Fall 2017 Newsletter

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Fall 2017 Newsletter
7th Residency Announcement

Exciting Residency Announcement!

ACGME approves seventh resident complement; first increase in over 30 years!

Grand Rounds

Grand Rounds and Case Studies

Check out our weekly presentations



USC Ophthalmology Researchers Find More
Effective Treatments For Blinding Eye Diseases


Case Study: A Whirlwind Diagnosis

Greer Heur
Presenter: Christine Greer, MD Discussant: J. Martin Heur, MD, PhD


  • 50-year-old Caucasian man from Wyoming presents with blurry vision in the left eye
    • Patient reports fuzzy and monocular double vision in the left eye for prior two to three months
    • Patient states he feels growth on the cornea OS
  • No previous ophthalmologic problems within his immediate family
  • Past medical history: hypertension, hyperlipidemia, under good control
  • Social history: professional photographer, non-smoker
  • Previous surgical history of superficial keratectomy in both eyes

Exam Findings

  • VA 20/20 || 20/60 PH 20/40
  • Pupils RR OU, no RAPD
  • IOP (Tp) 12, 13
  • EOMI
Figure 1
Figure 1: External photograph of patient’s right eye depicting large, paracentral corneal opacification.
Figure 2
Figure 2: Slit lamp photograph of patient’s right eye. Note that the layer of involvement of the corneal opacity is within the epithelium.
Figure 3
Figure 3: Sclerotic scatter demonstrating white-gray paracentral opacification with feathery borders and densely crowded microcysts without clear, intervening zones.
Figure 4
Figure 4: Slit lamp photograph of patient’s left eye. Corneal opacity within the epithelium.
Figure 5
Figure 5: Sclerotic scatter demonstrating white-gray paracentral opacification with feathery borders and densely crowded microcysts without clear, intervening zones.
Figure 6
Figure 6: Anterior segment OCT with sharp demarcation of the epithelium, from hyperreflective to normal cornea.
Figure 7
Figure 7: A and B show no astigmatism OU.


Differential Diagnosis

  • Lisch corneal dystrophy
  • Meesmann corneal dystrophy
  • Epithelial basement membrane dystrophy
  • Thiel-Behnke corneal dystrophy
  • Reis-Bücklers corneal dystrophy
  • Systemic: verticillata
  • Limbal stem cell deficiency
  • Ocular surface squamous neoplasia


  • Lisch corneal dystrophy


  • Corneal dystrophies
    • Bilateral, symmetric inherited conditions
    • Slowly progressive and more pronounced over age
    • Genetics: TGFB1, protein keratoepithelin
    • corneadystrophy.org for classifications
  • Lisch corneal dystrophy
    • X-linked dominant; unknown gene
    • Slit lamp: discrete sectoral, gray, band-shaped and feathery lesions that appear in whorled pattern
    • Retroillumination: intraepithelial, densely crowded microcysts with surrounding clear cornea
    • No pain (recurrent erosions)
      • Differentiates from other anterior corneal dystrophies
    • Pathology
      • Light microscopy: diffuse cytoplasmic vacuolization
      • Sharp delineation from normal areas
      • Scattered staining with Ki-67 without evidence of increased mitotic activity
Figure 8
Figure 8: A. shows high-power field cornea epithelial with intracytoplasmic vacuoles; B. shows this finding in low-power field.



  • Epithelial debridement (superficial keratectomy)
    • Typically recurs


  • Middle East Afr J Ophthalmol. 2013 Jan-Mar;20(1):5-10.
  • Lisch WA, A new, band-shaped and whorled microcystic dystrophy of the corneal epithelium. Amer J Ophthal. 1992 July;114:35-44.
  • Cirino AC, Color Atlas and Synopsis of Clinical Ophthalmology-Wills Eye Hospital. 2012. 49(4):109.


Section Editors


Produced by: Monica Chavez, John Daniel, Joseph Yim and Dr. Vivek Patel
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