Semiquantitative Criteria in the Eye Bank That Correlate with Cornea Guttata in Donor Corneas

Background Cornea guttata may not be recognized in the eye bank and recent studies have displayed that guttae are transplanted in about 15% of cases in varying severities. The purpose of this study was to establish semiquantitative criteria for the detection of cornea guttata in donor corneas in the eye bank. Methods In this retrospective cohort study, preoperative endothelial pictures of donor corneas were collected and classified according to the post-penetrating keratoplasty cornea guttata grade into three distinct groups: group 1 consists of healthy corneas with no guttae (guttata grade 0); group 2 constitutes corneas with mild asymptomatic cornea guttata (guttata grade +); and group 3 comprises corneas with advanced widespread cornea guttata (guttata grade ++/+++/++++). The preoperative pictures of each group were then individually analyzed using the following five semiquantitative criteria: The number and the area of the cell-depleted surfaces, the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions, the presence of blebs in the cell membrane, and the presence of groups of cells with a distinct whitish color. Results In total, 262 patients were included in this study, with a total number of 1582 preoperative donor corneal endothelial pictures. Out of those pictures, groups 1, 2, and 3 encompassed 995 (62.9%), 411 (26.0%), and 176 (11.1%) pictures, respectively. Three out of the five eye bank criteria were found to correlate with postoperative cornea guttata with a highly significant p value of < 0.001. These three criteria are the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions and, the presence of blebs. The presence of groups of cells with a distinct whitish color was only a weak predictive factor for cornea guttata (p = 0.069). There was no statistically significant correlation between the number and the area of cell-depleted surfaces and postoperative cornea guttata with a p = 0.181. Conclusion Three semiquantitative criteria that can be detected in the eye bank using inverted light microscopy seem to correlate with postoperative cornea guttata: The presence of blebs, the presence of cell membrane defects and interruptions, as well as endothelial pictures with less than 50% of the cells having a hexagonal of circular shape. The presence of groups of cells with a distinct whitish color appears to be a weak predictor of cornea guttata.

Visual outcome after trifocal IOL implant in a patient with cornea guttata. A case report.

Background We report the case and management of a patient that started with primary cornea guttata symptoms after cataract surgery with trifocal intraocular lens (IOL) implant. The unusual postoperative presentation of the disease in association with a trifocal IOL resulted in increased corneal surface aberrations that resulted in visual dissatisfaction. Case presentation A 67 year-old male was evaluated due to blurred vision for two months, as well as a desire to stop using glasses in his everyday life. At the initial refraction, myopia, corneal astigmatism and nuclear cataract were diagnosed in both eyes. A nuclear cataract was diagnosed in both eyes. Phacoemulsification surgery was performed in OS, implanting a trifocal IOL. The postoperative refraction in OS was -1.25DCx120º, with a best-corrected visual acuity (BCVA) of 20/20. Six months later, the patient kept complaining of blurred vision and night glare. In slit lamp examination, corneal guttae were denoted and changes in corneal endothelium morphology suggested primary cornea guttata. A monofocal IOL exchange was performed in order to reduce corneal aberrations with excellent outcome at 2-year follow up. Conclusions Screening for endothelial dysfunction is a key element for successful outcomes in cataract surgery. Corneal guttae accent optical aberrations when in combination with premium IOLs.

Cornea guttata associated with special phenotypic variants of granular corneal dystrophy type 2 in a Chinese family

Purpose: The aim of this study was to analyze the relevant gene mutations in a Chinese family with special phenotypic variants of granular corneal dystrophy type 2 with cornea guttata. Methods: A total of 11 individuals from the affected family underwent complete ophthalmic examination. Genomic DNA was extracted from peripheral leukocytes of affected and unaffected family members. High-throughput sequencing was performed to screen for mutations in 290 genes associated with inherited ophthalmic diseases. Results were validated by bidirectional Sanger sequencing. Results: An Arg124His (R124H) mutation of the transforming growth factor beta-induced gene was identified in three members of the affected family: the proband (II-1), his mother (I-2), and his son (III-1). The eyes of the proband and his mother had bilateral superficial whitish ring patches with clear centers occupying their central corneas and appeared to be discoid or ring shaped. In addition, specular microscopic examination showed the presence of dark, round bodies. In vivo confocal microscopy showed some hyporeflective round images (cornea guttata), containing occasionally central highlight, in the proband, his mother, and one of his elder sisters. Conclusion: We report, for the first time, atypical granular corneal dystrophy type 2 with cornea guttata associated with a single R124H mutation in a Chinese family. Our findings emphasize that genotyping is essential for the accurate diagnosis and classification of granular corneal dystrophy type 2.