Scrolls of Descemet's membrane in healed syphilitic interstitial keratitis

A 45-year-old woman with healed syphilitic interstitial keratitis presented with decreased vision, foreign-body sensation of the right eye, and bilateral conjunctival injection. Examination disclosed a network of tissue on the posterior corneal surface, with extension into the anterior chamber. Bullous keratopathy developed after intracapsular cataract extraction, and a keratoplasty was performed. Pathologic examination of the corneal button disclosed corneal edema, posterior stromal vascularization, much thickening of Descemet's membrane, and concentrically laminated scrolls of Descemet's membrane-like tissue that extended from the posterior corneal surface into the anterior chamber. Endothelium was attenuated considerably throughout and in one area was replaced by a single layer of iris melanocytes.