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About 30 years ago, I went to an eye specialist just once

about having surgery to correct...
About 30 years ago, I went to an eye specialist just once about having surgery to correct stigmatizem and near sightedness. He told me that he would not operate because I was born with less than the norm cells on the outer layer of my eye. He said that even lazer surgery uses up some of these cells. He was afraid that I would not have enough of these cells left when I needed cataract surgery.
Also, the inner lining of my cornea isn't functioning properly the inner layer's pump isn't working properly. So, I also need cornea surgery. The eye specialist suggest the cataract surgery on my right eye first since it has the worst vision. After 4 weeks, cornea surgery on the same eye is to be done. My concern is that the specialist didn't know anything about lack of cells that the (now retired) specialist had brought to my attention.
So my question is what about the outer layer of cells? Are these Bubar Corconjumctiva or Corneal Endothelia cellls? What can I do or ask to determine if these are a factor?
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Answered in 2 hours by:
5/2/2011
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Hello and thanks for your question. The cells he was referring to with respect to having vision correction surgery and/or laser surgery would be the cells that lie within the corneal stroma (in other words, the cells that make up the majority of the thickness of the cornea). When the thickness of the cornea is less than a certain amount, it becomes risky to perform corneal refractive surgery on that cornea, for fear that after the surgery is done, the cornea will decompensate and break down. This is likely what your eye doctor was referring to when talking about the vision correction surgery.

When speaking of the cataract surgery and the need to possibly have a corneal surgery after the cataract surgery, your surgeon is referring to the corneal endothelial cells. These cells act as the pump in the cornea, to pump fluid out of the cornea that it takes on from inflammation related to the surgery. If you have a decreased # of these cells, then it puts you at risk for having the corneal inflammation from the surgery not clear after the surgery, which would then require you to have a corneal transplant surgery after the cataract surgery.

Perhaps you may need a second opinion to have these measurements taken again and have an evaluation with another surgeon to see whether their findings are consistent with the evaluation that you've already had.

Does this information help address your concerns? Does this make sense? Do you have any other concerns that I haven't addressed?

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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

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Customer reply replied 6 years ago
Would a regular eye physician be able to determine what the # and thickness of the corneal endothelial cells was?

An ophthalmologist (not an optometrist) would be able to determine what the # and thickness of the corneal endothelial cells was only if they had a special instrument that measures that. Specular microscopy is the way to determine this. Many corneal specialists have this type of testing equipment as would an eye department at a tertiary care medical center.

However, most comprehensive ophthalmologists can do a test called corneal pachymetry that can measure the thickness of the cornea which can indirectly comment on the function of those cells. It can be an indirect marker of the # and function of the corneal endothelial cells.

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Customer reply replied 6 years ago
does "at risk for having the corneal inflammation from the surgery not clear after the surgery, which would then require you to have a corneal transplant surgery after the cataract surgery" mean that ( a complete corneal transplant may possibly be needed rather than just the inside layer?
No, actually, I would expect that if a corneal transplant were needed, that the inside layer (corneal endothelial cells) could just be transplanted and you would not need a complete, full-thickness corneal transplant. Most people who have this kind of transplant do very, very well compared to traditional corneal transplants.
Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3,343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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