Before surgery protection of corneal endothelium and after

Corneal endothelium protection in phaco

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Psuedophakic Bullous Keratopathy (PBL)complicated cataract surgery with inadequate management posterior cap rupture management ,or intracapsular lens implanted in the AC. PBK courts in 1 to 2% of patients in conventional surgery ,it can be 11 to 20% in eyes with endothelial count less than 1000cell / cu mm2 Risk factor for PBK , Fucks endothelial dystrophy , shallow AC,angle closure glaucoma , previous eye surgery,& very dense cataract Systemic approach for protection Recognize eye at risk — advance age ,systemic conditions,diabetes ,renal insufficiency , chronic occlusive pulmonary disease,are known to decrease endothelial cells and function Medications as amantadine for Parkonism , topical carbonic inhibitors , temsulosin increases chances of posterior cap rupture Customize the surgery be aware of surgical operations , avoid intra operative damage Increase distance from cornea , decrease amount U/S energy ,working on the iris plane holding U/S tip downwards , placing dispersing viscoelastic for every 3 to five units of cumulative energy against the endothelium create a barrier between tip and the cornea , avoiding fluid loss through paracentesis to allow deeper AC, avoid turbulence

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