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22 Clinical Anatomy of the Visual System

A

B

FIGURE 2-15

Endothelial integrity can be evaluated by determining the coefficient of variation (CV) of cell size. Normal endothelium has a CV of 0.25. A, Endothelium of healthy 25-year-old non-contact lens wearer. Endothelial cell density is 2000 cells/mm2, hexagonality is 69%, and CV is 0.25. B, Endothelium of 40-year-old patient who has worn polymethyl methacrylate contact lenses for 23 years. Endothelial cell density is 1676 cells/mm2, hexagonality is 24%, and CV is 0.66. (A courtesy Scott MacRae, M.D., Oregon Health Sciences University, Portland, Ore.; B from MacRae SM, Matsuda M, Shellans S et al: The effects of hard and soft contact lenses on the corneal endothelium, Am J Ophthalmol 102:50, 1986.)

called corneal crystallins, and they share many of the attributes of the long recognized lens crystallins, important in maintaining the transparency of the lens.77

Because the stroma makes up 90% of the cornea, the regularity of spacing between the collagen fibrils is important in maintaining corneal transparency. The negatively charged molecules located around each collagen fibril maintain this precise arrangement by their

bonds with water molecules, and corneal transparency is optimal when the stroma is 75% to 80% water.4,78

Corneal Hydration

This relative corneal deturgescence (78% water content) requires precise control of stromal extracellular water content and is dependent upon: (1) the barrier