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Descemet's scroll in syphilitic interstitial keratitis: a case report with anterior segment evaluation and a literature review.

Kasetsuwan N, Reinprayoon U, Chantaren P - Int Med Case Rep J (2015)

Bottom Line: The corneal lesion remained stable during the 6-year follow-up period without the need for keratoplasty, while the previous literature reported spontaneous and postoperative corneal decompensation.Although we did not obtain the corneal tissue for examination, the anterior segment investigation provides insight into the underlying histopathology and natural disease history.Failure to detect the corneal endothelium due to stromal opacity in these cases is possible, however, compromised endothelium may present.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ; Ophthalmology Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

ABSTRACT

Purpose: To present a case of syphilitic interstitial keratitis with Descemet's scrolls, as well as its characteristic findings in an anterior segment investigation in relation to the histopathologic findings from a literature review.

Case presentation: A case report of a 64-year-old woman with syphilitic infection presented with band keratopathy and retrocorneal scrolls. Slit-lamp photography, confocal microscopy, anterior segment optical coherence tomography (AS-OCT), and ultrasound biomicroscopy were performed. Four previous reports were reviewed to describe the pathogenesis, natural history, and histopathologic and immunohistologic findings of the Descemet's scroll.

Results: The spectacle-corrected visual acuity was 20/50 and 20/30 in the right and left eyes, respectively. The scrolls appeared as a translucent web extending from Descemet's membrane into the anterior chamber. Confocal microscopy showed decreased endothelial cell density, pleomorphism, polymegathism, and hyperreflective fibrocellular rods with central hollow. The AS-OCT and ultrasound biomicroscopy showed rod-shaped retrocorneal scrolls. The corneal thickness was 494 microns, as measured by AS-OCT. The corneal lesion remained stable during the 6-year follow-up period without the need for keratoplasty, while the previous literature reported spontaneous and postoperative corneal decompensation.

Conclusion: We present a case of syphilitic interstitial keratitis with rare Descemet's scrolls featuring relatively good visual acuity. Although we did not obtain the corneal tissue for examination, the anterior segment investigation provides insight into the underlying histopathology and natural disease history. The central hollow and cellular component seen during confocal microscopy might correspond to the amorphous core and the abnormal endothelial cells in the histopathologic findings. Failure to detect the corneal endothelium due to stromal opacity in these cases is possible, however, compromised endothelium may present.

No MeSH data available.


Related in: MedlinePlus

Slit-lamp photograph of the left eye.Note: (A) Slit-lamp photograph of the left eye (B) showing a fine Descemet’s scroll and (C) stromal ghost vessels.
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f2-imcrj-8-219: Slit-lamp photograph of the left eye.Note: (A) Slit-lamp photograph of the left eye (B) showing a fine Descemet’s scroll and (C) stromal ghost vessels.

Mentions: A 64-year-old woman presented to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 2007 with irritation in the right eye from band keratopathy. The patient gave informed consent to this case presentation. At the time of this study, the Institutional Review Board did not require approvals for this type of article. She reported a remote history of bilateral red eyes with decreased vision at the age of 15 years in 1964 that improved after the injection of kanamycin. The Treponema pallidum haemagglutination assay test was positive, while the venereal disease research laboratory and human immunodeficiency virus antibody tests were negative. Her neurologic examination performed by an internist was unremarkable. Her best spectacle-corrected VA upon her first visit was 20/50 in the right eye and 20/30 in the left eye. The intraocular pressure values were 10 mmHg and 9 mmHg in the right and left eyes, respectively. There was no substantial stromal opacity or corneal edema. The Descemet’s scrolls appeared as multiple translucent rods with a central gray core, and they were arranged in a web and extended into the anterior chamber (Figure 1). Few guttae were observed. The involvement in the left eye was milder, with fine retrocorneal scrolls but dense stromal ghost vessels (Figure 2). A pupillary membrane was also present in the right eye and Koeppe nodules were evident in the left eye (Figure 3). At the 6-year follow-up examination, the corneal lesion remained stable, but the patient’s vision had deteriorated slightly due to cataract formation, with best spectacle-corrected VA values of 20/70 in the right eye and 20/50 in left eye, respectively. The anterior segment evaluation was performed at the last visit.


