Histopathologic Findings of Cornea Verticillata in a Woman Heterozygous for Fabry's Disease

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Abstract
To report the histopathologic findings of the cornea verticillata observed in a woman who was heterozygous for Fabry's disease. A 67-year-old woman was found to have a whorl-like corneal opacity on her visit to the Department of Ophthalmology, Aichi Saiseikai Hospital. Her visit was because of a sudden loss of vision in her right eye owing to a central retinal artery occlusion in association with an ophthalmic artery occlusion. The patient died suddenly of an acute heart failure; with family consent, an autopsy was performed and the right eye was removed for histopathologic examination by light and electron microscopy. Low levels of α-galactosidase in the leukocytes together with the corneal finding led to the diagnosis of heterozygous Fabry's disease. Light microscopy revealed a 0.3-to 0.5-μm thick layer between the epithelial and Bowman's layers. Oil red O positive deposits were accumulated in the subepithelial layer, and the density varied in different regions. Electron microscopy showed that subepithelial layer differed in thickness, and the basal lamina reduplicated regionally. We were not able to determine the structure that correlated with the “ridge” in the central part of the cornea. The oil red O positive deposits and their variation in density in the subepithelial area of the cornea may have caused the characteristic whorl-like corneal opacity in this woman who was heterozygous for Fabry's disease.