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Confocal Microscopy of Stellate Stromal Deposits in Two Cornea Grafts Treated with Moxifloxacin and Prednisolone Acetate

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Confocal Microscopy of Stellate Stromal Deposits in Two Cornea Grafts Treated with Moxifloxacin and Prednisolone Acetate


Angela Y. Chang, BA, James D. Auran, MD, Asma Asghar, James Flatow, BA, George J. Florakis, MD


corneal deposits, confocal, crystals, fluoroquinolone deposits, moxifloxacin


Purpose: To describe unusual anterior stromal stellate deposits, imaged by confocal microscopy, appearing in corneal graft stro- ma shortly after penetrating keratoplasty (PK) with postoperative topical moxifloxacin and prednisolone acetate treatment.

Methods: We report two cases and a review of the literature. Corneas were evaluated using the Heidelberg Retinal Tomograph II confocal laser scanning ophthalmoscope with the Rostock Corneal Module.

Results: Two corneal grafts, treated with topical moxifloxacin and prednisolone acetate, developed birefringent stellate deposits at all stromal levels. On confocal microscopy, they appear as blunt- and sharp-ended spikes radiating from a central nexus (rosette form) up to 50 microns in diameter. Morphologically, they resemble fluoroquinolone and (more so) calcium phosphate (blunt-ended needle, rosette form) crystals and do not resemble lipid (spikes with sharp ends), cholesterol (rhomboid, rectan- gular, notched, polychromatic), or prednisolone (birefringent, irregular, branched, and pleomorphic) crystals in solution. How- ever, these deposits do not resemble the typical anterior stromal, epithelial, or surface punctate or plaque deposition of calcium or fluoroquinolones.

Conclusions: This is the first report of stellate intrastromal depos- its following PK and topical moxifloxacin and prednisolone ace- tate, with the deposits morphologically similar to those reported in a single case in a PK graft following gatifloxacin and prednisolone acetate treatment. The cause and composition of these deposits remain unknown, but the etiologic role of fluoroquinolones, pred- nisolone acetate, and calcium must be considered.

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