Descemet’s scroll in syphilitic interstitial keratitis: a case report with anterior segment evaluation and a literature review

Abstract

PurposeTo present a case of syphilitic interstitial keratitis with Descemet’s scrolls, as well as its characteristic findings in an anterior segment investigation in relation to the histopathologic findings from a literature review.Case presentationA case report of a 64-year-old woman with syphilitic infection presented with band keratopathy and retrocorneal scrolls. Slit-lamp photography, confocal microscopy, anterior segment optical coherence tomography (AS-OCT), and ultrasound biomicroscopy were performed. Four previous reports were reviewed to describe the pathogenesis, natural history, and histopathologic and immunohistologic findings of the Descemet’s scroll.ResultsThe spectacle-corrected visual acuity was 20/50 and 20/30 in the right and left eyes, respectively. The scrolls appeared as a translucent web extending from Descemet’s membrane into the anterior chamber. Confocal microscopy showed decreased endothelial cell density, pleomorphism, polymegathism, and hyperreflective fibrocellular rods with central hollow. The AS-OCT and ultrasound biomicroscopy showed rod-shaped retrocorneal scrolls. The corneal thickness was 494 microns, as measured by AS-OCT. The corneal lesion remained stable during the 6-year follow-up period without the need for keratoplasty, while the previous literature reported spontaneous and postoperative corneal decompensation.ConclusionWe present a case of syphilitic interstitial keratitis with rare Descemet’s scrolls featuring relatively good visual acuity. Although we did not obtain the corneal tissue for examination, the anterior segment investigation provides insight into the underlying histopathology and natural disease history. The central hollow and cellular component seen during confocal microscopy might correspond to the amorphous core and the abnormal endothelial cells in the histopathologic findings. Failure to detect the corneal endothelium due to stromal opacity in these cases is possible, however, compromised endothelium may present.

Bilateral retrocorneal hyaline scrolls secondary to asymptomatic congenital syphilis: A case report

“…They are primarily associated with interstitial keratitis, especially congenital syphilis. Additionally, retrocorneal scrolls have been reported in herpes interstitial keratitis, congenital glaucoma, and trauma[ 1 - 3 ]. Here, we report a rare case of bilateral retrocorneal translucent scrolls with corneal endothelial gutta.…”

Descemet Membrane Endothelial Keratoplasty for Corneal Edema and Visually Significant Descemet Membrane Scrolls Due to Syphilitic Keratitis

“…7 Despite the decrease in endothelial cell density, these corneal lesions can remain during the average of 6-year follow-up timeframe without the need for keratoplasty. 7 Other reports have described an increased rate of late spontaneous corneal decompensation in these eyes, which ultimately led to PK. [3][4][5][6] DMEK was first described in 2006 8 and has become increasingly adopted because of faster visual recovery and better postoperative refractive and rejection rate profiles.…”

“…Descemet membrane scrolls are a rare finding in syphilitic interstitial keratitis, 3−7 occurring in the later stages of the disease. 4 Increased fibroblast-like activity of the endothelial cells has been theorized as a cause for the development of such scrolls.…”

“…Retrocorneal scrolls of Descemet membrane is an additional rare finding reported in syphilitic interstitial keratitis. [3][4][5][6][7] Penetrating keratoplasty (PK) has been previously described as a surgical management option for corneal edema with retrocorneal scrolls or membranes formed in syphilitic keratitis. [3][4][5][6] We herein describe a patient who underwent Descemet membrane endothelial keratoplasty (DMEK) for corneal edema and visually significant Descemet membrane scrolls as sequelae of syphilitic keratitis.…”

“…Retrocorneal scrolls of Descemet membrane is an additional rare finding reported in syphilitic interstitial keratitis. 3–7…”