PubMed · 8844367
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A Loewenstein, O Geyer, M Lazar. Descemetotomy.. https://doi.org/10.1016/s0886-3350(96)80292-6
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Descemet's membrane consists of two zones, the 'anterior banded zone' which contains wide-spaced collagen and the amorphous 'posterior non-banded zone'. It is attached anteriorly to the corneal stroma by a narrow transitional zone termed the 'interfacial matrix'. The distribution of fibronectin and P component within the different layers of Descemet's membrane was investigated using an ultrastructural immunogold technique. Seven normal human corneas from an eye bank and one specimen from an orbital exenteration were examined. Fibronectin was predominantly present in the posterior part of the posterior non-banded zone and in the anterior banded zone. The anterior part of the posterior non-banded zone contained less fibronectin. P component was present throughout the anterior banded and posterior non-banded zones. There was a sharp demarcation at the interfacial matrix since neither substance was observed in the corneal stroma. The differences shown in the distribution of fibronectin and P component within Descemet's membrane may have resulted from their binding to other substances or alternatively from differences in the quantities laid down during the evolution of this basement membrane.
The SEM-pictures represent a keratoconus in a 59-year-old patient with a Descemet rupture, which had led to a so-called Kammerwassereinbruch, where the failure of the endothelial structure has become manifest in the epithelium. In the Descemet-rupture the onset of stromal pathology is observable, while outside the rupture severe degradation of endothelial cells is seen. This is manifested as cell-membrane perforation, loss of cell contents and oedema formation in general. On the epithelial side the pathology is expressed as cell-membrane degradation and the presence of very irregularly shaped, sometimes swollen and in other cases shrunken, epithelial cells, in particular in the areas of the surface depressions. The topographical correspondence of these pathological phenomena on the endothelial and the epithelial sides is stressed.