Electron microscopic study of recurrent Reis-Bücklers' corneal dystrophy

We studied the cornea of a 51-year-old woman with recurrent Reis-Bücklers' dystrophy with the transmission electron microscope. The patient had had a superficial keratectomy nine years earlier. The epithelium removed in a second keratectomy contained distended endoplasmic reticulum and swollen mitochondria. The basal layer showed some cells in mitosis and a slight increase in the number of dark cells. The anterior portion of the removed stroma contained dense collagen fibrils, with the appearance of curly fibrils, which is characteristic of this disease. There were also severe degenerative changes in the stroma. These changes in the collagen fibers and alterations in keratocytes of the deeper layers were less severe than those of the superficial layer. A biopsy of the bulbar conjunctiva showed reduplication of the basement membrane.