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

Abstract

BACKGROUND

Retrocorneal hyaline scrolls are a rare phenomenon. We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis.

CASE SUMMARY

A 71-year-old woman presented with blurred vision due to cataracts. Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea. The patient was positive for syphilis-specific antibodies, with no ocular or systemic evidence of congenital or acquired syphilis. Binocular cataract, retrocorneal scroll, and corneal endothelial gutta were considered. The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin–eosin staining and scanning electron microscopy. The cornea of the right eye remained transparent, and the residual scroll seemed stable, however, the corneal endothelial density declined at 13 mo after surgery. In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium, with enlarged endothelial cells in both eyes. Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet’s membrane were observed. The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure.

CONCLUSION

Occult congenital syphilis could induce corneal endothelial gutta and the formation of retrocorneal scrolls without other signs of ocular syphilis.

Keywords: Scroll, Corneal endothelium, Congenital syphilis, Syphilitic interstitial keratitis, In vivo confocal microscopy, Case report

Core Tip: Retrocorneal scrolls are usually considered to be associated with some infectious keratitis. Here, we report a case of bilateral retrocorneal hyaline scrolls and corneal gutta, without other ocular or systemic positive signs, which was likely induced by asymptomatic congenital syphilis. The characteristic changes of the cornea were observed by in vivo confocal microscopy. The removed scrolls were analyzed by hematoxylin-eosin staining and scanning electron microscopy. Our findings provide new insight into the pathogenesis of keratopathy in congenital syphilitic corneal disease.