Posterior polymorphous keratopathy

Seven cases with posterior polymorphous changes of the cornea are reported. After clinical and pathological examination of the above cases, as well as a short review of the literature, the following points are made: (1) Some cases are congenital, being either familial or sporadic, but others are acquired. (2) The term "posterior polymorphous keratopathy" covers all the variants of the condition and is preferred to the traditional "posterior polymorphous dystrophy". (3) The congenital type is a mild variant of the mesodermal dysplasia, whereas the acquired type follows local disease. (4) The condition can be static, but over 50% of cases are slowly progressive, calling for penetrating keratoplasty.

[Crystalline corneal dystrophy (Schnyder) in the presence of familial type IIa hyperlipoproteinaemia (author's transl)]

A family with dominant autosomal hyperlipoproteinaemia typ IIa is reported. One sibling, a 19-year-old man, showed in addition to the hyperlipoproteinaemia typical corneal signs of crystalline corneal dystrophy of Schnyder. From 1964 to 1976 these corneal deposits increased. The problems of hyperlipoproteinaemia combined with corneal crystalline dystrophy are discussed.

Recurrence of macular corneal dystrophy after lamellar keratoplasty

A 20-year-old man required bilateral lamellar keratoplasties for macular corneal dystrophy. Histochemical proof of macular corneal dystrophy was demonstrated in both of the excised lamellar corneal buttons. Eleven years later, the patient underwent a penetrating kiratoplasty in his left eye. Light microscopic, histochemical, and electron microscopic study of the excised button disclosed characteristic features of macular corneal dystrophy in the donor cornea. Recurrence of macular corneal dystrophy in a corneal graft appeared to be the result of replacement of the donor keratocytes by genetically defective host cells.

[Contribution to the changes in the epithelium in macular corneal dystrophy (Groenouw's type II) (author's transl)]

In macular corneal dystrophy the epithelial cells display increased activity: they produce proteins and glucosaminoglucans. This may lead to the synthesis of collagen and of pathologic proteoglugans.

The clinical spectrum of posterior polymorphous dystrophy

We examined 61 affected members of eight families with an inherited corneal dystrophy. The corneal abnormalities varied greatly from one member of a family to another. Some patients had only a few isolated endothelial vesicles, while others in the same family had severe secondary stromal and epithelial edema. In some patients edema was present at birth or in early childhood; in others it developed later in life. The wide variation of corneal abnormalities suggests the possibility that several conditions previously described as separate disease entities, such as grouped vesicles, Schnyder's posterior herpes, posterior polymorphous dystrophy, and congenital hereditary endothelial dystrophy, are part of the clinical spectrum of expression of a single familial corneal dystrophy. Some affected family members also had ocular hypertension or open-angle glaucoma. Broad iridocorneal adhesions were present in some of the patients with glaucoma and in others with normal intraocular pressures. Other ocular abnormalities present in a few patients include pupillary ectropion, "glass membranes" on the anterior iris surface, and bands in Descemet's membrane. The transmission in most of the families was autosomal dominant. In two families it appeared to be autosomal recessive.

Variable expression in flecked (speckled) dystrophy of the cornea

Five members of a three-generation pedigree had flecked corneal dystrophy. The number of flecks varied from patient to patient, and one individual was affected in only one eye. Visual acuity was normal in all family members. Homocystinuria also occurred in this family, but appeared to be coincidental. Central cloudy dystrophy of the cornea appears to be genotypically identical to flecked dystrophy of the cornea but is phenotypically distinct.

[Familial dermo-chondro-corneal dystrophy (François' syndrome)]

The François' syndrome associates disseminated firm nodular subcutaneous lesions, a deforming arthropathy and a corneal dystrophy. Inheritance seems to be recessive. Six cases of this rare syndrome have been previously published. The syndrome is reported here in two Mexican brothers. In the authors' opinion the François' syndrome is not related to the xanthomatoses. It should be considered as a genetically recessive arthropathic nodular fibromatosis.

