Focal production of pseudoexfoliative material is a stress to the endothelial cells, leading to a secondary degeneration and corneal decompensation. This typically occurs as a bilateral, asymmetrical, slowly progressive corneal endotheliopathy, more frequent in women, after the seventh decade of age. A severe decrease of endothelial cell density occurs--shown by specular microscopy. A persistent high level of the intraocular pressure and the metabolic disturbance in glaucoma affect the endothelium function. A severe decrease of the endothelial cell density occurs (up to 35%) in pseudoexfoliative keratopathy were glaucoma is associated.
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