PMC4206355_01
(A) Slit-lamp examination photograph of the left eye of a 39-year-old female. A white milky mass is noted in the center of the cornea with mild ciliary injection. The patient had suffered from trichiasis for more than 30 years. (B) Ultrahigh-resolution optical coherence tomography image of the left eye. The image shows homogeneous material above Bowman's layer. The material occupied the epithelial layer and caused thinning of the layer. In contrast, Bowman's layer was intact throughout the entire pathological region.
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Slit-lamp examination revealed multiple milky-white soft masses on the corneal surface of her left eye (Figure 1A).
(A) Slit-lamp examination photograph of the right cornea. Linear opacity was observed at the cilia-attached region (arrow). (B) Slit-lamp examination shows that fluorescein did not stain the epithelial layer. (C) Optical coherence tomography indicates a high-density spot that is coincident with the linear opacity at Bowman's layer (arrow). No other remarkable changes were seen in the stroma.
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On the other hand, the fellow cornea exhibited a linear subepithelial opacity that was not stained by fluorescein when observed under a slit-lamp examination (Figure, 2A and B). OCT revealed a high-density spot in Bowman's layer (Figure 2C), and this spot was coincident with the cilia-attached region and linear line observed under slit-lamp examination.
Immunohistochemistry of the corneal tissue excised from the left cornea.. Notes: Homogeneous material was positive with hematoxylin and eosin staining (A) and Congo red (B), and was depicted as apple-green under polarized microscopy (C). The mass region was also positively stained by the antilactoferrin antibody (D). The control that lacked the first antibody was negative (E).
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Histological analysis showed that the eosinophilic material was positively stained, with Congo red showing apple-green birefringence under polarized light (Figure 3, A-C). The material was also positive when using the antilactoferrin antibody (Figure 3D), with this area matching the Congo red-positive region.