The endothelium of failed corneal grafts

Corneal buttons of failed grafts were obtained at the time of regrafting and studied with the scanning electron microscope. The condititions studied varied from failed donor tissue to graft rejections and herpetic endothelial disease. The scanning electron microscope offers a tridimensional, panoramic high-power view of pathologic endothelium that can be correlated to the clinical picture and light or transmission electron microscopy. The endothelium of recent grafts may be damaged by organized blood clots; leukocytes were present over the graft endothelium, possibly as a normal reaction to surgery. Herpetic infection of the graft may cause death of endothelial cells and formation of granulomatous lesions, with damage to Descemet's membrane. A large detachment and rupture of Descemet's membrane was found in a case of wound dehiscense.