Case Study: October 2009


A 30 year-old male has a PK for a hazy cornea.

Figure 1 shows a PAS stain of the cornea, with Descemet’s shown.

Figure 2 shows Descemet’s and residual endothelium stained with another special stain.


1. What does the PAS reveal?
2. What is the aetiological differential diagnosis of this appearance?
3. Which stain has been used in Figure 2?
4. What is the diagnosis?

Click to show answers
  1. Guttae
  2. Isolated idiopathic cases are seen quite often
    1. Advanced cornea guttata may be discovered by chance, when a long-standing case of aphakia or pseudophakia is subjected to specular endothelial microscopy to gauge the health of the cornea.
    2. Association with glaucoma, including acute angle closure form
    3. Association with keratoconus
    4. Cardiovascular disease
    5. Axial hypermetropia
    6. Female hormones
    7. Trauma
    8. Inflammation (pseudo-Fuchs)
    9. Viruses
    10. Macular dystrophy.
    11. Toxins
  3. Alcian Blue. Shows mucopolysaccharide in the cytoplasm of surviving endothelial cells.
  4. Macular dystrophy.