Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 824
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
BRIEF REPORT
Year : 2007  |  Volume : 55  |  Issue : 5  |  Page : 376-378

In vivo confocal microscopy in different types of posterior polymorphous dystrophy


Prabha Eye Clinic and Research Center, Bangalore and Vittala Institute of Ophthalmology, Bangalore, India

Date of Submission03-Mar-2006
Date of Acceptance03-Oct-2006

Correspondence Address:
Kalpana Babu
Prabha Eye Clinic and Research Center, 504, 40th cross, Jayanagar 8th block, Bangalore - 560 070
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.33826

Rights and Permissions
  Abstract 

Posterior polymorphous dystrophy is a rare corneal dystrophy, usually detected by chance. This case series describes the morphologic features in the three different types of posterior polymorphous dystrophy using confocal microscopy.

Keywords: Confocal microscopy, posterior polymorphous dystrophy.


How to cite this article:
Babu K, Murthy K R. In vivo confocal microscopy in different types of posterior polymorphous dystrophy. Indian J Ophthalmol 2007;55:376-8

How to cite this URL:
Babu K, Murthy K R. In vivo confocal microscopy in different types of posterior polymorphous dystrophy. Indian J Ophthalmol [serial online] 2007 [cited 2019 Aug 21];55:376-8. Available from: http://www.ijo.in/text.asp?2007/55/5/376/33826

Posterior polymorphous dystrophy is a rare, often innocuous, autosomal dominant and usually asymptomatic corneal dystrophy which may frequently be diagnosed by chance in later life. [1] It is asymmetrical and consists of three types: vesicular, band-like and geographic (placoid) patterns. The principle of confocal microscopy allows us to study the morphology of the cornea in vivo . This series describes the morphologic features in different types of posterior polymorphous dystrophy using confocal microscopy using the Rostock corneal module of the Heidelberg retinal tomograph II (Heidelberg Engineering, Germany). A Tomey pachymeter (Tomey Corporation, Japan) was used to obtain the central corneal thickness.


  Case Reports Top


Case 1

A 28-year-old asymptomatic male was diagnosed on routine examination to have a vesicular type of posterior polymorphous dystrophy in both eyes by slit-lamp examination. The best-corrected visual acuity was 20/20 (Snellens) in both eyes. White flecks with guttae were seen involving the Descemet's membrane and endothelium [Figure - 1]A. Central corneal thickness measurements were 570 mm and 566 mm in the right and left eyes respectively. Confocal microscopy findings included vesicular abnormalities ranging from 10 to 160 mm. Endothelial cells were visible within some vesicular lesions [Figure - 1]B. Patchy hyperreflective lesions were noted at the level of the Descemet's membrane and around the vesicular lesions [Figure - 1]C. The endothelial densities were 1757 ± 40 cells/mm2 and 1497 ± 51 cells/mm2 (normal: 2218 to 4434 cells/mm 2 ) [1] in the right and left eyes respectively.

Case 2

A 72-year-old asymptomatic male was diagnosed to have a band type of posterior polymorphous dystrophy in the left eye on slit-lamp examination [Figure - 2]A. The best-corrected visual acuity was 20/30 (Snellens) in both eyes. Clinically, his right eye appeared normal. Central corneal thickness measurements were 526 mm and 611 mm in the right and left eyes respectively. Confocal microscopy findings in both eyes showed endothelial polymorphism and polymegathism with folding and scalloping of the endothelial cell borders [Figure - 2]B. Occasionally, bright endothelial nuclei were noted. The endothelial densities were 2056 ± 66 cells/mm2 and 1609 ± 40 cells/mm2 (normal: 2218 to 4434 cells/mm2)[1] in the right and left eyes respectively.

Case 3

A 64-year-old symptomatic woman with decrease in vision was diagnosed to have a geographic pattern of posterior polymorphous dystrophy in the right eye on slit-lamp examination [Figure - 3]A. Her best-corrected visual acuity was counting fingers three meters and 20/60 (Snellens) in the right and left eyes respectively. Clinically, her left eye was normal. Central corneal thickness measurements were 668 mm and 559 mm in the right and left eyes respectively. Confocal microscopy findings in the right eye showed needle-shaped lesions suggestive of scarring in the stroma [Figure - 3]B. Large vesicles were noted in the endothelium. The borders of the endothelial cells appeared indistinct [Figure - 3]C. The left eye showed plenty of hyperreflective dot-like lesions in the endothelium and polymegathism [Figure - 3]D. The endothelial cells could not be counted in the right eye due to indistinct cell margins while the endothelial cell density in the left eye was 1541 ± 45 cells/mm2 (normal: 2218 to 4434 cells/mm2).[1]


  Discussion Top


In vivo confocal microscopy allows observations of the living human eye at a cellular level. It is based on the principle that the illumination (condenser) and observation (objective) systems are focused on a single point (have common focal points). [2] This eliminates out of focus information and brings a lateral resolution of 1-2 mm and an axial resolution of 5-10 mm increasing the magnification up to 600 times. Findings such as cracks, vesicles, craters have been described in general in posterior polymorphous dystrophy. [3],[4] This case series delineates the morphological features seen on confocal microscopy in each type of posterior polymorphous dystrophy.

In case 1, both eyes showed similar findings on slit-lamp and confocal microscopy examinations. The presence of vesicles and patchy hyperreflective lesions at the level of the Descemet's membrane and around the vesicles corresponded to the guttae and white flecks seen clinically.