[Familial dermo-chondro-corneal dystrophy (François' syndrome) (author's transl)]

The François' syndrome associates disseminated firm nodular subcutaneous lesions, a deforming arthropathy and a corneal dystrophy. Inheritance seems to be recessive. Six cases of this rare syndrome have been previously published. The syndrome is reported here in two Mexican brothers. In the authors' opinion the François' syndrome is not related to the xanthomatoses. It should be considered as a genetically recessive arthropathic nodular fibromatosis.

Posterior amorphous corneal dystrophy

A family of ten individuals aged 18 months to 75 years had biomicroscopic findings consisting of large, amorphous, sheet-like opacifications of the posterior stroma and Descemet's membrane, and alterations of the endothelium. A uniform thinning of the cornea was present. These findings do not conform to previously described corneal dystrophies. The condition appears minimally progressive and the three-generation pedigree indicated an autosomal-dominant inheritance pattern.

Meesmann's epithelial dystrophy of the cornea

Two separate pedigrees had typical Meesmann's dystrophy of the corneal epithelium. Histologic examination of one patient from each pedigree showed two characteristic findings in corneal epithelium; the previously designated "peculiar substance" in the cells, and the vacuolated homogeneous substance mostly within the cysts. The primary disturbance probably involves the cytoplasmic ground substance that ultimately may result in complete homogenization of cells and the formation of cysts. Thickening of the epithelial basement membrane is variable and is a nonspecific response by the epithelial basal cells.

A clinical and histopathological study of François-Neetens speckled corneal dystrophy

A 57-year-old black man had François-Neetens speckled dystrophy of the cornea and orbital phycomycosis. Examination of family members confirmed an auto-somal-dominant pattern of inheritance. Light and electron microscopic study of the cornea of a blind eye disclosed that the corneal opacities were represented by swollen, vacuolated keratocytes filled with histochemically demonstrable acid mucopolysaccharide and complex lipids. Thus, this dystrophy may represent a dominantly inherited metabolic disorder confined to the cornea.

Fleck corneal dystrophy

Fourteen members of four families with fleck systrophy of the corneal stroma were examined and studied. Corneal and lens changes were noted in all patients. Corneal sensation was normal. Corneal biopsies were performed on two patients and a corneal button of a patient with fleck dystrophy and keratoconus was studied. Light and electron microscopy and histochemical studies showed this dystrophy to consist of abnormal keratocytes with variable numbers of membrane-limited intracytoplasmic vacuoles containing a granular to fibrogranular material that stains positively for mucopolysaccharide. This appears to be the first reported incidence of a dominantly inherited disorder of mucopolysaccharides affecting the eyes.

[Bilateral dendritic pseudokeratitis (Richner-Hanhart syndrome)]

A Turkish baby was treated several times for bilateral "recurrent dendritic keratitis" before a diagnosis of Richner-Hanhart syndrome could be made (recessively inherited keratosis palmaris et plantaris with pathognomonic corneal dystrophy). No effective conservative treatment has been reported in the literature for the recurrent eye pain. Highly hydrophilic contact lenses gave prompt and absolute symptomatic relief.

[Primary hereditary band-shaped corneal dystrophy and its association with other hereditary corneal lesions (author's transl)]

The results of examinations of members of a large Tyrolian family tree with primary band-shaped corneal dystrophy and other hereditary corneal leasons are reported. Corneal lesions occurred in 16 family members. In three male members, the primary band-shaped corneal dystrophy is associated either with parenchymal opacification and endo-epithelial dystrophy or epithelial dystrophy or with parenchymal opacification and epithelial dystrophy. In some cases, various corneal dystrophies (parenchymal opacification, endo-epithelial dystrophy, cornea guttata, epithelial dystrophy, band-shaped nasal corneal dystrophy) exist without band-shaped corneal dystrophy. A polyphenic gene is responsible for the manifestation of the various corneal lesions. The occurrence of typical primary band-shaped corneal dystrophy only in male family members can be explained by sex-linked inheritance. Because of some flutuations in the expression, the primary band-shaped corneal dystrophy can only be manifested slightly on the nasal border. The hereditary character of the occurrence of the primary band-shaped corneal dystrophy and of the closely related other corneal dystrophies together with the already in 1974 observed association with keratokonus is stressed. Our observations show the variety of the manifestations of a polyphenic gene in the corneal region.

