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Corneal endothelium— Submitted by Mardi/Canada The main physiologic function of this thin inner layer is water transport. Corneal transparency hinges on the precisely controlled hydration required to maintain the stromal matrix structures in their correct spatial organization. The endothelium forms a barrier from the aqueous humor, based on the tight junctions and gap junctions between individual cells, and it maintains a fluid pumping mechanism controlled by a membrane-associated enzyme (Na+,K+-ATPase) that transports excess water out of the stroma. Without this pumping action, the stroma would develop edema, becoming swollen with water and cloudy. The human corneal endothelium has no regenerative and only limited repair capabilities. If endothelial cells are destroyed by disease or trauma, the remaining cells must enlarge and migrate to maintain function. When sufficient endothelial cell loss occurs, corneal edema and blindness ensue, with corneal transplantation as the only available therapy.
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