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Photo Essay
April 2001

Posterior Polymorphous Membranous Dystrophy With Overlapping Features of Iridocorneal Endothelial Syndrome

Arch Ophthalmol. 2001;119(4):624-625. doi:10.1001/archopht.119.4.624

A 40-YEAR-OLD woman had a 3-year history of cloudy vision and pain in both eyes. Her visual acuity was 20/40 OU. She had corneal edema in both eyes and grouped posterior corneal vesicles in the left eye. The remainder of her ophthalmic examination results were normal. Throughout the following 7 years, her right eye developed posterior corneal vesicles, an elliptical pupil (Figure 1), broad peripheral anterior synechiae, and severe corneal edema that required penetrating keratoplasty. The intraocular pressure was 16 mm Hg OU. The left eye was unchanged from the time of her initial visit. Electron microscopic examination of the corneal button (right eye) showed a demarcation line between normal corneal endothelium (Figure 2) and "epithelial-like" cells with microvilli (Figure 3). The anterior banded portion of the Descemet membrane was normal, and a thick posterior collagenous layer was present (Figure 3). Immunohistochemical stains were positive for cytokeratins in the endothelium (Figure 4).

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