Striate Melanokeratosis Secondary to Neurotrophic Keratitis

Abstract

Abstract: : Purpose:To describe for the first time the development of striate melanokeratosis (pigmented vortex keratopathy) secondary to neurotrophic keratitis (NTK). Methods:Observational case series. Results:Case 1: A moderately pigmented 51–year–old Hispanic male was followed at frequent intervals (q 1–8 weeks) over a 20–month period for HSK OD complicated by repetitive episodes of dendritic keratitis, disciform keratitis, immune stromal keratitis, iritis, and glaucoma. Initial central corneal sensation (CCS) quantitated by Cochet–Bonnet esthesiometry was 35mm. After 20 months, the patient suddenly developed prominent arcs of pigmented epithelium extending centrally for approximately 4mm from the 4 and 8 o’clock limbal positions. This was associated with new onset of 2+ central and inferocentral punctate keratopathy. Repeat CCS was 1.0mm, reflecting late onset of Stage 1 NTK. Case 2: A 43–year–old heavily pigmented African–American female presented with a several month history of progressive loss of vision OS. Slit–lamp exam OD was unremarkable, but OS revealed a 4+ pigmented epithelial verticillata pattern extending from the 4 and 8 o’clock limbus across the entire inferocentral cornea. Superimposed centrally and inferocentrally was a 2+ punctate keratopathy. CCS was 0.0mm, again reflecting Stage 1 NTK. A diagnosis of CMV retinitis (vitreous tap PCR confirmed) was ultimately made OS. Conclusion:Striate melanokeratosis appears to represent a previously undescribed potential secondary complication of NTK in highly pigmented individuals. As such, it may represent a simple clinical marker for the presence of NTK. Mechanistically, it may represent increased limbal stem cell turnover driven by the inflammatory component of NTK associated aqueous deficient dry eye.

Keywords: keratitis • cornea: epithelium