FECD-like histopathological features of descemet's membrane in bullous keratopathy associated with primary angle...

To investigate the histopathological features of Descemet's membrane (DM) in eyes with bullous keratopathy associated with primary angle closure (PAC), with or without a history of argon laser iridotomy.

This multicenter, retrospective, observational study included eyes that underwent endothelial keratoplasty for corneal endothelial failure. Eyes with clinically diagnosed Fuchs endothelial corneal dystrophy (FECD) were excluded. DM specimens excised from eyes with PAC-associated endothelial failure were flat-mounted and examined using phase-contrast microscopy. The presence and spatial distribution of corneal guttae-like changes were evaluated and compared with those of reference specimens from FECD.

In total, 13 eyes with PAC-associated endothelial failure were included in this study. Guttae-like changes were identified on the excised DM in 9 of the 13 eyes. Of these, four eyes exhibited an atypical peripheral-predominant distribution of guttae-like changes with relative sparing of the central DM, differing from the typical central-predominant pattern observed in FECD. Additionally, guttae-like changes identified in the affected eyes were not consistently accompanied by corresponding guttae in the fellow eyes.

These findings demonstrate that excised Descemet's membranes from some eyes with endothelial failure associated with primary angle closure exhibit guttae or guttae-like changes, sometimes with an atypical distribution. These observations raise the possibility of heterogeneous underlying endothelial vulnerability and should be interpreted as hypothesis-generating.