specular microscopy- simple way to learn cornea

1. Specular microscopy
Dr.Ruchi sood

2. • Introduction
• Principle
• Types
• Procedure and analysis
• Clinical applications
• Limitation

4. Principle

8. Types
• Good resolution and magnification
• Patients discomfort, infections, artifactsContact
• Comfort, less infections/trauma, broader field of view
• less resolution and magnification
Non-
contact
• 10-15 times more resolution and field of view
• Improves optics so less reflections hindranceWide-field

9. Procedure
• Explain the procedure
• Patient should be seated comfortably for a good scan.
• NON Contact- blink
• Contact- topical anesthesia coupling fluid used
• Internal fixation target is used to keep eye straight

12. Image analysis

22. Clinical applications

23.  To study the normal endothelium morphology.
 To diagnose and study pathological changes in corneal
endothelial diseases.
 Eye banking- assessment of donor cornea status.
 Pre operative endothelial health – surgery decision making.
 Research and monitoring of epithelium in below
Aging
DM
CONTACT LENS
WEARER
POST SURGERY
GLAUCOMAS
UVEITIS
TRAUMA
COMPARISION OF
DIFFERENT
SURGICAL TECH.

24. • Corneal endothelial disorders
Fuch’s endothelial dystrophy
Posterior polymorphous dystrophy
Iridocorneal endothelial disorder
Lattice corneal dystrophy
DM tear

26. Fuch’s endothelial corneal
dystrophy

30. Ice syndrome

31. Lattice
stromal
dystrophy

33. DIABETICS

39. Surgery Endothelial cell loss
PHOCOEMULSIFICATION 5-8% in 6 months
10.5% at 1 year
SICS 4.21% at 6 weeks
PKP 11%+-20% at 6 months
20% at 1 year
DALK 14.2%+-11.7% at 1 month
8.6% at 1 year
DSAEK 34%-+22% at 6 months
Same at 1 year
DMEK 35% at 6 months
38% at 1year
PPV 9%+-14.6% at 3 months
TRABECULAECTOMY 7%

40. summary
• Explain the procedure to the patient
• Image the region 3x at the same sitting
• Use same analysis method during follow-up
• To obtain maximum efficacy count 75-100 cells or more