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Year : 2011  |  Volume : 59  |  Issue : 5  |  Page : 398-400

Late occurrence of granular dystrophy in bilateral keratoconus: Penetrating keratoplasty and long-term follow-up

1 Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
2 Pathology Services, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
3 Kallam Anji Reddy Molecular Genetics Laboratory, LV Prasad Eye Institute, Hyderabad, Andhra Pradesh, India

Correspondence Address:
Varsha M Rathi
LV Prasad Eye Institute, LV Prasad Marg, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad - 500 034, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.83624

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We report a rare case of keratoconus with granular dystrophy with a follow-up of two decades, documenting the sequential presentation of two diseases confirmed by histology and genetic studies. A 13-year-old boy was diagnosed in 1988 with keratoconus in both eyes (BE) based on slit-lamp biomicroscopy findings of corneal ectasia in BE accompanied by Fleischer's ring, Vogt's striae, a small, old, healed hydrops. The left eye (LE) had central corneal thinning and scar in the central area involving the mid and posterior stroma secondary to healed hydrops. Penetrating keratoplasty (PKP) was advised. The boy was lost to follow-up till 1991 and presented with white, dot-like opacities in the central cornea in the RE only, suggestive of granular corneal dystrophy. Similar findings of white, dot-like opacities were noted in the LE in 1995 and the patient subsequently underwent PKP in BE. Histopathology of corneal buttons confirmed the presence of patchy, crystal-like orange deposits, which stained bright red with Masson's trichrome. Mutational analysis of the TGFBI gene in patient's DNA revealed a heterozygous mutation corresponding to a change in Arg555Trp in the keratoepithelin protein. Granular dystrophy recurred after 8 years in the RE.

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