergents; D005452:Fluoresceins