Specular microscopic appearance of the corneal endothelium in iridocorneal endothelial syndrome.

The corneal endothelium of a 71-year-old woman with iridocorneal endothelial syndrome had two types of cell structure and density demonstrated by specular microscopy. In parts of the central cornea, characterized by normal endothelium on examination with the slitlamp biomicroscope, a substantial increase in cell density over that in the opposite normal eye was observed. In other focal areas of the central cornea, characterized by a typical beaten-silver appearance on slit-lamp biomicroscopy, considerable cell loss and cellular pleomorphism were observed in comparison with the surrounding normal-appearing endothelium. Nevertheless, the endothelial cell density in these areas was not significantly greater than that of the opposite uninvolved eye. This finding supports the theory that endothelial proliferation in this disease occurs not only on the iris but also in the endothelial cell layer of the cornea.