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Figure 1: Vesicle-like lesions in PPMD

Figure 1: Vesicle-like lesions in PPMD

Contributor: Jesse Vislisel, MD and Kenneth M. Goins, MD

Photographer: Brice Critser, CRA

March 2,2015

Vesicle-like lesions at the level of Descemet's membrane and endothelium are the hallmark lesions of PPMD. They appear as transparent cystic lesions surrounded by gray halos and commonly occur in lines or clusters. The figures below demonstrate the classic appearance of these lesions with direct illumination, retroillumination, and on specular microscopy.

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Figure 2: Band lesions in PPMD

Figure 2: Band lesions in PPMD

Contributor: Jesse Vislisel, MD and Kenneth M. Goins, MD

Photographer: Brice Critser, CRA

Band lesions, sometimes called "snail tracks," are classically horizontal lesions with parallel, scalloped, non-tapering edges at the level of the posterior cornea. Below are examples of these lesions in 2 separate patients.

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Figure 3: Diffuse posterior stromal opacities in PPMD

Figure 3: Diffuse posterior stromal opacities in PPMD

Contributor: Jesse Vislisel, MD and Kenneth M. Goins, MD

Photographer: Brice Critser, CRA

PPMD may present with diffuse, gray-white opacities at the level of Descemet's membrane. There may be deep stromal haze adjacent to the lesions. Below are slit lamp photographs of two patients with such lesions.

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Figure 4: Confocal microscopy of affected endothelium in PPMD

Figure 4: Confocal microscopy of affected endothelium in PPMD

Contributor: Andrew Doan, MD, PhD, University of Iowa

Confocal microscopy of the endothelium in PPMD shows epithelial-like cells. Normal endothelial cells are hexagonal and flat.