Descemet's scroll in syphilitic interstitial keratitis: a case report with anterior segment evaluation and a literature review.

Kasetsuwan N, Reinprayoon U, Chantaren P - Int Med Case Rep J (2015)

Slit-lamp photograph of the left eye.Note: (A) Slit-lamp photograph of the left eye (B) showing a fine Descemet’s scroll and (C) stromal ghost vessels.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592032&req=5

f2-imcrj-8-219: Slit-lamp photograph of the left eye.Note: (A) Slit-lamp photograph of the left eye (B) showing a fine Descemet’s scroll and (C) stromal ghost vessels.
Mentions: A 64-year-old woman presented to King Chulalongkorn Memorial Hospital, Bangkok, Thailand, in 2007 with irritation in the right eye from band keratopathy. The patient gave informed consent to this case presentation. At the time of this study, the Institutional Review Board did not require approvals for this type of article. She reported a remote history of bilateral red eyes with decreased vision at the age of 15 years in 1964 that improved after the injection of kanamycin. The Treponema pallidum haemagglutination assay test was positive, while the venereal disease research laboratory and human immunodeficiency virus antibody tests were negative. Her neurologic examination performed by an internist was unremarkable. Her best spectacle-corrected VA upon her first visit was 20/50 in the right eye and 20/30 in the left eye. The intraocular pressure values were 10 mmHg and 9 mmHg in the right and left eyes, respectively. There was no substantial stromal opacity or corneal edema. The Descemet’s scrolls appeared as multiple translucent rods with a central gray core, and they were arranged in a web and extended into the anterior chamber (Figure 1). Few guttae were observed. The involvement in the left eye was milder, with fine retrocorneal scrolls but dense stromal ghost vessels (Figure 2). A pupillary membrane was also present in the right eye and Koeppe nodules were evident in the left eye (Figure 3). At the 6-year follow-up examination, the corneal lesion remained stable, but the patient’s vision had deteriorated slightly due to cataract formation, with best spectacle-corrected VA values of 20/70 in the right eye and 20/50 in left eye, respectively. The anterior segment evaluation was performed at the last visit.

Bottom Line: The corneal lesion remained stable during the 6-year follow-up period without the need for keratoplasty, while the previous literature reported spontaneous and postoperative corneal decompensation.Although we did not obtain the corneal tissue for examination, the anterior segment investigation provides insight into the underlying histopathology and natural disease history.Failure to detect the corneal endothelium due to stromal opacity in these cases is possible, however, compromised endothelium may present.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ; Ophthalmology Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

ABSTRACT

Purpose: To present a case of syphilitic interstitial keratitis with Descemet's scrolls, as well as its characteristic findings in an anterior segment investigation in relation to the histopathologic findings from a literature review.

Case presentation: A case report of a 64-year-old woman with syphilitic infection presented with band keratopathy and retrocorneal scrolls. Slit-lamp photography, confocal microscopy, anterior segment optical coherence tomography (AS-OCT), and ultrasound biomicroscopy were performed. Four previous reports were reviewed to describe the pathogenesis, natural history, and histopathologic and immunohistologic findings of the Descemet's scroll.

Results: The spectacle-corrected visual acuity was 20/50 and 20/30 in the right and left eyes, respectively. The scrolls appeared as a translucent web extending from Descemet's membrane into the anterior chamber. Confocal microscopy showed decreased endothelial cell density, pleomorphism, polymegathism, and hyperreflective fibrocellular rods with central hollow. The AS-OCT and ultrasound biomicroscopy showed rod-shaped retrocorneal scrolls. The corneal thickness was 494 microns, as measured by AS-OCT. The corneal lesion remained stable during the 6-year follow-up period without the need for keratoplasty, while the previous literature reported spontaneous and postoperative corneal decompensation.

Conclusion: We present a case of syphilitic interstitial keratitis with rare Descemet's scrolls featuring relatively good visual acuity. Although we did not obtain the corneal tissue for examination, the anterior segment investigation provides insight into the underlying histopathology and natural disease history. The central hollow and cellular component seen during confocal microscopy might correspond to the amorphous core and the abnormal endothelial cells in the histopathologic findings. Failure to detect the corneal endothelium due to stromal opacity in these cases is possible, however, compromised endothelium may present.

No MeSH data available.


Related in: MedlinePlus