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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

OD and OS AS-OCT and OD ultrasound biomicroscope.Notes: (A) OD and (B) OS AS-OCT show a thickened Descemet’s membrane; (A) the scroll extended from the posterior corneal surface into the anterior chamber. Arrowhead shows the rod-shaped Descemet’s scroll. (C and D) UBM of the right eye shows Descemet’s scrolls. Arrowheads show the rod-shaped Descemet’s scroll.Abbreviations: OD, right eye; OS, left eye; AS-OCT, anterior segment optical coherence tomography; UBM, ultrasound biomicroscopy.
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f6-imcrj-8-219: OD and OS AS-OCT and OD ultrasound biomicroscope.Notes: (A) OD and (B) OS AS-OCT show a thickened Descemet’s membrane; (A) the scroll extended from the posterior corneal surface into the anterior chamber. Arrowhead shows the rod-shaped Descemet’s scroll. (C and D) UBM of the right eye shows Descemet’s scrolls. Arrowheads show the rod-shaped Descemet’s scroll.Abbreviations: OD, right eye; OS, left eye; AS-OCT, anterior segment optical coherence tomography; UBM, ultrasound biomicroscopy.

Mentions: Anterior segment optical coherence tomography (AS-OCT) (Spectralis® HRA, Heidelberg Engineering GmbH, Heidelberg, Germany) showed a thickened Descemet’s membrane. The scrolls extended from the Descemet’s membrane into the anterior chamber. The outer portion of the scrolls appeared to be hyperreflective when compared with the inner portion, which was hyporeflective. There was no stromal opacity and the central cornea was 494 microns thick (Figure 6A and B).


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)

OD and OS AS-OCT and OD ultrasound biomicroscope.Notes: (A) OD and (B) OS AS-OCT show a thickened Descemet’s membrane; (A) the scroll extended from the posterior corneal surface into the anterior chamber. Arrowhead shows the rod-shaped Descemet’s scroll. (C and D) UBM of the right eye shows Descemet’s scrolls. Arrowheads show the rod-shaped Descemet’s scroll.Abbreviations: OD, right eye; OS, left eye; AS-OCT, anterior segment optical coherence tomography; UBM, ultrasound biomicroscopy.
© Copyright Policy
Related In: Results  -  Collection

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

f6-imcrj-8-219: OD and OS AS-OCT and OD ultrasound biomicroscope.Notes: (A) OD and (B) OS AS-OCT show a thickened Descemet’s membrane; (A) the scroll extended from the posterior corneal surface into the anterior chamber. Arrowhead shows the rod-shaped Descemet’s scroll. (C and D) UBM of the right eye shows Descemet’s scrolls. Arrowheads show the rod-shaped Descemet’s scroll.Abbreviations: OD, right eye; OS, left eye; AS-OCT, anterior segment optical coherence tomography; UBM, ultrasound biomicroscopy.
Mentions: Anterior segment optical coherence tomography (AS-OCT) (Spectralis® HRA, Heidelberg Engineering GmbH, Heidelberg, Germany) showed a thickened Descemet’s membrane. The scrolls extended from the Descemet’s membrane into the anterior chamber. The outer portion of the scrolls appeared to be hyperreflective when compared with the inner portion, which was hyporeflective. There was no stromal opacity and the central cornea was 494 microns thick (Figure 6A and B).

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