The corneal endothelium is a single layer of cells lining the posterior corneal surface. Its function – actively pumping fluid from the corneal stroma to maintain transparency – is irreplaceable. Endothelial cells do not regenerate in any clinically meaningful sense. Cell loss, from whatever cause, is permanent. ¹ ²
Pre-operative endothelial cell count (ECC) serves two purposes in ICL candidacy assessment. First, it establishes a baseline from which any subsequent change can be detected and quantified. Second, it identifies patients with insufficient endothelial reserve in whom ICL surgery carries a materially higher risk of progressive corneal decompensation. A count below 2,000 cells per mm² requires careful scrutiny; counts in the low-normal range require careful sizing decisions to maximise the distance between the implant and the endothelium. ³
At Blue Fin Vision®, specular microscopy ECC measurement is performed as part of every pre-operative ICL assessment. The result is discussed explicitly at the consultation, including its clinical significance, the minimum threshold for safe implantation, and the monitoring schedule that will apply post-operatively. Every patient should leave their pre-operative appointment knowing their ECC, understanding what it means, and having a clear account of how it will be monitored. If a clinic does not measure ECC before ICL surgery, that is a contraindication to proceeding with that clinic.
References
- Igarashi A, Shimizu K, Kato S, Kamiya K. Posterior chamber phakic intraocular lens and corneal endothelium: 5-year follow-up. J Cataract Refract Surg. 2009;35(3):488–492. PMID: 19251139.
- Fernandes P, González-Méijome JM, Madrid-Costa D, Ferrer-Blasco T, Jorge J, Montés-Micó R. Implantable collamer posterior chamber intraocular lenses: a review of potential complications. J Refract Surg. 2011;27(10):765–776. PMID: 21610721.
- Packer M. Meta-analysis and review: effectiveness, safety, and central port design of the intraocular collamer lens. Clin Ophthalmol. 2016;10:1059–1077. PMID: 27390517.
Related Topics
- ICL Surgery Checklist
- Are You on the GMC Specialist Register for Ophthalmology?
- Does Your Surgeon Hold the CertLRS Qualification?
- How Many ICL Procedures Has Your Surgeon Performed?
- Can You Show Me Your Refractive Outcome Data?
- Is Surgery Performed in a Proper Hospital Theatre with Laminar Airflow?
- What Is My Pre-Operative Endothelial Cell Count?
- How Often Will ECC and Vault Be Monitored, and Is This Included?
- What Vault Are You Targeting?
- Does the Clinic Have Access to Laser Eye Surgery for Enhancement?
- Which ICL System and Calculator Do You Use?
- What Happens If I Develop a Cataract Within Two Years?
- What Is the Arrangement If Cataract Develops Between Two and Ten Years?
- Have You Performed Cataract Surgery in an Eye with an Existing ICL?
- How Do You Manage Biometry Calculations in Post-ICL Eyes?
- What Happens If My Myopia Continues to Progress?
- At What Level Would Enhancement Be Considered?
- When After Surgery Would Enhancement Be Performed?
- Who Performs the Enhancement – the Same Consultant?
- Is Laser Enhancement Included in the Price?
- Is Sedation Available, and What Does It Cost?
- Is Oral Diazepam Available for Anxious Patients?
- What Is the Minimum Stay Required Near the Clinic?
- Will You Identify a Named Local Ophthalmologist Before Surgery?
- How Will Annual Vault and ECC Monitoring Be Arranged If I Live Far Away?
