Bowman’s layer

Descemet’s membrane

Pathologic Diagnosis

• Diagnosis– Pseudophakic bullous keratopathy with • Chronic bullous keratopathy• Degenerative pannus• Stromal edema• Severe endothelial atrophy

Pseudophakic bullous keratopathy

• Iatrogenic disease – Direct or delayed endothelial damage associated

with cataract surgery and intraocular lens implantation

• One of the most common indications for corneal transplantation.

Pseudophakic bullous keratopathy

• Histology– Subepithelial bullae– Stromal edema – Severe endothelial loss– Descemet’s membrane is NOT thickened

with regular caliber WITHOUT guttate excrescences

Pannus Flat superficial scar of the anterior cornea

Degenerative pannusChronic edema and bullous keratopathyLayer of connective tissue between the epithelium and Bowman’s layer (BL)BL remains intact

Inflammatory pannusTracoma Subepithelial ingrowth of inflamed fibrovascular tissue from limbusDestroys BL

Case 4

Case History

• 64 yo M• Gross description ( Contributor )– Endothelial cells of

right eye– 0.5 x 0.3 cm

translucent shave

• Diagnosis– Fuchs’ endothelial dystrophy

Descemet’s stripping with endothelial keratoplasty

(DSEK) • Alternative to corneal transplantation for

patients in primary dysfunction of the cornea endothelium.

• Advantages over traditional keratoplasy – Minimal refractive change– More rapid visual recovery – Maintenance of the structual integrity of the

recipient’s cornea

Fuchs’ dystrophy

• Often bilateral –may be asymmetric• Late onset, slow progression• Patient generally present s after age 50• Female predominance• Autosomal dominant inheritance• Associated with several mutations in the gene

for collagen type VIII at 1p34.2-p32

Fuchs’ dystrophy• Histology– Subepithelial bullae– Stromal edema – Atrophy of endothelium– Mulitilaminar thickening of Descemet’s membrane

with guttate excrescences in the central cornea– Cytoplasm of the residual endothelial cells contain

round granules of melanin pigment from iris pigment epithelium

Iris Cases

Case 5

Case History• 54 yo WF, Irritable, infected right eye for 4 M.• Vision : 20/30 OD, 20 /15 OS. • IOP: 50 mm Hg, OD, 12mm Hg OS.• Fleshy brown mass in the anterior chamber angle

inferonasally. • 3mm in width and was accompanied by and ectropion

uveae.• Marked cupping of the right optic disc. • Diagnosis at time of enucleation was intraocular tumor

with secondary glaucoma.

Case History (Gross)

• 25x25x24 mm with 1 mm ON.• Clear cornea :11 x10 mm.• The eye transmitted light well. • Pigment was scattered along the back of the

cornea, and AC was deep. • Chamber angle inferiorly was filled with a

slightly elevated gray mass.