Iridocorneal adhesions in posterior polymorphous dystrophy

The variability of clinical expression in posterior polymorphous dystrophy is illustrated with emphasis on the occurrence of iridocorneal adhesions. These are believed to be synechiae and not Rieger's anomaly. The occurrence of glass-membrane-like material extending onto the iris from the cornea, causing synechiae and pupillary ectropion, is documented.

Contributions of electron microscopy to the study of corneal pathology

Most of the electron microscopic studies of pathological corneas have been done only recently. Keratoplasty has been the most important source of specimens for ultramicroscopic investigation. With the introduction of electron microscopic techniques, we have been able to confirm many light microscopic studies in pathological corneas. This contribution has been most valuable in the identification of the sites and types of pathological changes in corneal dystrophies and degenerations. This review of electron microscopic studies describes the present concepts on the nature of the histological changes in dystrophies and degenerations of the anterior and posterior corneal layers and corneal stroma. It also includes a review of some corneal inflammatory conditions as well as metabolic disorders affecting its transparency.

Posterior polymorphous corneal dystrophy and juvenile glaucoma: a case report and brief review of the literature

A family with posterior polymorphous corneal dystrophy is presented that includes a child with juvenile glaucoma. A review of the literature reveals an increased incidence of juvenile glaucoma associated with this dystrophy. It is of practical importance that the dystrophy be recognized and glaucoma be ruled out as the latter is asymptomatic in the infant.

Central cloudy corneal dystrophy of François

A family is reported with central cloudy dystrophy of the cornea, as described by François in 1956. The lesion consists of a grey zone deep in the stroma, made up of polygonal or rounded areas with indistinct margins, separated by apparently clear, normal stroma. No deposits are visible in the slit lamp. The anterior and posterior boundary layers appear normal. The corneal thickness is normal. Open angle glaucoma was present in the family. The pathogenesis of the dystrophy is unknown, and histopathological examination has not been described. The differential diagnosis is briefly discussed. The family tree is suggestive of a dominant mode of transmission.

[Schnyder's corneal dystrophy and hyperlipidemia (author's transl]

Five out of ten members of a kinship were found to be affected by Schnyder's corneal dystrophy. Hyperlipoproteinemia was present in five out of eight cases examined (3 times type II, twice type IV). In one case with corneal dystrophy lipid levels were in the normal range, in another case, a child, hyperlipidemia was present without corneal abnormalities. The interrelationship of Schnyder's corneal dystrophy and disorders of lipoprotein metabolism is discussed. It is concluded that patients with Schnyder's corneal dystrophy and their relatives should be screened for hyperlipidemia; prophylactic treatment should be instituted when cases with hypercholesterinemia are found.

[Ultrastructure of macular corneal dystrophy (Groenouw II): investigations of paracentral deep corneal layers (author's transl)]

Electron microscopic studies proved, that in cases of macular corneal dystrophy (Groenouw II) abnormal deposits of acid mucopolysaccharide are demonstrable in the different layers of the cornea in a polymorphic form. Because of the investigations now performed it can be established, that the opacities of the paracentral, deep corneal layers result from both dispersed vesicular and plaque-like deposits of storage material in the border area of the stroma and Descemet's membrane.