In case 2, although band-shaped areas were seen clinically only in the left eye, the right eye also showed similar changes on confocal microscopy. The confocal microscopy findings of the folding and scalloping of the endothelial cell borders represent edges of individual vesicles that might have fused to give the above appearance. [5]

In case 3, clinically evident geographic pattern was noted in the right eye. The confocal microscopy findings of needle-shaped lesions in the stroma with large vesicles in the endothelium and indistinct cellular margins indicate the corneal edema with scarring seen in these eyes. However, certain changes like dot-like hyperreflective lesions were also seen in the left eye indicating abnormal changes in the endothelium.

Confocal microscopy thus enhances the clinicopathological diagnosis and aids in the follow-up of corneal dystrophies with subtle clinical presentations.

 
  References Top

1.
Vanathi M, Tandon R, Sharma N, Titiyal JS, Pandey RM, Vajpayee RB. In vivo slit scanning confocal microscopy of normal corneas in Indian eyes. Indian J Ophthalmol 2003;51:225-30.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.
Guthoff RF, Stave J. In vivo micro morphology of the cornea: Confocal microscopy principles and clinical application. In : Reinhard T, Larkin F, editors. Cornea and External eye disease. 16 th ed. Springer; 2006. p. 174-81.  Back to cited text no. 2
    
3.
Cheng LL, Young AL, Wong AK, Law RW, Lam DS. Confocal microscopy of posterior polymorphous endothelial dystrophy. Cornea 2005;24:599-602.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Patel DV, Grupcheva CN, McGhee CN. In vivo confocal microscopy of posterior polymorphous dystrophy. Cornea 2005;24:550-4.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.
Laganowski HC, Sherrard ES, Kerr Muir MG. The posterior corneal surface in posterior polymorphous dystrophy: A specular microscopical study. Cornea 1991;10:224-32.  Back to cited text no. 5
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


This article has been cited by
1 Posterior Polymorphous Corneal Dystrophy (PPCD) Combined with Traumatic Descemetæs Membrane Fold
Na Hyun Kim,Ji Young Shin,Man Soo Kim
Journal of the Korean Ophthalmological Society. 2014; 55(8): 1238
[Pubmed] | [DOI]
2 Self-limiting corneal edema with multiple parallel lines on the endothelium (SCEMPLE)
Sofie Le Piane,Toine Hillenaar,Lies Remeijer
International Ophthalmology. 2014;
[Pubmed] | [DOI]
3 The Clinical Features and Progression of the Disease in Posterior Polymorphous Corneal Dystrophy (PPCD)
Na Hyun Kim,Man Soo Kim
Journal of the Korean Ophthalmological Society. 2014; 55(3): 368
[Pubmed] | [DOI]
4 Anterior Segment Applications of In Vivo Confocal Microscopy
George D. Kymionis,Vasilios F. Diakonis,Mohammad M. Shehadeh,Aristofanis I. Pallikaris,Ioannis G. Pallikaris
Seminars in Ophthalmology. 2013; : 1
[Pubmed] | [DOI]
5 In Vivo Confocal Microscopic Findings in Posterior Polymorphous Corneal Dystrophy
Banu Bozkurt,Murat Irkec,Mehmet C. Mocan
Cornea. 2013; 32(9): 1237
[Pubmed] | [DOI]
6 Aspects en microscopie confocale in vivo (HRT-II®) de la dystrophie polymorphe postérieure (DPP)
F.X. Kouassi, D. Touboul, C. Schweitzer, L. Pinsard, C. Garra, J. Colin
Journal Français d Ophtalmologie. 2011;
[VIEW] | [DOI]
7 Photorefractive keratectomy in posterior polymorphous dystrophy with vesicular and band subtypes
Kraig S. Bower, Edward W. Trudo, Denise S. Ryan, Rose K. Sia, Michael J. Mines, Richard D. Stutzman, Keith J. Wroblewski
Journal of Cataract & Refractive Surgery. 2011; 37(6): 1101
[VIEW] | [DOI]
8 Observation of posterior corneal vesicles with in vivo confocal microscopy and anterior segment OCT
Watanabe, R., Nakazawa, T., Fuse, N.
Clinical Ophthalmology. 2010; 4(1): 1243-1247
[Pubmed]
9 Clinical in vivo confocal microscopy of the human cornea in health and disease
Niederer, R.L., McGhee, C.N.J.
Progress in Retinal and Eye Research. 2010; 29(1): 30-58
[Pubmed]
10 The clinical spectrum between posterior polymorphous dystrophy and iridocorneal endothelial syndromes
Lefebvre, V., Sowka, J.W., Frauens, B.J.
Optometry. 2009; 80(8): 431-436
[Pubmed]
11 In vivo confocal microscopy findings of corneal granular dystrophy | [Microscopía confocal in vivo de la distrofia granular de la córnea]
Ramírez-Fernández, M., Hernández-Quintela, E., Naranjo-Tackman, R.
Revista Mexicana de Oftalmologia. 2009; 83(2): 113-115
[Pubmed]
12 The clinical spectrum between posterior polymorphous dystrophy and iridocorneal endothelial syndromes
Valerie Lefebvre,Joseph W. Sowka,Barry J. Frauens
Optometry - Journal of the American Optometric Association. 2009; 80(8): 431
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Case Reports
Discussion
References
Article Figures

 Article Access Statistics
    Viewed3200    
    Printed44    
    Emailed4    
    PDF Downloaded262    
    Comments [Add]    
    Cited by others 12    

Recommend this journal