Abstract
A 41-year-old white woman was referred to our Department to rule out the presence of a Fuch's corneal dystrophy. On slit-lamp biomicroscopy, small bilateral punctuate opacities appearing mostly in the posterior stroma were observed, suggesting a differential diagnosis of pre-Descemet's dystrophy as opposed to Cornea Farinata.Confocal microscopy in the central cornea of both eyes revealed the normal appearance of superficial and basal epithelial layers. However throughout the full thickness of the cornea fine highly refractive granules, localized both in the keratocytes cytoplasm and in the stroma matrix were noted. In both eyes abnormal polymegatism and pleomorphism was observed.
Highlights
Several corneal dystrophies such as Cornea Farinata, Punctuate Dystrophy, pre-Descement's Dystrophy, Fleck's Dystrophy, Deep Filiform Dystrophy and Posterior Punctiform Dystrophy have the clinical appearance of fine opacities limited to the posterior corneal stroma
Corneal dystrophies affecting the entire corneal stroma, and in particular the posterior stroma, can often show a similar appearance on slit-lamp examination, the differential diagnosis may prove challenging and some of these dystrophies may be a variation of the same disease [1]
In vivo confocal microscopy (CM) has been used by several authors in an attempt to clarify the diagnosis of several deep stroma corneal dystrophies
Summary
Several corneal dystrophies such as Cornea Farinata, Punctuate Dystrophy, pre-Descement's Dystrophy, Fleck's Dystrophy, Deep Filiform Dystrophy and Posterior Punctiform Dystrophy have the clinical appearance of fine opacities limited to the posterior corneal stroma. On slit lamp biomicroscopy small bilateral punctuate opacities mostly located in the posterior stroma were observed, suggesting the differential diagnosis between preDescemet's dystrophy as against Cornea Farinata (Figure 1).
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