title: Landolt ring-shaped epithelial keratopathy: a novel clinical entity of the cornea.
abstract: OBJECTIVE
  Landolt ring-shaped epithelial keratopathy is a newly identified disease with vesicular changes of unknown origin in the epithelial cells.
  
  
  METHODS
  Eleven Japanese patients with specific epithelial lesions that resembled a Landolt ring in the corneal epithelium were assessed. The main symptoms of Landolt ring-shaped epithelial keratopathy are foreign-body sensation and photophobia. Slitlamp examination indicates that Landolt ring-shaped lesions located only in the corneal epithelium are randomly distributed and occur unilaterally, bilaterally, or asymmetrically. Small lesions are sometimes connected to each other to form a large Landolt ring in a fractal pattern. Confocal microscopy reveals that the Landolt ring lesions are vesicular changes in the epithelial cells from the basal cell layer to the superficial cell layer without inflammation. The lesions form for weeks to months with sporadic exacerbations and natural remissions with or without treatments. The outcomes do not include epithelial disorders in the affected corneas or visual disruptions.
  
  
  CONCLUSIONS
  We describe a new disease entity of unknown origin referred to as Landolt ring-shaped epithelial keratopathy, which is usually bilateral and characterized by specific Landolt ring-shaped focal epithelial lesions with vesicular changes only in the epithelial cells. The disorder has an insidious onset and self-limiting nature despite treatment and should be included in the differential diagnosis of corneal epithelial disorders.
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Maeda
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Mitsuyama Eye Clinic, Kanagawa, Japan.
authors.forename: Daikichi
authors.initials: D
authors.lastname: Mitsuyama
authors.affiliation: Okamoto Eye Clinic, Osaka, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Okamoto
authors.affiliation: Okubo Ophthalmological Clinic, Suzaka Branch Hospital, Nagano, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Miura
authors.affiliation: Tane Memorial Eye Hospital, Osaka, Japan.
authors.forename: Tomiya
authors.initials: T
authors.lastname: Mano
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003316:Corneal Diseases / Q000175:diagnosis*; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D020795:Photophobia / Q000175:diagnosis; D014792:Visual Acuity / Q000502:physiology