Distrofia corneal de Meesmann en paciente con queratotomía hexagonal / Meesmann corneal dystrophy in a patient with hexagonal keratotomy

RESUMEN Las distrofias corneales constituyen un grupo de enfermedades hereditarias que suelen ser bilaterales y simétricas, las cuales progresan lentamente y sin relación con factores ambientales o sistémicos. Se presenta una paciente de raza blanca, de 45 años de edad, remitida al Servicio de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", quien refirió sensación de cuerpo extraño, sensibilidad a la luz y mala visión de ambos ojos, así como antecedente de queratotomía hexagonal hacía aproximadamente 20 años. En lámpara de hendidura se observaron en el epitelio numerosas lesiones puntiformes en forma de vesículas claras, semejantes a ampollas, distribuidas paracentralmente, que respetaban ligeramente el centro, con espacios de córnea transparente entre ellas y mejor visibilidad de las lesiones en retroiluminación. En la microscopia confocal se observaron en el ojo derecho estructuras redondas u ovales, de forma quística, hiporreflectivas. En el ojo izquierdo se encontraron imágenes difusas hiperreflectivas en el epitelio corneal basal. Se detectó la presencia de nervios corneales tortuosos, de aspecto fragmentado en ambos ojos. Se consideró como diagnóstico la distrofia de Meesmann y se realizó queratectomía superficial, con lo cual se logró alivio de la sintomatología de la paciente(AU)

ABSTRACT Corneal dystrophies are a group of hereditary diseases often bilateral and symmetrical which progress slowly and without any relationship to environmental or systemic factors. A case is presented of a white 45-year-old female patient referred to the Cornea Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology, who reported a foreign body sensation, light sensitivity and poor vision in both eyes, as well as a history of hexagonal keratotomy from approximately 20 years before. Slit lamp examination revealed numerous punctiform lesions in the form of clear blister-like vesicles distributed paracentrally and slightly sparing the center, with transparent cornea spaces between them and better visibility of the lesions under retroillumination. Confocal microscopy showed round or oval cystic and hyporeflective structures in the right eye, whereas the left eye exhibited diffuse hyperreflective images in the basal corneal epithelium. Tortuous corneal nerves of a fragmented appearance were detected in both eyes. A Meesmann dystrophy diagnosis was considered and superficial keratectomy was performed, with which the patient's symptoms were relieved(AU)

Meesmann corneal dystrophy associated with epithelial basement membrane and posterior polymorphous corneal dystrophies.

PURPOSE: To report a rare case of bilateral and symmetric Meesmann corneal dystrophy concurrent with bilateral epithelial basement membrane dystrophy and bilateral but asymmetric posterior polymorphous corneal dystrophy in a patient of Armenian origin. METHODS: Complete ophthalmologic examination was performed on a 6-year-old boy from Armenia who was diagnosed with bilateral symmetric Meesmann corneal dystrophy combined with bilateral epithelial basement membrane dystrophy and bilateral but asymmetric posterior polymorphous corneal dystrophy. This case was observed and treated for 24 years. RESULTS: On slit-lamp biomicroscopy, the patient showed bilateral multiple intraepithelial cystic lesions, bilateral irregularly shaped grayish-white opacities in the superficial corneal epithelium, and bilateral but asymmetric transparent vesicles surrounded by gray halos at the level of the Descemet membrane and the endothelium. CONCLUSIONS: This case is reported because of the unusual occurrence of Meesmann corneal dystrophy with other corneal dystrophies.