The ultrastructure of Descemet's membrane. II. Aphakic bullous keratopathy.

The ultrastructure of Descemet's membrane was studied by transmission electron microscopy in nine corneal buttons from aphakic eyes with bullous keratopathy. All nine corneas had abnormal collagenous material in the posterior portion of Descemet's membrane. Five of the buttons had abnormalities in layers of Descemet's membrane secreted at an early age. These abnormalities are evidence of endothelial dysfunction long before cataract extraction. In the remaining four corneas, the Descemet's membrane secreted prior to cataract extraction remained relatively normal, despite corneal endothelial decompensation for up to five years. Thus, the layers of Descemet's membrane remain relatively unchanged after their formation and serve as a historic record of one aspect of endothelial function.