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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 8

Pre-Descemet's corneal dystrophy


Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India

Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Samrat Chatterjee
MGM Eye Institute, 5th Mile, Vidhan Sabha Road, Raipur - 493 111, Chhattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2400_20

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How to cite this article:
Sonkeshri A, Agrawal D, Chatterjee S, Gomase SN. Pre-Descemet's corneal dystrophy. Indian J Ophthalmol Case Rep 2021;1:8

How to cite this URL:
Sonkeshri A, Agrawal D, Chatterjee S, Gomase SN. Pre-Descemet's corneal dystrophy. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 27];1:8. Available from: https://www.ijoreports.in/text.asp?2021/1/1/8/305521



A 46-year old male presented with bilateral diminution of near vision. Slit-lamp biomicroscopy revealed bilateral diffuse, white punctiform opacities anterior to Descemet's membrane [Figure 1] suggestive of pre-Descemet's corneal dystrophy (PPCD). The family history was negative. He was prescribed glasses. PPCD is an uncommon dystrophy in people after 30 years of age, characterized by punctiform or polymorphic opacities anterior to the Descemet's membrane,[1] which represent enlarged keratocyte and extracellular lysosomal particles.[2] Although previous investigators have reported normal endothelial cell counts, they did not comment on the size and shape of the cells.[2],[3],[4] In our patient, the endothelial cell counts were normal, but the cell size and shape lay outside the normal range reported in Indian eyes.[5] The differential diagnoses include cornea farinata and opacities associated with pseudoxanthoma elasticum, X-linked ichthyosis, posterior polymorphous dystrophy, and central cloudy dystrophy of François.[1] There are no longitudinal studies on the natural history of PPCD. In two previous studies,[3],[4] which included 22 patients and 4 patients, respectively, between ages of 31 and 66 years, visual reduction was not attributable to the disease.[3] All these patients,[2],[3],[4] including our patient, were diagnosed incidentally during an ocular examination. As no visual disturbance or corneal decompensation has been ever reported,[1],[2],[3],[4] we can infer that the corneal lesions of PPCD do not progress to cause visual loss, and therefore, they do not require any treatment.
Figure 1: Slit-lamp photographs of the right (a) and left eye (b) showing diffuse white punctiform opacities in the central cornea, which are more prominent in optic section (c and d). The opacities are nearer the posterior margin of the slit beam (arrowheads) indicating their deep location. Specular microscopy of the central cornea in the right (e) and left eye (f) reveals normal endothelial cell counts with mild polymegethism and pleomorphism. In anterior segment optical coherence tomography (g) of the left eye, hyperreflective opacities lie anterior to the Descemetfs membrane in the central cornea, corresponding to the optic sections

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Weiss JS, Møller HU, Aldave AJ, Seitz B, Bredrup C, Kivelä T, et al. IC3D classification of corneal dystrophies - Edition 2. Cornea 2015;34:117-59.  Back to cited text no. 1
    
2.
Malhotra C, Jain AK, Dwivedi S, Chakma P, Rohilla V, Sachdeva K. Characteristics of pre-Descemet membrane corneal dystrophy by three different imaging modalities - In vivo confocal microscopy, anterior segment optical coherence tomography, and scheimpflug corneal densitometry analysis. Cornea 2015;34:829-32.  Back to cited text no. 2
    
3.
Grayson M, Wilbrandt H. Pre-Descemet dystrophy. Am J Ophthalmol 1967;64:276-82.  Back to cited text no. 3
    
4.
Alafaleq M, Georgeon C, Grieve K, Borderie VM. Multimodal imaging of pre-Descemet corneal dystrophy. Eur J Ophthalmol 2019. doi: 10.1177/1120672119862505.  Back to cited text no. 4
    
5.
Rao SK, Sen PR, Fogla R, Gangadharan S, Padmanabhan P, Badrinath SS. Corneal endothelial cell density and morphology in normal Indian eyes. Cornea 2000;19:820-3.  Back to cited text no. 5
    


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