Phacoemulsification in Mature Cataract and Uveitis

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Asymmetrical Corneal Topography in
Map-Dot-Fingerprint Dystrophy Resembling
Keratoconus
Arie L. Marcovich1,2, Ori Mahler1,2, Ayala
Pollack1, Samuel Levinger2
1 Department of Ophthalmology, Kaplan Medical
Center Rehovot, Israel 2 Enaim Laser Surgery,
Tel Aviv Jerusalem, Israel
No Financial Interest
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Background

• In map-dot-fingerprint dystrophy, the corneal
  epithelium above an abnormal basement membrane,
  is not firmly attached to the underlying stroma,
  and may cause recurrent erosions.
• Irregular epithelium can reduce vision

Purpose
To report 2 patients with map-dot-fingerprint
corneal dystrophy with asymmetrical topographies
that resembled keratoconus
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Patient 1
A 38 year-old female underwent corneal topography
due to blurred vision in both eyes. Best
corrected visual acuity was OD 20/40 cc - 3.75
D
OS 20/30 cc - 2.25 D Topography
demonstrated superior asymmetry and the patient
was referred to our cornea service with the
diagnosis of keratoconus.
EyeSys topography
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Patient 1
Orbscan did not demonstrate posterior keratoconic
changes.
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Patient 1
On slit examination In both corneas, signs of
map-dot-fingerprint dystrophy were present.
OD
OS
The patient was treated with sodium chloride 5
eye drops qid and lubricating ointment at
night. Best corrected Visual acuity improved to
20/20 in both eyes with the same refraction.
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Patient 2
A 41 year-old female complained of blurred vision
in her right eye. She underwent extensive medical
work-up including fluorescein angiography and MRI
scan that were normal. Corneal topography was
performed due to newly detected astigmatism in
her right eye.
20/50 - 0.75 / 3.25 X 160
20/20 without correction
Topography showed inferior steepening in the
right eye and a diagnosis of keratoconus was
done. The patient was offered a surgical
treatment with intracorneal rings.
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Patient 2
Orbscan did not demonstrate posterior keratoconic
changes.
The patient was referred to our cornea
service. On examination, signs of
map-dot-fingerprint dystrophy were present in
both corneas. The patient was treated with sodium
chloride 5 eye drops qid and an ointment at
night.
Visual acuity did not improve, and the patient
began to suffer from recurrent erosions in her
right eye.
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Patient 2
The patient underwent alcohol 20 assisted
epithelial removal. Best corrected visual acuity
improved to 20/20. Recurrent erosions did not
recur in a one year follow up. Corneal topography
demonstrated regular astigmatism.
20/20 - 0.25 / - 0.50 X 138
20/50 - 0.75 / 3.25 X 160
10 months post alcohol delamination regular
astigmatism on topography
OD inferior steepening misdiagnosed as
keratoconus
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Conclusions

• Map-dot-fingerprint dystrophy may cause blurring
  of vision and astigmatism due to epithelial
  irregularity, and induce topographic changes that
  may mimic keratoconus.
• Asymmetry on topography may lead to misdiagnosis
  of keratoconus.