Clinical specular microscopy of posterior polymorphous endothelial dystrophy

By means of clinical specular microscopy in 27 patients with posterior polymorphous corneal endothelial dystrophy diagnosed by slit lamp examination and 26 relatives with normal findings by slit-lamp and specular microscopic examinations, we identified two clinical and specular microscopic patterns of posterior polymorphous dystrophy. (1) The localized vesicular or band pattern consisted of clear corneas with localized lesions resembling craters that were lined by abnormal cells and surrounded by enlarged, pleomorphic cells. (2) The geographic pattern was associated with Descemet's membrane haze and deep stromal haze, occasional peripheral iridocorneal adhesions, and glaucoma. By specular microscopy, this type had large, well circumscribed areas of abnormal pleomorphic cells with indistinct borders and increased reflective highlights. These areas were surrounded by normal-sized and smaller polygonal cells. The former cells appear to represent epithelial cells and the latter endothelial cells.