Case Reports

Atypical lipid keratopathy

Case Report Details

First Author: M.Rekik TUNISIA

Co Author(s):    M. Rekik   S. Kammoun   S. Affes   S. Ben Amor   A. Trigui   J. Feki     

Abstract Details

Purpose:

Diseases of the cornea can be attributed to inflammation; degeneration; dystrophies; and, rarely, neoplasms. A yellowish discoloration of the cornea usually is associated with a deposition of lipids that in most instances arises from neovascularization secondary to inflammation.We report an atypical case of lipid keratopathy with corneal neovascularization secondary to anabolics in a sports trainer.

Setting:

Department of ophthalmology, Habib Bourguiba Hospital 3029 Sfax-Faculty of médicine of SfaxTunisia

Report of Case:

A 26-year-old patient, presented with a bilateral corneal clouding that had been slowly progressive over the last 2 years. He was a sports trainer having consumed protein for bodybuilding. Visual acuity of the right eye was 6/10, but acuity of the left eye was 1/20. Slit lamp examination showed deep yellow corneal deposits in the temporal periphery cornea with stromal neovascularization in both eyes. In the left eye, the central area of the cornea was not totally clear, and the opacification did partially cover the pupil under the normal daylight. No other ocular abnormalities were found. The anterior segment optical coherence tomography revealed a hyper-reflective area in the deep stroma. Confocal microscopy showed hyper-reflective structures in deep stroma. Evidence of hyperlipidemia was not apparent. No evidence was found for a systemic or an infectious disease. The patient presented with a flare-up of his keratitis revealed by bilateral conjunctival hyperemia and bilateral retro-corneal precipitates. He was given intravenous aciclovir associated with corticosteroid therapy after 48 hours. A slight improvement was noted. Although, the PCR looking for herpes or Shingles was negative. The patient was diagnosed with lipid keratopathy secondary to anabolics. The patient was given topical cyclosporine. No further development was observed about the lesion and the patient's visual acuity remained stable. Subconjunctival injections of anti-VEGF have been used to treat the new corneal vessels. A slight improvement was noted.

Conclusion/Take Home Message:

Lipid keratopathy is a rare disease. It has a primary and a secondary form, the secondary being the more common entity because of leakage from lipids out of newly formed corneal vessels after inflammation.

Financial Disclosure:

None