Abstract

A 55-year-old man came to the cornea clinic with complaints of diminution of vision in both eyes. On slit lamp examination, the endothelium shows a gravel tile pattern due to greyish pigment like deposits distributed all over the endothelium. No other deposits were seen in the corneal stroma, iris, lens, or macula. Endothelial cell density by specular microscopy was 3155 and 3460 cells/mm2 on right and left eyes, and almost all endothelial cells displayed a dark cell body in the center, which was of small size on the right cornea but completely filling some cells on the left cornea, which also showed signs of pleomorphism (CV-37 and 6A-50). ASOCT showed sharply demarcated thickened and hyper reflective Descemet’s membrane, measuring 38 and 31 microns in both eyes. Both eye dilated examination revealed cataractous lens, presumably the cause for diminution of vision. Clinical features and ancillary investigations suggested a diagnosis of a novel phenotype “salt and pepper endothelium”.