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Rama P., Insacco C., Knutsson K. A., Viganò M.
Unità Operativa Oculistica, Unità Cornea e Superficie Oculare, Istituto Scientifico San Raffaele, Milano, Italia
The primary function of the cornea is the transmission and refraction of light. This optical function is guaranteed by a state of dehydration of the corneal stroma regulated by a fine system that controls the flow of water and ions across the different corneal layers, allowing the cornea to maintain its physiological transparency. Corneal edema develops every time that this fine equilibrium is broken. Corneal edema is a frequent condition in ophthalmology; the causes are numerous and often determined by different pathological mechanisms. The most frequent causes in developed countries are overuse of contact lenses, pseudophakic or aphakic bullous keratopathy after cataract surgery and Fuchs’ dystrophy. The endothelium plays a fundamental role in maintaining corneal transparency through the process of corneal deturgescence. The endothelial cells contain a system of energy-dependent pumps that determine the transport of water from the stroma to the aqueous humor. Every time that the structure or function of the endothelium is altered, corneal edema may develop. The integrity of the epithelium is also of fundamental importance in maintaining corneal transparency. In most cases, an accurate ophthalmological examination helps to understand the nature of the pathophysiological processes causing corneal edema, allowing an adequate medical or surgical therapeutic approach.