Case Study: December 2010
- A 35 year old male presents with bilateral corneal opacities
- Examination shows a honeycomb-type dystrophy
- A PK is performed
- Figure 1 is the H&E
- Figure 2 is a Masson trichrome
- Figure 3 is a transmission electron micrograph of the pathology shown in
Figures 1 and 2
- What are the key features on the H&E?
- What does the Masson trichrome show?
- What does the electron micrograph display?
- What is the likeliest diagnosis?
- What is the H&E differential diagnosis?
Click to show answers
- Sub-epithelial eosinophilic diffuse deposit with some in the anterior stroma, with epithelial atrophy
- Masson’s trichrome positive deposits matching the distribution on the H&E
- Electron dense rhomboidal deposits
- This is a good example of Reiss Buckler dystrophy (BIG-H3 family), which is essentially an anterior variant of granular dystrophy
- The main H&E differential is Thiel Behnke dystrophy, secondary amyloid deposits and primary gelatinous drop-like dystrophy