Sir,

Lattice dystrophy of the cornea is caused by the deposition of amyloid in characteristic linear branching patterns in the corneal stroma. In vivo laser confocal microscopy (IVCM) images the different layers of the cornea with a resolution of up to 4 microns and has the potential to provide ultra-structural information that may not be visible on slit-lamp examination. The IVCM appearance in lattice dystrophy is well described.1

Case report

A 25-year-old male patient was referred to the ophthalmologist by his optician, who noted lattice changes in the left eye. The patient was asymptomatic and did not have symptoms of photophobia, recurrent erosions, or reduced vision. He did not have a family history of corneal dystrophies and did not have any systemic illnesses. His best corrected visual acuity was 6/5 in the right eye and 6/9 in the left eye. Slit lamp examination of the cornea revealed lattice dystrophy in his left eye (Figure 1b), but no abnormalities in the right eye (Figure 1a). He had normal corneal sensation and an intact corneal epithelium. The reminder of the eye examination was normal. Both eyes were examined using IVCM.

Figure 1
figure 1

Colour photos of (a) the right eye and (b) left eye.

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IVCM was performed with the Heidelberg Retinal Tomograph Rostock Cornea Module (Heidelberg Engineering GmbH, Heidelberg, Germany). The linear branching hyper-reflective deposits were seen in both eyes. The left eye had larger and more intense deposits with blurred margins (Figures 2d–f), whereas the right eye had less intense thinner lattice-shaped branching hyper-reflective deposits with more defined margins (Figures 2a–c).

Figure 2
figure 2

In-vivo confocal microscopy images of the (a–c) right eye and (d–f) left eye.

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Comment

Lattice corneal dystrophy is usually a bilateral condition that is commonly asymmetric. Rarely, it has been reported to occur unilaterally. In our patient, the clinical diagnosis of lattice corneal dystrophy in the left eye was supported by the IVCM findings. In the right eye, the most plausible explanation for the IVCM findings is that of preclinical amyloid deposition (not seen on slit-lamp examination).

As far as we are aware, IVCM has previously not been reported to show changes suggestive of lattice dystrophy in a clinically unaffected eye.