Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Descemet Membrane Folds

  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 23, 2016
 

Background

The cornea[1] plays a crucial and vital role in the visual pathway. To maximize the visual potential of the eye, both the clarity of the cornea and the refractive power (curvature) are important. Any disturbance to the clarity or thickness of the cornea will affect its visual potential. The Descemet membrane and endothelial cells play a critical role. See the image below.

Diffuse illumination showing Descemet membrane fol Diffuse illumination showing Descemet membrane folds after surgery.
Next

Pathophysiology

The cornea is composed of 5 discrete anatomical components, each with specific functions to achieve the goal of clarity and refractive potential. The outermost component, the epithelium, provides a smooth surface due to the interactions of cytoskeletal components and tear film matrix. It also serves an important protective barrier function. The Bowman layer[2] or membrane, the second layer moving in toward the eye, serves as the smooth adhesion layer for the basement membrane of the epithelial cells. This layer is not crucial for clarity or visual function since removal of the Bowman layer during photorefractive keratectomy does not negatively affect vision.

The corneal stroma makes up the majority of the width of the cornea. It is composed of collagen fibrils arranged in a regular pattern to allow light to enter and pass through without being diffracted or reflected. Inflammation manifesting as stromal infiltrates and/or stromal edema results in the interruption of the regular periodicity of the collagen matrix and decreased corneal clarity. Because the cornea is avascular, nutrients and wastes are delivered and deposited anteriorly via the tear film and external environment, internally via corneal nerves, and posteriorly via the aqueous humor.

The innermost layer of the cornea is the endothelial cell layer, a monolayer of polarized cells. They are arranged with their apical portion toward the aqueous humor in the anterior chamber. The endothelial cells are responsible for maintaining the desiccation of the stroma by actively removing water. The Descemet membrane is the specialized basement membrane of the endothelial cells positioned between the stroma and the endothelial cell layer. Any condition that causes inflammation of the cornea or the anterior chamber can cause Descemet membrane folds.

Previous
Next

Epidemiology

Frequency

United States

Descemet membrane folds is common because it is associated with many inflammatory conditions of the eye.

International

The frequency is similar to that in the United States.

Mortality/Morbidity

Morbidity due to decreased vision and pain exists.

Race

No predisposition to race exists.

Sex

Descemet membrane folds affects women and men equally.

Age

Descemet membrane folds affects all age groups with slower resolution of the folds in elderly persons.

Previous
 
 
Contributor Information and Disclosures
Author

Robert H Graham, MD Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona

Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, Arizona Ophthalmological Society, American Medical Association

Disclosure: Partner received salary from Medscape/WebMD for employment.

Coauthor(s)

Magdalena F Shuler, MD, PhD Consulting Staff, Retina Specialists, PA

Magdalena F Shuler, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, Florida Medical Association, American Society of Cataract and Refractive Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

References
  1. American Academy of Ophthalmology. External disease and cornea. Basic and Clinical Science Course, Section 8. 2006-2007.

  2. Obata H, Tsuru T. Corneal wound healing from the perspective of keratoplasty specimens with special reference to the function of the Bowman layer and Descemet membrane. Cornea. 2007 Oct. 26(9 Suppl 1):S82-9. [Medline].

  3. Wilson FM. Slit-lamp biomicroscopy. Practical Ophthalmology. 4th ed. 1996. 213-229.

  4. Espana EM, Huang B. Confocal microscopy study of donor-recipient interface after Descemet's stripping with endothelial keratoplasty. Br J Ophthalmol. 2010 Jul. 94(7):903-8. [Medline].

  5. Dirisamer M, van Dijk K, Dapena I, Ham L, Oganesyan O, Frank LE, et al. Prevention and Management of Graft Detachment in Descemet Membrane Endothelial Keratoplasty. Arch Ophthalmol. 2011 Nov 14. [Medline].

  6. Thomson Reuters. Physicians Desk Reference. 63rd ed. 2009.

  7. Scuderi B, Driussi GB, Chizzolini M, Salvetat ML, Beltrame G. Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery. Eur J Ophthalmol. 2003 Jul. 13(6):536-40. [Medline].

  8. Denion E, Dalens PH, Huguet P, Petitbon J, Gerard M. Radial Descemet's membrane folds as a sign of pterygium traction. Eye. 2005 Jul. 19(7):800-1. [Medline].

  9. Melles GR, Ong TS, Ververs B, van der Wees J. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. 2008 Feb. 145(2):222-227. [Medline].

 
Previous
Next
 
Descemet membrane folds after surgery.
Diffuse illumination showing Descemet membrane folds after surgery.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.