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Case Study: September 2007
History
A 65-year-old man presented with a unilateral corneal stromal opacity of long duration. There was a history of corneal inflammation in the past related to a viral illness. There was no family history of corneal dystrophy.
The patient underwent a PK. The PK histology is shown in the figures.
Figure 1-shows epithelial irregularity with loss of Bowman’s (arrow points to where Bowman’s should be). The stroma was scarred (not shown).
Figure 2-shows a ghost type vessel in the mid, peripheral stroma (arrow).
Figure 3-arrows show a degree of secondary lipid keratopathy.
Figure 4- shows unexpected spindle shaped eosinophilic deposits in the mid to deep stroma. These were positive for Congo red and showed apple green birefringence when viewed under polarised optics.
Questions
1. What is the likeliest diagnosis?
2. Is the amyloid dystrophic or secondary?
Answers
1. The diagnosis is interstitial keratitis.
2. Despite the shape and distribution of the amyloid, this is secondary localised amyloid following the original stromal inflammation and not dystrophic amyloid (ie not concurrent lattice).
References
1. Hill JC, Maske R, Bowen RM. Secondary localized amyloidosis of the cornea associated with tertiary syphilis. Cornea 1990; 9: 98-101.
2. Dutt S, Elner VM, Soong HK, Meyer R, Sugar A. Secondary localized amyloidosis in interstitial keratitis. Ophthalmology 1992; 99 (5): 817-823.
