Grand Rounds

A patient with a remote history of syphilis treated with IV penicillin presented with decreased vision in the left eye. He had previously undergone uncomplicated phacoemulsification with intraocular lens implantation in both eyes and superficial keratectomy in the right eye for Salzmann’s nodular degeneration. Best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/70 in the left eye. Slit-lamp examination of the right eye revealed an overall clear cornea with areas of peripheral and paracentral Descemet scrolls and nodules minimally involving the visual axis. Examination of the left eye was significant for peripheral corneal stromal scarring with Descemet membrane folds, corneal stromal edema, and central and paracentral Descemet membrane lesions. Small iris nodules—which were presumed to be remnants of iris gummas—were observed on the pupillary margin bilaterally. The remainder of the ocular examination, including the posterior segment, was unremarkable in both eyes. Central corneal thickness measured by ultrasound pachymetry was 618 and 641 mm in the right and left eyes, respectively. The patient underwent DMEK in the left eye for corneal edema and visually significant Descemet membrane scrolls. No intraoperative or postoperative challenges were encountered, and the patient maintained good vision and a clear cornea for several years after transplantation. Five years later, the patient presented with decreased vision and corneal edema in the right eye. The patient recently underwent DMEK in the right eye and is recovering well from surgery.

Presentation Date: 10/22/2026
Issue Date: 10/23/2026