2020–2021 BCSC Basic and Clinical Science Course™
4 Ophthalmic Pathology and Intraocular Tumors
Part I: Ophthalmic Pathology
Chapter 6: Cornea
Degenerations, Depositions, and Ectasias
Bullous Keratopathy
Bullous keratopathy can occur after cataract surgery (pseudophakic or aphakic bullous keratopathy) or after other forms of intraocular surgery. It may also occur in endothelial dystrophies such as Fuchs endothelial corneal dystrophy. Bullous keratopathy is a result of widespread endothelial cell loss or dysfunction. Corneal deturgescence cannot be maintained with insufficient endothelial cell function.
Clinically, bullous keratopathy is characterized initially by stromal edema and resulting folds in Descemet membrane, followed by intracellular epithelial edema (hydropic degeneration) and, ultimately, separation of the epithelium from the Bowman layer. Small separations called microcysts may coalesce to form large separations, known as bullae. In advanced cases of bullous keratopathy, secondary epithelial basement membrane changes, loss of stromal keratocytes, and pannus may occur (Fig 6-13).
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.