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Tip of the Month
Tip of the month - Consider evaluation of corneal endothelial cell count in pseudoexfoliation patients undergoing surgery
Consider evaluation of corneal endothelial cell count in pseudoexfoliation patients undergoing surgery

Publishing date: October 2022

Corneal endothelial cell loss may lead to corneal decompensation with loss of vision, which may necessitate future endothelial transplantation for the rehabilitation of vision. Numerous etiologies relevant to glaucoma are associated with reduced endothelial cell density, including pseudoexfoliation, Fuchs’endothelial corneal dystrophy, surgical trauma, iridocorneal endothelial syndromes and chronic uveitis.

In pseudoexfoliation patients, endothelial cell counts are shown to be lower than in primary open angle glaucoma (1,2). The preoperative evaluation of the corneal endothelium in pseudoexfoliation patients may be relevant in assessing the impact of surgical interventions. A corneal endothelial cell count below 1200 cells/mm2 may lead to postoperative edema and corneal decompensation. This is particularly important in glaucoma tube implant surgery, which can lead to increased endothelial cell loss and corneal decompensation.

Contributor: Florentina Freiberg, City hospital Zurich and Waid, Zurich, Switzerland


1. Sarowa S, Manoher J, Jain K, Singhal Y, Devathia D. Qualitative and quantitative changes of corneal endothelial cells and central corneal thickness in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Int J Med Sci Public Heal. 2016;5(12):1.
2. Kocabeyoglu S, Mocan MC, Irkec M, Karakaya J. In Vivo Confocal Microscopic Evaluation of Corneas in Patients With Exfoliation Syndrome. J Glaucoma. 2016;25(2):193–197.

Tip of the Month manager: Frances Meier-Gibbons
Tip of the Month editorial board: Francisco Goni, Karl Mercieca, Humma Shahid
Tip of the Month editors in chief: Manuele Michelessi, Francesco Oddone

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