Localized amyloidosis of the cornea secondary to trichiasis - Clinical course and pathogenesis

Purpose. To present four cases of localized corneal amyloidosis secondary to trichiasis and to discuss its pathogenesis. Methods. Medical and pathologic records of four patients with corneal amyloidosis secondary to trichiasis were reviewed retrospectively. Two patients underwent trichiasis surgery and then lamellar keratectomy. One patient underwent trichiasis surgery only, and one patient received keratectomy only. The excised specimens were examined by light and electron microscopy. In two cases, they were stained with antibodies against K and X immunoglobulin light chains. All patients were followed for evidence of progression or recurrence of the lesions. Results. Three cases presented with blurring of vision and a progressively enlarging vascularized unilateral corneal mass. One case had normal vision and a smaller, nonvascularized mass. All four cases had a history of trichiasis. After trichiasis surgery but before corneal surgery, two patients were followed for 24 and 18 months, respectively, and showed no progression of the corneal lesions. The patient who did not undergo trichiasis surgery had a recurrence of the corneal lesion after lamellar keratectomy. Pathologic examination confirmed amyloid deposition in all three excised specimens with almost no inflammatory cells. Immunohistochemical stains were negative. Conclusion. The close correlation between trichiasis surgery and the clinical course of corneal amyloidosis provides further evidence for their association. The pathologic findings in this study do not confirm that the amyloid deposits are light chain proteins (AL).