Specular microscopy is used to examine the corneal endothelium and analyze pathological changes. There are contact and non-contact types, with contact providing higher resolution but potential discomfort. The procedure involves placing the patient comfortably and using fixation to keep the eye still while obtaining images. Images are then analyzed to study normal endothelium morphology, diagnose corneal endothelial diseases, and monitor conditions like aging, diabetes, surgery, trauma, and compare surgical techniques. Specular microscopy can detect disorders like Fuchs' endothelial dystrophy and help with decisions like eye banking and surgery.

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