Corneal endothelial cells do not naturally regenerate; when lost, they are gone forever.
As endothelial cell loss worsens:
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The remaining cells can spread to cover the exposed portions of the cornea to maintain visual function
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However, as corneal endothelial cells enlarge and as density decreases to 400 cells/mm2 or fewer, the remaining cells may be unable to keep the cornea dry and maintain functional vision
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Corneal edema (swelling) may occur, with associated vision loss
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In addition, epithelial edema may occur, which can result in a painful, debilitating foreign body sensation in the eye