The corneal endothelium. Normal and pathologic structure and function.

A summary of normal and abnormal endothelial structure and function is presented. Endothelium originates from neural crest and it elaborates a banded basement membrane in utero. It is involved in mesenchymal dysgenesis of the anterior segment, like the central defect of Peters' anomaly. Cytoplasmic organelles include mitochondria that provide energy for the metabolic pump, rough endoplasmic reticulum that participate in secretion of extracellular matrix, and a terminal web that may participate in cell migration. The endothelium's main function is to control corneal hydration and nutrition with a leaky barrier formed by the apical gap and macula occludens junctions that keep some water out of the stroma but allow nutrients to pass, and with an ATPase-dependent metabolic pump that is located in the lateral plasma membranes. Endothelial wound healing involves flattening and enlargement of cells to maintain an intact monolayer as well as production of abnormal collagenous material posterior to Descemet's membrane. HLA antigens located in the plasma membrane may participate in corneal endothelial graft rejection. Clinical assessment of the endothelium involves three modalities: specular microscopy to study endothelial morphology, fluorophotometry to measure barrier function, and pachymetry to measure corneal thickness.