Author/Authors :
Moshirfar, Majid John A. Moran Eye Center - Department of Ophthalmology and Visual Sciences - School of Medicine - University of Utah - Salt Lake City, USA , Harry Y. Liu Health Science Center - McGovern Medical School - University of Texas, USA , Vaidyanathan, Uma Health Science Center - McGovern Medical School - University of Texas, USA , Somani, Anisha N Health Science Center - McGovern Medical School - University of Texas, USA , Hopping, Grant C Health Science Center - McGovern Medical School - University of Texas, USA , Barnes, James R School of Medicine - Virginia Commonwealth University, USA , Heiland, Madeline B College of Medicine-Phoenix - University of Arizona, USA , Rosen, David B College of Medicine-Phoenix - University of Arizona, USA , Motlagh, Mahsaw N College of Medicine-Tucson - University of Arizona, USA , Hoopes, Phillip C Hoopes Durrie Rivera Research Center - Hoopes Vision, USA
Abstract :
Corneal pseudoguttata (PG), also known as pseudoguttae or secondary guttata, is a transient, reversible endothelial edema commonly associated with anterior segment pathology. While considered rare, PG presents on slit-lamp examination more commonly than originally thought. We have clinically observed PG after refractive surgeries, in association with infectious keratitis, and following medication use. PG presents as dark lesions on slit-lamp exam with specular illumination, similar to primary corneal guttata. PG is distinct from guttata because PG resolves over time and does not involve Descemet’s membrane. Other ocular findings that may be confused with guttata include endothelial blebs (EB) and endothelial denudation (ED). EB are possibly a type of PG that present after contact lens use or hypoxia. ED is a distinct entity that is characterized by loss of endothelial cells without involvement of Descemet’s membrane. Confocal microscopy may be useful in differentiating these four endothelial lesions, with differences in border definition and the presence of hyperreflective areas two main distinctions. PG presents as a hyporeflective, elevated shape without clear borders on confocal microscopy. PG, EB, and ED can resolve with time without the need for surgical intervention, unlike corneal guttata. Treatment of the underlying condition will lead to resolution of both PG and EB.
Keywords :
Pseudoguttata , Pseudoguttae , Guttae , Endotheliitis , Secondary Guttae , Secondary Guttata , Endothelial Cell Edema