Microcystic corneal dystrophy

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Fleck (Mouchetée) dystrophy of the cornea

Five families, four Caucasian and one Negro (14 patients) with fleck (speckled or Mouchetée) dystrophy of the cornea are presented. In each, the typical presentation of fine scattered fleck-like dystrophic lesions was found throughout all layers of the central and peripheral corneal stroma but not affecting the epithelium, Bowman's membrane, Descemet's membrane or the endothelium. Clear stroma was noted between each lesion. Visual acuity in all patients was normal or only slightly affected. Except for an occasional patient with minor photophobia, almost all patients found affected with this dystrophy were asymptomatic in regard to their corneal condition. There was no decrease in corneal sensitivity noted in any patient. All families displayed evidence of an autosomal dominant hereditary pattern and progression of the dystrophy is slow and benign in character. With the exception of one family with atopic disease, no systemic organic illness was noted by histroy in all of the families. Laboratory screening of 2 of the 5 families showed no abnormalities of any systemic metabolic disorders. The characteristic clinical picture and favorable prognosis of this condition enables one to easily differentiate this condition from other known parenchymatous corneal dystrophies. The incidence of this condition is probably much more common than the reported cases in the literature might indicate.

Hereditary corneal dystrophy in the Manx cat: a preliminary report

A progressive, apparently inherited corneal dystrophy is described in an inbred line of Manx cats. Initial changes in the cornea are seen at four months of age and characterized by anterior stromal edema. Progressive worsening of the condition produces severe bullous keratopathy with eventual breakdown of both epithelium and stroma. Light microscopic and ultrastructural studies in the advanced disease state revealed marked edema of the corneal stroma, disintegration of collagen material, and the formation of epithelial bullae. Ultrastructural evidence shows a normal endothelium to be present. The pathogenesis of this corneal dystrophy is not clear and further studies are underway.

[The ultrastructive of spotty corneal dystrophy (Groenouw II) (author's transl)]

Examination of the ultrastructure of cases of spotty corneal dystrophy (Groenouw II) showed polymorphous results in various layers of the cornea. Inclusions of acidic mucopolysaccharides occur in membrane surrounded storage granules and also in the free state. The results from sections of the central and peripheral regions are extraordinarily variable. The present investigations showed for the first time, that numerous vesicular inclusions can occur also in the boundary region between the stroma and Descemet's membrane.

[Congenital hereditary corneal dystrophy associated with various extraoculary anomalies]

Two subjects (brother and sister), children of consanguineous parents, showed a typical congenital corneal dystrophy associated with mental retardation and a bilateral malformation of the little finger. One of them, a boy of 10, was fat and showed a hearing loss for high tones. His corneal opacity diminished during 7 years observation. Seeing that the affected tissues were of mesenchymal origin, the authors conclude that the syndrome was mesodermal.

[Results of perforating keratoplasty in hereditary corneal diseases (author's transl)]

Operation results of keratoplasty in 50 eyes having keratoconus are presented and discusses. Furthermore a report is made on keratoplasty in cases of keratotorus in reticulate, maculate, and granulate dystrophies as well as in congenital ichthyosis with corneal involvement. The prognosis and complications of this intervention are presented.

Recurrent corneal granular dystrophy: a clinicopathologic study

Recurrence of granular corneal dystrophy occurred in two patients following two successive penetrating corneal grafts. In the first patient, the deposits involved the central stroma of the donor cornea, almost to the level of Descemet's membrane. The second patient had predominantly subepithelial deposits in bilateral recurrences. Electron microscopy revealed rod-shaped, electron dense material typical of granular dystrophy in both patients.

[Clinical considerations and genetics of the lattice dystrophy of the cornea]

Lattice dystrophy of the cornea is reported in 4 families. For purposes of linkage analysis we did serological tests on pertinent family members, including marker testing of the blood group systems ABO, MNSs, Rh, K, Ky, and P; protein group systems Hp, Ge, Gm, and Inv; and enzyme polymorphisms SEP, PGM, ADA, and AK.

The nature of hereditary deep polymorphous dystrophy of the cornea: its association with iris and anterior chamber dygenesis

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