fuchs endothelial corneal dystrophy (fecD) is a degenerative eye disease characterized by corneal endothelial cell (CEC) death and the formation of guttae, an abnormal thickening of CEC's basement membrane. At the tissue level, an oxidative stress causing mitochondrial damage and CEC death have been described to explain FECD pathogenesis. At the cellular level, our group has previously observed significant variability in the mitochondrial mass of FECD CECs. This led us to hypothesize that mitochondrial mass variability might play a key role in the chronology of events eventually leading to CEC death in FECD. We thus used different fluorescent markers to assess mitochondrial health and functionality as a function of mitochondrial mass in FECD corneal endothelial explants, namely, intramitochondrial calcium, mitochondrial membrane potential, oxidation level and apoptosis. This has led us to describe for the first time a sequence of events leading to what we referred to as a mitochondrial burnout, and which goes as follow. FECD CECs initially compensate for endothelial cell losses by incorporating mitochondrial calcium to help generating more ATP, but this leads to increased oxidation. CECs then resist the sustained need for more ATP by increasing their mitochondrial mass, mitochondrial calcium and mitochondrial membrane potential. At this stage, CECs reach their maximum capacity and start to cope with irreversible oxidative damage, which leads to mitochondrial burnout. This burnout is accompanied by a dissipation of the membrane potential and a release of mitochondrial calcium, which in turn leads to cell death by apoptosis. The cornea is composed of three cellular layers, i.e. the epithelium, the stroma and the endothelium 1. The stroma needs to be maintained partially dehydrated to allow for the optimal arrangement of its collagen fibrils necessary to ensure its transparency 2. This ATP-demanding function is achieved mainly by the corneal endothelium, a leaky cell monolayer that pumps fluid out of the stroma, into the anterior chamber, maintaining the proper hydration of the corneal stroma 2,3. Fuchs endothelial corneal dystrophy (FECD) is characterized by a loss of corneal endothelial cells (CECs), abnormal extracellular matrix deposition on its basal membrane (Descemet's membrane) leading to the formation of excrescences called guttae, and changes in cellular morphology 4. The loss of CECs ultimately compromises the role of the endothelium to preserve corneal deturgescence. This leads to corneal edema and vision loss 4. FECD affects 4 percent of the US populations over 40 years old 5 and the only treatment currently available for FECD is corneal transplantation 6,7. Although the exact cause of FECD is not yet determined, there is growing evidence that oxidative stress and mitochondria are major contributors 8,9. The mechanism and the sequence of events leading to mitochondrial dysfunction and cell loss still remain to be elucidated. Manifestations of cumulative oxidative damage and mitochondrial dysfunction in ...