Asymmetrical Corneal Topography

in Map-Dot-Fingerprint Dystrophy
Resembling Keratoconus
Arie L. Marcovich1,2, Ori Mahler1,2,
Ayala Pollack1, Samuel Levinger2
Department of Ophthalmology, Kaplan Medical Center
Rehovot, Israel
2
Enaim Laser Surgery, Tel Aviv & Jerusalem, Israel
1

No Financial Interest

Background
In map-dot-fingerprint dystrophy, the
corneal epithelium above an abnormal
basement membrane, is not firmly
attached to the underlying stroma, and
may cause recurrent erosions.
Irregular epithelium can reduce vision

Purpose
To report 2 patients with map-dot-fingerprint
corneal dystrophy with asymmetrical
topographies that resembled keratoconus

Patient 1
A 38 year-old female underwent corneal topography due
to blurred vision in both eyes.
Best corrected visual acuity was: OD 20/40 cc - 3.75 D
OS 20/30 cc - 2.25 D
Topography demonstrated superior asymmetry and the
patient was referred to our cornea service with the
diagnosis of keratoconus.

EyeSys
topography

Patient 1

Orbscan did not demonstrate posterior

keratoconic changes.

Patient 1
On slit examination: In both corneas, signs of map-dotfingerprint dystrophy were present.

OD

OS

The patient was treated with sodium chloride 5% eye

drops qid and lubricating ointment at night.
Best corrected Visual acuity improved to 20/20 in both
eyes with the same refraction.

Patient 2
A 41 year-old female complained of blurred vision in her right eye.
She underwent extensive medical work-up including fluorescein
angiography and MRI scan that were normal. Corneal topography
was performed due to newly detected astigmatism in her right eye.

20/50

- 0.75 / + 3.25 X 160

20/20 without correction

Topography showed inferior steepening in the right eye and a

diagnosis of keratoconus was done. The patient was offered a
surgical treatment with intracorneal rings.

Patient 2
Orbscan did not demonstrate posterior keratoconic changes.

The patient was referred to our cornea service.

On examination, signs of map-dot-fingerprint dystrophy
were present in both corneas. The patient was treated with
sodium chloride 5% eye drops qid and an ointment at night.
Visual acuity did not improve, and the patient began to
suffer from recurrent erosions in her right eye.

Patient 2
The patient underwent alcohol 20% assisted epithelial
removal. Best corrected visual acuity improved to 20/20.
Recurrent erosions did not recur in a one year follow up.
Corneal topography demonstrated regular astigmatism.
20/50

- 0.75 / + 3.25 X 160

OD inferior steepening
misdiagnosed as keratoconus

X 138 0.50 / - 0.25 - 20/20

10 months post alcohol delamination

regular astigmatism on topography

:Conclusions
Map-dot-fingerprint dystrophy may
cause blurring of vision and
astigmatism due to epithelial
irregularity, and induce topographic
changes that may mimic keratoconus.
Asymmetry on topography may lead to
misdiagnosis of keratoconus.