Moshirfar Majid, Y Liu Harry, Vaidyanathan Uma, N Somani Anisha, C Hopping Grant, R Barnes James, B Heiland Madeline, B Rosen David, N Motlagh Mahsaw, C Hoopes Phillip
John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA.
Utah Lions Eye Bank, Murray, UT, USA.
Med Hypothesis Discov Innov Ophthalmol. 2019 Fall;8(3):156-162.
Corneal pseudoguttata (PG), also known as pseudoguttae or secondary guttata, is a transient, reversible endothelial edema commonly associated with anterior segment pathology. While considered rare, PG presents on slit-lamp examination more commonly than originally thought. We have clinically observed PG after refractive surgeries, in association with infectious keratitis, and following medication use. PG presents as dark lesions on slit-lamp exam with specular illumination, similar to primary corneal guttata. PG is distinct from guttata because PG resolves over time and does not involve Descemet's membrane. Other ocular findings that may be confused with guttata include endothelial blebs (EB) and endothelial denudation (ED). EB are possibly a type of PG that present after contact lens use or hypoxia. ED is a distinct entity that is characterized by loss of endothelial cells without involvement of Descemet's membrane. Confocal microscopy may be useful in differentiating these four endothelial lesions, with differences in border definition and the presence of hyperreflective areas two main distinctions. PG presents as a hyporeflective, elevated shape without clear borders on confocal microscopy. PG, EB, and ED can resolve with time without the need for surgical intervention, unlike corneal guttata. Treatment of the underlying condition will lead to resolution of both PG and EB.
角膜假性滴状病变（PG），也称为假性滴状物或继发性滴状物，是一种常见于眼前节病变的短暂性、可逆性内皮水肿。虽然被认为较为罕见，但PG在裂隙灯检查中的出现频率比最初认为的更高。我们在临床中观察到，屈光手术后、与感染性角膜炎相关以及用药后会出现PG。在裂隙灯检查的镜面照明下，PG表现为深色病变，类似于原发性角膜滴状病变。PG与滴状病变不同，因为PG会随时间消退且不累及Descemet膜。其他可能与滴状病变混淆的眼部表现包括内皮小泡（EB）和内皮剥脱（ED）。EB可能是在使用隐形眼镜或缺氧后出现的一种PG。ED是一种独特的病变，其特征是内皮细胞丢失而不累及Descemet膜。共聚焦显微镜检查可能有助于区分这四种内皮病变，边界清晰度和高反射区的存在是两个主要区别点。在共聚焦显微镜下，PG表现为低反射、隆起的形态，边界不清晰。与角膜滴状病变不同，PG、EB和ED可随时间消退，无需手术干预。治疗潜在疾病将导致PG和EB消退。
