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JAMA Ophthalmology Clinical Challenge
March 5, 2020

A Man With Bilateral Corneal Verticillata and Corneal Crystals

Author Affiliations
  • 1Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Ophthalmol. 2020;138(5):580-581. doi:10.1001/jamaophthalmol.2020.0128

A 77-year-old man was referred to the cornea service for bilateral corneal verticillata noted first by his general ophthalmologist. One year prior to presentation, the patient had undergone coronary artery bypass grafting (CABG). He was discharged with amiodarone and used the medication for 6 weeks. He did not use amiodarone for the 10 months prior to presentation. Prior to his CABG procedure, the patient only used a low dose of lisinopril until he began experiencing progressive dyspnea and fatigue. He was found to have a 5-vessel blockage once he became symptomatic. His symptoms resolved after the CABG surgery, and he remained otherwise healthy. He denied any other symptoms, including headache, rash, joint pain, or chest pain. His medications at time of presentation were aspirin, atorvastatin, and carvedilol. His best-corrected visual acuity was 20/20 OD and 20/25 OS. A slitlamp examination revealed bilateral corneal verticillata and numerous fine anterior stromal crystals (Figure). He had mild nuclear sclerosis in both eyes. His pupils were round and equally reactive, and the remainder of the slitlamp examination and dilated fundus examination were within normal limits.

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