Endothelial viral inclusions in Fuchs' corneal dystrophy

A case of Fuchs' corneal dystrophy is presented. The patient, a 70-year-old white woman, had bilateral decreasing vision, especially while reading and driving at night. Clinical features were characteristic of Fuchs' corneal dystrophy. Ultrastructural studies demonstrated findings in Descemet's membrane typical of those previously reported with numerous tactoids of fibrous long-spacing collagen in the posterior collagenous layer and in the guttata. In the endothelial cells were encapsulated ellipsoid viral particles, 400 nm long and 225 nm in diameter. They contained an outer and inner membrane with an electron-dense intervening region and a central dense core. Nucleocapsids were present in the endothelial cells and stromal keratocytes. The authors suggest that the pathogenesis of Fuchs' corneal dystrophy may be endothelial damage, and that in this case, the etiology is a viral infection.