Ultrastructure of keratoconus with healed hydrops

Area of Science:

• Ophthalmology
• Corneal Science
• Regenerative Medicine

Background:

• Keratoconus is a progressive eye condition causing corneal thinning and bulging.
• Severe hydrops can occur in keratoconus, leading to significant vision impairment.
• Understanding the corneal response to hydrops is crucial for treatment strategies.

Observation:

• Microscopic examination of three keratoconus patients' corneas after severe hydrops.
• Rupture and detachment of Descemet's membrane were observed, forming ledges.
• New endothelial cells covered exposed stromal surfaces and ledge areas.

Findings:

• Endothelium regenerated extensively, resurfacing stromal defects and ledges.
• Significant regeneration of basement membrane by the new endothelium was noted.
• In one case, endothelial cells near ledge edges showed fibrous metaplasia, secreting matrix material.

Implications:

• Demonstrates the cornea's regenerative capacity following severe injury.
• Suggests potential for endothelial cell-based therapies in keratoconus.
• Provides insights into the healing mechanisms of Descemet's membrane ruptures.