Restoring anatomical and functional integrity of human corneal endothelium after large Descemet’s membrane tear (clinical case)

is case report describes Descemet’s membrane tear occurred during phaco. Early post-op corneal edema involved optical zone. 1-month treatment was ineffective, and the patient was referred to endothelial keratoplasty. Considering that corneal endothelium is able to cover local Descemet’s membrane defects if endothelial cell density is initially high, we decided to postpone endothelial keratoplasty and to observe the patient. Topical medications included osmotic, antiinflammatory, and hypotensive agents. 2 months after phaco, corneal edema began to reduce. 4 months after phaco, the cornea was almost transparent. Endothelial cell density in the central zone (where Descemet’s membrane was absent) was 1002 cells/mm2. The cornea remained transparent for 2-year observation. In a year after phaco, visual acuity was 20/32. Post-op bullous keratopathy treatment provided good therapeutic and optical outcome. Complete resolution of corneal edema due to Descemet’s membrane tear that persisted for 4 months after complicated cataract surgery demonstrates the possibility to recover structural integrity and functions of corneal endothelium even in large Descemet’s membrane tears. In corneal edema due to mechanical injury, endothelial keratoplasty should be performed at least 3 or 4 months after the injury since endotheliocyte function recovery is possible if endothelial cell density is initially high. 

1. Carlson K. H., Bourne W. M., McLaren J. W., Brubaker R. F. Variations in human corneal endothelial cell morphology and permeability to fluorescein with age. Exp. Eye Res. 1988; 47 (1): 27-41.

2. Jones R. F., Maurice D. M. New methods of measuring the rate of aqueous flow in man with fluorescein. Exp. Eye Res. 1966; 5: 208.

3. Bourne W.M., Nelson L.R., Hodge D.O. Central corneal endothelial cell changes over a ten-year period. Invest. Ophthalmol. Vis. Sci. 1997; 38: 779-782.

4. Fischbarg J., Lim J. J. Role of cations, anions and carbonic anhydrase in fluid transport across rabbit corneal endothelium. J. Physiol. 1974; 241: 647-675.

5. Maurice D. M. The location of the fluid pump in the cornea. J. Physiol. 1972; 221: 43.

6. Bourne W. M. Clinical estimation of corneal endothelial pump function. Trans. Am. Ophthalmol. Soc. 1998; 96: 229-239.

7. Polse K. A., Brand R., Mandell R., Vastine D., Demartini D., Flom R. Age differences in corneal hydration control. Invest. Ophthalmol. Vis. Sci. 1989; 30: 392.

8. Riley M. V., Winkler B. S, Starnes C. A., Peters M. I., Dang L. Regulation of corneal endothelial barrier function by adenosine, cyclic AMP, and protein kinases. Invest. Ophthalmol. Vis. Sci. 1998; 39: 2076.

9. Laing R. A., Sanstrom M. M., Berrospi A. R., Leibowitz H. M. Changes in the corneal endothelium as a function of age. Exp. Eye Res. 1976; 22: 587-594.

10. Murphy C., Alvarado J., Juster R., Maglio M. Prenatal and postnatal cellularity of the human corneal endothelium. A quantitative histologic study. Invest. Ophthalmol. Vis. Sci. 1984; 25: 312-322.

11. Nucci P., Brancato R., Mets M.B., Shevell S.K. Normal endothelial cell density range in childhood. Arch. Ophthalmol. 1990; 108: 247.

12. Bourne W. M., Kaufman H. E. Specular microscopy of human corneal endothelium in vivo. Am. J. Ophthalmol. 1976; 81: 319-323.

13. Speedwell L., Novakovic P., Sherrard E. S., Taylor D. S. The infant corneal endothelium. Arch. Ophthalmol. 1988; 106: 771-775.

