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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

Confocal microscopy of the right eye shows a Descemet’s scroll.Notes: The scrolls appeared as (A and B) tubular structures with (C) outer hyperreflectivity and inner hyporeflectivity. (D) Some areas show cellular components on the surface.
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f5-imcrj-8-219: Confocal microscopy of the right eye shows a Descemet’s scroll.Notes: The scrolls appeared as (A and B) tubular structures with (C) outer hyperreflectivity and inner hyporeflectivity. (D) Some areas show cellular components on the surface.

Mentions: Confocal microscopy, using a ConfoScan4 (Nidek Inc., Fremont, CA, USA) showed endothelial pleomorphism and polymegathism. The endothelial cell density values were 587 cells/mm2 and 1,082 cells/mm2 in the right and left eyes, respectively. No guttae were observed (Figure 4). The scrolls appeared as tubular structures, with outer hyperreflectivity and inner hyporeflectivity. Some areas had cellular components on the surface (Figure 5). The epithelium and keratocytes appeared normal.


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)

Confocal microscopy of the right eye shows a Descemet’s scroll.Notes: The scrolls appeared as (A and B) tubular structures with (C) outer hyperreflectivity and inner hyporeflectivity. (D) Some areas show cellular components on the surface.
© Copyright Policy
Related In: Results  -  Collection

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

f5-imcrj-8-219: Confocal microscopy of the right eye shows a Descemet’s scroll.Notes: The scrolls appeared as (A and B) tubular structures with (C) outer hyperreflectivity and inner hyporeflectivity. (D) Some areas show cellular components on the surface.
Mentions: Confocal microscopy, using a ConfoScan4 (Nidek Inc., Fremont, CA, USA) showed endothelial pleomorphism and polymegathism. The endothelial cell density values were 587 cells/mm2 and 1,082 cells/mm2 in the right and left eyes, respectively. No guttae were observed (Figure 4). The scrolls appeared as tubular structures, with outer hyperreflectivity and inner hyporeflectivity. Some areas had cellular components on the surface (Figure 5). The epithelium and keratocytes appeared normal.

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