Bullous keratopathy following intracapsular cataract cloudy_cornea.jpg

Bullous keratopathy following intracapsular cataract 1189694-1193218-3.jpg

The endothelium is the inner, single cell layer of the cornea. These cells form a tightly packed and waterproof mosaic forming the inner lining of the cornea.

These cells are busy fellows, serving in much the same way as did the windmills in Holland. They actively pump water out of the cornea keeping it transparent. The eye only gets one set as well; that is, these fellows do not regenerate once lost — which is what all the brouhaha is over endothelial cell loss during cataract surgery. Normally the eye will lose about 10% per decade of life. When a cell is lost, the others enlarge to fill up the gap as much as they can. If they cannot completely fill the gap, then those ‘good old’ GAG's soak up the aqueous causing the stromal fibers to move apart. Once the separation of these fibers exceeds ½ the wavelength of light, light begins to become scattered and vision suffers. Too much fluid in the cornea and the cornea becomes opaque.

Once that happens the epithelium may become blistered (bullous keratopathy) and blood vessels may start to migrate into the once clear cornea. When that happens, a penetrating keratoplasty (corneal transplant) may become necessary.