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Granulomatous reaction to Bowman's layer in herpetic keratitis and band keratopathy
J A Mauriello1, I W McLean, P J Riddle
1Department of Ophthalmology, New Jersey Medical School, Newark 07103-2499, USA.
Objective:
To characterize granulomatous reactions around Bowman's layer.
Design:
Case series.
Setting:
Registry of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington.
Patients:
All patients with a code for granulomatous reactions to Bowman's (membrane) layer or Descemet's membrane. In addition, all corneas identified as having elastotic or calcific degeneration of Bowman's layer were reexamined to identify a possible granulomatous reaction to Bowman's layer.
Results:
Review of 210 corneal buttons and enucleated eyes yielded eight cases in which evidence of a granulomatous reaction to Bowman's layer was present: five patients with chronic keratitis, including three with herpetic keratitis (disciform in two and ulcerative in one), and three patients whose corneas had old degenerative pannus with calcification of Bowman's layer. In the patients with chronic keratitis the reaction tended to be focal and accompanied by inflammation; in those with degenerative pannus the reaction was diffuse and accompanied by minimal inflammation.
Conclusions:
Granulomatous reactions to Bowman's layer are observed much less frequently than granulomatous reactions to Descemet's membrane. Although the pathogenesis of granulomatous reaction to Bowman's layer is unclear, a change in the antigenic properties of Bowman's layer may be implicated.
Insights
Granulomatous reactions to Bowman's layer are rare, occurring in chronic keratitis or degenerative pannus. Pathogenesis remains unclear, possibly involving altered antigenic properties of Bowman's layer.
Area of Science:
- Ophthalmology
- Pathology
Background:
- Granulomatous reactions in the cornea are typically associated with Descemet's membrane.
- The occurrence and characteristics of granulomatous reactions specifically around Bowman's layer are less understood.
Purpose of the Study:
- To characterize the nature and presentation of granulomatous reactions occurring around Bowman's layer in the cornea.
Main Methods:
- A case series design was employed.
- Data were sourced from the Registry of Ophthalmic Pathology.
- Corneal buttons and enucleated eyes were reviewed for granulomatous reactions to Bowman's layer, including cases with elastotic or calcific degeneration.
Main Results:
- Eight cases with granulomatous reactions to Bowman's layer were identified among 210 specimens.
- Five cases were associated with chronic keratitis (three herpetic), showing focal reactions with inflammation.
- Three cases involved degenerative pannus with calcification, exhibiting diffuse reactions with minimal inflammation.
Conclusions:
- Granulomatous reactions to Bowman's layer are significantly less common than those involving Descemet's membrane.
- The exact cause of these reactions is unknown, but alterations in Bowman's layer's antigenic properties are suspected.
- This finding contributes to understanding corneal inflammatory and degenerative processes.