Homeostatic maintenance of corneal endothelial cells is essential for maintenance of corneal deturgescence and transparency. in fuchs endothelial corneal dystrophy (fecD), an accelerated loss and dysfunction of endothelial cells leads to progressively severe visual impairment. An abnormal accumulation of extracellular matrix (ecM) is a distinctive hallmark of the disease, however the molecular pathogenic mechanisms underlying this phenomenon are not fully understood. Here, we investigate genome-wide and sequence-specific DNA methylation changes of miRNA genes in corneal endothelial samples from fecD patients. We discover that miRnA gene promoters are frequent targets of aberrant DNA methylation in FECD. More specifically, miR-199B is extensively hypermethylated and its mature transcript miR-199b-5p was previously found to be almost completely silenced in FECD. Furthermore, we find that miR-199b-5p directly and negatively regulates Snai1 and ZEB1, two zinc finger transcription factors that lead to increased ECM deposition in FECD. Taken together, these findings suggest a novel epigenetic regulatory mechanism of matrix protein production by corneal endothelial cells in which miR-199B hypermethylation leads to miR-199b-5p downregulation and thereby the increased expression of its target genes, including Snai1 and ZEB1. our results support miR-199b-5p as a potential therapeutic target to prevent or slow down the progression of FECD disease. Corneal transparency is critical for good visual acuity. The corneal endothelium regulates the hydration status of the cornea and has an essential role in maintaining corneal deturgescence and preventing edema that can degrade corneal transparency. It is the innermost layer of the cornea and is composed of a single layer of cells that pump excess fluid out of the cornea through active ion-transport processes 1,2. Fuchs endothelial corneal dystrophy (FECD) is a bilateral, slowly progressive disorder in which the corneal endothelial cells are diseased and become less efficient at removing fluid. As a result, the highly ordered arrangement of collagen fibers in the corneal stromal layer become disrupted, leading to corneal opacification and vision loss 3. Other clinical phenotypic changes that occur in FECD include an excessive accumulation of extracellular matrix (ECM), formation of central excrescences (corneal guttae), thickening of Descemet's membrane, and corneal scarring 4. At earlier stages of FECD, the formation of corneal guttae can cause light scatter and optical aberrations that can impair vision, even in the absence of overt corneal edema. In later FECD, overt endothelial dysfunction and resultant corneal edema contribute significantly to visual loss. Corneal endothelial cells are largely non-regenerative in vivo and their loss is often irreversible 5. Medical management is often inadequate and corneal endothelial transplantation remains the main therapeutic option to restore vision in patients with advanced FECD. FECD is a leading indication for corneal transplantation i...