Endothelial cell density (ECD) describes the number of corneal endothelial cells per square millimetre. These cells maintain corneal clarity by pumping fluid out of the cornea and do not regenerate significantly.
Measurement
ECD is measured using specular or confocal microscopy, which captures magnified images of the endothelium.
- Software counts cells in a defined area and reports cell density, size variation, and shape regularity.
- Normal adult values typically range around 2000-3000 cells/mm² and decline slowly with age.
- Very low counts increase the risk of corneal swelling after intraocular surgery.
- Serial measurements can monitor progressive endothelial diseases such as Fuchs dystrophy.
Clinical Uses
Knowing ECD helps ophthalmologists plan safe surgery and monitor corneal health.
- Pre‑operative assessment before cataract, glaucoma, or corneal procedures identifies eyes at higher risk of decompensation.
- Post‑operative checks can detect endothelial damage early.
- ECN informs decisions about whether to combine cataract surgery with endothelial keratoplasty.
- Patients with low counts may be counselled about modified techniques or alternative treatments.
