1. Specular in Secondary corneal endothelial disorders
1.1. After surgical procedure
1.1.1. endothelial cell density is lower and mean cell area larger
1.2. Pseudoexfoliation
1.2.1. guttae and reduced cell density
1.3. Forceps Injury
1.3.1. endothelial cell density is lower
1.4. Macular corneal dystrophy
1.4.1. guttae similar to that seen in FECD
1.5. Uveitis
1.5.1. Lowered endothelial cell density and increased mean cell area
1.6. Contact lens-induced hypoxia
1.6.1. increased polymegathism and pleomorphism
2. Imaging corneal endothelium
3. Principle
3.1. Specular Reflection
3.1.1. light reflected from the endothelial surface--> collected by the same objective lens and focussed onto a film plane/video monitor screen
4. two types
4.1. corneal epithelial contact
4.2. noncontact models
5. Endothelial Cell Morphology Analysis
5.1. Cell area ± SD (square micrometers, µm2)
5.2. Cell density (cells/mm2)
5.3. Pleomorphism (percentage of hexagonal cells)
5.4. Polymegathism (CV)
6. Specular in Various endothelial diseases
6.1. FECD
6.1.1. Guttae lead to drop out areas on the endothelial image.
6.1.2. Inability to image the endothelial cells does not necessarily mean absence of endothelial cells or its functionality
6.1.3. The pre‑requisite for DWEK is peripheral endothelial cell density above 1000 cells/mm2
6.1.4. cataract surgery with or without endothelial keratoplasty in early stages of FECD is mainly based on the patient’s symptoms
6.1.5. Specular microscopy imaging in different gazes to image the peripheral corneal endothelial health --> preoperative evaluation and decision making of those cases that may be considered for DWEK over conventional management
6.2. PPCD
6.2.1. lower endothelial cell density and increase in average cell area .
6.2.2. In the area of vesicles and bands, endothelial cells are not visualized
6.3. CHED
6.3.1. fails to capture endothelial images--> because of stromal haze
6.4. ICE syndrome
6.4.1. rounding of the cell borders, increased intracellular blackout areas, and dark‑ light reversal pattern of the normal endothelium