Outcomes of sequential keratoplasty for bilateral gelatinous drop-like corneal dystrophy: A case report.
Mohammed M Abusayf, Rana Alhumaemydi, Abeer Alkhodier et al.
✦ AI-curated · Sources linked
Case in brief
A 21-year-old woman of Yemeni ancestry with long-standing bilateral visual impairment, progressive left-eye decline, foreign-body sensation, and a positive family history had previously undergone right penetrating keratoplasty for an undiagnosed corneal opacity. Examination showed a clear right graft with recipient deposits and dense, vascularized left corneal opacity with mulberry-like deposits. Congo red-positive subepithelial amyloid with birefringence confirmed gelatinous drop-like corneal dystrophy. Deep stromal opacity required conversion from attempted lamellar surgery to full-thickness left keratoplasty. Both grafts remained clear without rejection; final corrected acuity was 20/100 right and 20/80 - 1 left.
What made this case unusual
The left cornea’s dense deep stromal opacity prevented completion of the planned lamellar procedure, requiring conversion to penetrating keratoplasty. The case also illustrates sequential bilateral grafting in a patient with limited access to transplantation.
Diagnostic / clinical pearl
In a patient with progressive bilateral corneal opacification and characteristic deposits, histopathology showing Congo red-positive amyloid with polarized-light birefringence can confirm gelatinous drop-like corneal dystrophy.
Why it matters
Despite clear grafts, visual recovery may remain incomplete after early-onset impairment and delayed treatment; recurrence can complicate long-term management.