Glyxambi
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 4503
  • Home
  • Print this page
  • Email this page


 
   Table of Contents      
LETTER TO THE EDITOR
Year : 2019  |  Volume : 67  |  Issue : 3  |  Page : 442

Unilateral corneal edema in young: A diagnostic dilemma


Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, India

Date of Web Publication18-Feb-2019

Correspondence Address:
Dr. Manisha Singh
Department of Cornea, Refractive Surgery and Ocular Surface Disorders, Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Marg, Daryaganj, New Delhi - 110 002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1895_18

Rights and Permissions

How to cite this article:
Singh M, Kapoor N, Sangwan VS. Unilateral corneal edema in young: A diagnostic dilemma. Indian J Ophthalmol 2019;67:442

How to cite this URL:
Singh M, Kapoor N, Sangwan VS. Unilateral corneal edema in young: A diagnostic dilemma. Indian J Ophthalmol [serial online] 2019 [cited 2019 Mar 20];67:442. Available from: http://www.ijo.in/text.asp?2019/67/3/442/252417



Dear Sir,

We read with great interest the article titled “Unilateral corneal edema in young: A diagnostic dilemma” by Angmo et al.[1] We have few observations and suggestions to make. A delayed onset congenital hereditary endothelial dystrophy (CHED) has been seen, but only described in the first decade. The 2015 IC3D findings suggested that autosomal dominant CHED1 was insufficiently distinct to continue as a unique dystrophy and is included in posterior polymorphous dystrophy (PPCD).[2] It would be interesting to see slit-lamp photomicrograph of patient to highlight the endothelium in retroillumination against a dilated fundus to look for vesicles, bands, guttae, or diffuse opacities. PPCD classically starts in teens to early 20s with vesicles, bands, mild thickening, and edema of deep stroma. Broad based or fine peripheral anterior synechiae are present in 25% of eyes with PPCD with 15% presenting with raised intraocular pressure.[3] This could also be a case of early onset Fuchs' endothelial corneal dystrophy (FECD) described as category 1 by IC3D[1] with mutation in gene for alpha 2 chain of collagen VIII (COL8A2) on chromosome 1p34.3-p32. Corneal guttae in early onset FECD are small, rounded, and found in patchy distribution in comparison to coarse, distinct guttae of late onset FECD. Another clinical entity called non-guttae endothelial dystrophy has been described by Abbott et al.[4] He described phakic young patients with unilateral corneal edema with clinically normal contralateral eyes. There was decreased cell counts in the affected eye nut, no evidence of guttae either clinically or histologically and contralateral eye had pleomorphic endothelial cells on specular microscopy very similar to this case. Moreover SLC4A11, a sodium-borate transporter, has been associated with both CHED with progressive deafness (Harboyan syndrome: MIM 217400) and FECD. LOXHD1 is the second FECD locus involved in both corneal dystrophy and deafness.[5]

It would be interesting to know if the authors send the stripped Descemet's membrane (DM) for histolopathological examination that would aid in differentiating PPCD (multi-layered endothelium with thickened DM), FECD (decreased endothelial cell with embedded guttae bodies), CHED (absence of endothelial cells, thickened DM 20–24 microns).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Angmo D, Selvan H, Behera AK, Suman PK. Unilateral corneal edema in young: A diagnostic dilemma. Indian J Ophthalmol 2018;66:1612-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Weiss JS, Møller HU, Aldave AJ, Seitz B, Bredrup C, Kivelä T, et al. IC3D classification of corneal dystrophies-edition 2. Cornea2015;34:117-59.  Back to cited text no. 2
    
3.
Krachmer JH. Posterior polymorphous corneal dystrophy: A disease characterized by epithelial-like endothelial cells which influence management and prognosis. Trans Am Ophthalmol Soc1985;83:413-75.  Back to cited text no. 3
    
4.
Abbott RL, Fine BS, Webster RG Jr, Paglen PG, Spencer WH. Specular microscopic and histologic observations in nonguttate corneal endothelial degeneration. Ophthalmology 1981;88:788-800.  Back to cited text no. 4
    
5.
Riazuddin SA, Parker DS, McGlumphy EJ, Oh EC, Iliff BW, Schmedt T, et al. Mutations in LOXHD1, a recessive-deafness locus, cause dominant late-onset Fuchs corneal dystrophy. Am J Hum Genet2012;90:533-9.  Back to cited text no. 5
    




 

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

 
  In this article
References

 Article Access Statistics
    Viewed271    
    Printed0    
    Emailed0    
    PDF Downloaded61    
    Comments [Add]    

Recommend this journal