A new form of primary, localized, corneal amyloidosis: a case report with confocal microscopy

We present a case of bilateral, primary, localized, corneal amyloid deposition with a unique appearance not, to our knowledge, previously described. The patient was a 73-year-old white man who complained of glare. Best corrected visual acuity was 20/25 in both eyes. Slit lamp examination revealed subepithelial/anterior stromal white-gray deposits in the peripheral cornea in both eyes. The corneal surface was smooth with no elevated areas. Superficial corneal scrapings showed focal deposits of an amorphous, glass-like material below the epithelial surface and within Bowman's membrane, which stained with Congo red. We examined the amyloid deposits using the confocal microscope to obtain high magnification images in vivo. The confocal microscopic views showed intercellular, cotton candy-like, fibrillar amyloid material scattered throughout the anterior stroma. The use of this instrument may permit clinical diagnosis of this rare disorder without the need for biopsy.