Clinical evaluation of cornea pseudoguttata

Abstract

Aim: To report on cornea pseudoguttata which occurred in 44 eyes from 40 patients. Methods: In 3521 consecutive patients seen at a local eye clinic, eyes were examined with a slit-lamp biomicroscope in specular illumination. When guttate appearance was found, specular microscopy was performed. Results: Cornea pseudoguttata was found in 44 eyes of 40 patients (1.1%). All patients had some form of anterior-segment ocular diseases, including keratitis (corneal infiltration) with contact lens wear (n = 16), epidemic keratoconjunctivitis (n = 8), corneal epithelial defect (n = 6), superficial punctate keratitis (n = 4), corneal foreign body (n = 3), keratitis of unknown causes (n = 3), corneal ulcer (n = 2), herpetic keratitis (n = 1), and iritis (n = 1). Six eyes were lost to follow-up, but in the remaining 38 eyes, cornea pseudoguttata completely resolved as the primary anterior-segment diseases subsided. Specular microscopy, measured after resolution of cornea pseudoguttata, showed that corneal endothelial cell density was not different between the affected and contralateral healthy eyes. Conclusion: Cornea pseudoguttata is commonly found in cases with corneal infiltration and inflammation. These results indicate that cornea pseudoguttata is reversible in its nature and resolves completely without any damage to the corneal endothelial cells. C ornea pseudoguttata represents transient corneal endothelial changes that are caused by anterior-segment diseases such as iritis and keratitis.1-3 Unlike primary cornea guttata, which is usually associated with corneal endothelial dystrophy and consists of focal thickening of Descemet's membrane, cornea pseudoguttata is characterised by reversible corneal endothelial cell oedema. 1In 1981, Krachmer et al 1 reported three cases of cornea pseudoguttata that were seen during a short-term episode of iritis and corneal inflammation. Zantos and Holden 2 described the rapid appearance and gradual disappearance of guttate endothelial changes in a patient who experienced an acute red-eye symptom associated with continuous wear of contact lenses.2 Several other reports described clinical findings of cornea pseudoguttata.4 5 To the best of our knowledge, however, there have been no other reports of cornea pseudoguttata in the literature, and thus its clinical characteristics are not known in detail, including long-term clinical consequences, incidence and influences on corneal endothelial cell morphology. In this article, we report on 44 eyes with cornea pseudoguttata that were found in 3521 consecutive cases at the Nakashima Eye Center, Fukuoka, Japan. SUBJECTS AND METHODSOf the 3521 consecutive patients (mean age 47.8 (standard deviation (SD)) 20.3 years) who were seen at the Nakashima Eye Clinic between March and October 2003, 1252 (35.6%) were men and 2269 (64.4%) were women. All patients were examined using the slit-lamp biomicroscope in specular illumination. Eyes with corneal opacity, which hindered observation of the corneal back surface, were excluded from the study. When da...

Keratoendotheliitis Fugax Hereditaria: A Novel Cryopyrin-Associated Periodic Syndrome Caused by a Mutation in the Nucleotide-Binding Domain, Leucine-Rich Repeat Family, Pyrin Domain-Containing 3 ( NLRP3 ) Gene

“…Cornea pseudoguttata, thought to correspond to patchy transient corneal endothelial edema, 20,21 was observed during an acute attack, but all patients had normal endothelium by biomicroscopy between attacks. The features of acute keratoendotheliitis on day 1 are presented for Patient 4-01, a sporadic case.…”

Central corneal thickness and intraocular pressure measures in human corneas with endothelial guttata: an observational quality control study

“…Based on the follow‐up of some cases with pseudo‐guttata, even if confluent, it has been concluded that they can resolve without obvious damage to the corneal endothelium 19 . Further studies would appear to be warranted and would be useful to assess the progressive (or resolving) effects of non‐dystrophic guttata on central corneal thickness.…”

“…The low‐magnification prints from the specular microscope were examined and assigned a grade 19 of 1 (‘several dark spots’), 2 (many dark spots not in contact with each other) or 3 (numerous dark spots that are in contact with each other). The last can also be referred to as semi‐confluent or confluent guttata.…”

Endothelial bedewing

“…Nakashima et al 16 reported the presence of corneal pseudoguttata in 44 out of 3,521 patients presenting consecutively to a local eye clinic. Of these patients, 16 were suffering from contact lens-induced keratitis.…”