14. Bahn C. F., Glassman R. M., MacCallum O. K., Lillie J. H., Meyer R. F., Robinson B. J., Rich N.M. Postnatal development of corneal endothelium. Invest. Ophthalmol. Vis. Sci. 1986; 27: 44-51.

15. Hiles D. A., Biglan A. W., Fetherholf E. C. Central corneal endothelial cell counts in children. Am. Intra-Ocular Implant Soc. J. 1979; 5: 292-300.

16. Hoffer K. J., Kraff M. C. Normal endothelial cell count range. Ophthalmology. 1980; 87: 861-865.

17. Sturrock G. O., Sherrard E. S., Rice N. S. C. Specular microscopy of the corneal endothelium. Br.J. Ophthalmol. 1978; 62: 809-814.

18. Wilson R.S., Roper-Hall M.J. Effect of age on the endothelial cell count in the normal eye. Br. J. Ophthalmol. 1982; 66: 513-515.

19. Williams K. K., Noe R. L., Grossniklaus H. E., Drews-Botsch C., Edelhauser H. F. Correlation of histologic corneal endothelial cell counts with specular microscopic cell density. Arch. Ophthalmol. 1992; 110: 1146.

20. Blatt H. L. Endothelial cell density in relation to morphology. Invest. Ophthalmol. Vis. Sci. 1979; 18: 856-859.

21. Laule A., Cable M.K., Hoffman C.E., Hanna C. Endothelial cell population changes of human cornea during life. Arch. Ophthalmol. 1978; 96: 2031-2035.

22. Kasparova Evg.A., Subbot A.M., Kalinina D.B. [Proliferative potential of human corneal posterior epithelium]. Proliferativnyy potentsial zadnego epiteliya rogovitsy cheloveka. [Annals of Ophthalmology]. Vestnik oftal’mologii. 2013; 129 (3): 82-88. (in Russ.).

23. Edelhauser H.F. The resiliency of the corneal endothelium to refractive and intraocular surgery. Cornea. 2000; 19: 263-273.

24. Joyce N.C. Proliferative capacity of the corneal endothelium. Prog. Retin. Eye Res. 2003; 22: 359-389.

25. Klintworth G. K. Corneal dystrophies. Orphanet J. Rare Dis. 2009; 4: 7.

26. Trufanov C. V., Malozhen S. A., Lyutkevich V. G., Pivin E. A. [Descemet’s membrane transplantation in bullous keratopathy surgical rehabilitation]. Transplantatsiya destsemetovoy membrany v khirurgicheskoy reabilitatsii bol’nykh s bulleznoy keratopatiey. [Fundamental Researches]. Fundamental’nye issledovaniya. 2012; 12 (2): 273-376. (in Russ.).

27. Trufanov S. V., Polunina E. G. [Thin descemet’s stripping automated endothelial keratoplasty (DSAEK) in bullous keratopathy patients with pre-op low vision]. Avtomatizirovannaya endotelial’naya keratoplastika s udaleniem destsemetovoy membrany (DSAEK) pri ispol’zovanii tonkikh transplantatov u bol’nykh bulleznoy keratopatiey s nizkoy dooperatsionnoy ostrotoy zreniya. [Ophthalmology]. Oftal’mologiya. 2013; 10 (2): 24-30. (in Russ.).

28. Trufanov S. V. [Descemet’s stripping automated endothelial keratoplasty (DSAEK) outcomes in bullous keratopathy.] Rezul’taty avtomatizirovannoj jendotelial’noj keratoplastiki s udaleniem descemetovoj membrany (DSAEK) pri bulleznoj keratopatii. [Ophthalmology]. Oftal’mologiya. 2012; 9 (1): 33-36. (in Russ.).

29. Trufanov S. V. [Partial top-hat keratoplasty for bullous keratopathy.] Chastichnaja obratnaja gribovidnaja keratoplastika v lechenii bulleznoj keratopatii. [Ophthalmology]. Oftal’mologiya. 2012; 9 (3): 14-19. (in Russ.).