BACKGROUND: PS, a 71 year old African male with DM controlled by oral medication, had a comprehensive eye examination at the Cincinnati V.A. Optometry clinic on July, 2001. He had no prior history of eye surgery, but he was hit numerous times while boxing as a young man.
CASE REPORT(S). Unaided VA at distance was 20/100 OD, 20/80 OS, and 20/60 OU. He was calm and alert for the examination. Motility was full, and mild exophoria at distance was found. Confrontation visual field testing was full OU, but Amsler Grid revealed some wavy lines in central vision area. Pupils were equally round and reactive to light and accommodation with - M.G. The slit lamp examination: lids, conjunctiva and sclera were clear in both eyes. The iris was flat, and the AC was deep and quiet OU. The right cornea was clear, while the left revealed two halide tracks on the endothelium oriented radially from 1:30 to 7:30. These lines were separated by about one mm, and extended about 2/3 radially across the cornea. The lens disclosed cortical opacities on the right eye, and snow flake opacities in both eyes. IOP measurement was 25 OD, and 29 OS at 3:35 p.m.. D.F.E. revealed c/d ratios of .8 OD, and .85 OS. The macula had a single centrally located drusen in both eyes.
CONCLUSIONS. The radially oriented track of deposits in the endothelium is called Posterior Polymorphous Dystrophy. Its clinical features include grouped vesicles of varying shapes and distribution. A gray thickening of Descement''s membrane between vesicles can produce linear patterns or lines that are parallel like tracks. The latter feature was present in our patient. Possible complication include mild stromal or epithelial edema, and slight decrease in vision; however, the dystrophy increases the risk for developing glaucoma.
The patient did not exhibit any edema, and his vision was compromised by ARMD. But, the patient does have Glaucoma. Generally, the condition is benign with a good prognosis. The poster will describe the differential diagnosis for posterior corneal dystrophies and present photodocumentation for the condition. In addition the impression and plan are described.