97th DOG Annual Meeting 1999

P67

INTRACORNEAL GRANULOMATOUS INFLAMMATION IN A CASE OF LATTICE CORNEAL DYSTROPHY

W. Meyer-Riemann, C.D. Quentin, M. Vogel


Introduction: Ocular involvement of anterior and/or posterior eye segments is well-known in granulomatous inflammations, for example sarcoidosis or tuberculosis. We report on a patient suffering from lattice corneal dystrophy, with a corneal, granulomatous infiltration. There were no signs of generalisation.

Case report: A phototherapeutic keratectomy (PTK) was performed in both eyes of a 33 year-old male patient with a hereditary lattice corneal dystrophy. Preoperatively, visual acuity of the right eye was 0,32 and of the left eye 0,4p; postoperatively, it increased up to 0,8p and 0,8 respectively. 8 months after treatment, an intracorneal, yellow-white, vascularisized tumor, located close to the limbus, occurred in the right eye. In a computed tomography of the orbita, there were no indications of an old foreign body injury. Detailed clinical examinations failed to give a hint regarding the etiology or dignity of the tumor. For this reason, a surgical lamellar excision was performed. 3 months after surgery, there was no relapse, visual acuity was 0,63.

Results: The histological examination revealed a dense inflammatory infiltration of the deeper corneal stroma with epithelioid cells, lymphocytes, eosinophilic leukocytes and polynuclear giant cells being characteristic signs of sarcoidosis. X-ray examination and computed tomography of the thorax, ultrasonography of the abdomen and laboratory findings did not give any indication of a generalization of a granulomatous inflammation. The biopsy of a suspect conjunctival tissue revealed no pathological changes typical of sarcoidosis.

Discussion: A monosymptomatic, intracorneal, granulomatous infiltration is very rare and, as far as we know, has not been discribed in a case of lattice corneal dystrophy. Histological examination leads to the diagnosis. Possibly, in this case the localized ocular involvement is the first symptom of sarcoidosis. Strangely, the granuloma occurred only several months after PRK; nevertheless, a pathogenetic connection seems to be unlikely.

Universitäts-Augenklinik, Robert-Kochstr. 40, D-37075 Göttingen

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