CPC PHS12-38442

CPCPHS12-38442

Amanda WayPGY-2

Clinical History

• 38 year old female with a several year history of blurry vision and intermittent eye pain

• Had been using muro ointment and timolol with no improvement of vision

• Patient unaware of any similar eye conditions in her family, but did remember her mother complaining of blurred vision as well

Clinical Exam

• Vision: 20/40| 20/60• IOP: 18, 21• Color Vision: 13/13 OU• Visual Fields: full to confrontation• Anterior Exam: endothelial blisters OU with

corneal edema• Fundus Exam: disc, macula, vessels and

periphery within normal limits OU

Anterior Segment Photos• Slit-lamp findings

include bands and vesicles in the posterior cornea as well as a thickened Descemet's membrane

• Secondary corneal edema and anterior synechiae

Note: This is a representative picture, not of our patient

AAO.org

Assessment and Plan

• Patient diagnosed with posterior polymorphous membrane dystrophy (PPMD)

• Given patient’s persistent corneal edema despite medical management, Descemet stripping automated endothelial keratoplasty (DSAEK) was performed on left eye

Descemet’s membrane, relatively thick for age

Cytokeratin Stain (CK7)

CK7: immunohistochemical stain that identifies keratinNote CK7+ endothelium

Cytokeratin Stain (CK7) – 40x

Light Blue: Descemet’s membrane Red: Endothelium

Endothelium appears stratified

Thickened Descemet’s

Vimentin Stain

Endothelium: redBlue counterstain: Descemet’s membrane

Discussion

• Bilateral, nonprogressive, inheritable (autosomal dominant) corneal dystrophy with variable penetrance

• Mutations in VSX1 homeobox (20q11) and COL8A2 (1p) have been described

• Endothelium has epithelial-like characteristics• Microvilli (noted on electronic microscopy)• Decrease in total # of endothelial cells• Variable thickening of Descemet’s membrane• Sometimes associated with secondary glaucoma (open

angle or associated with iridocorneal adhesions)

Héon et al. 2002

Differential Diagnoses

• ICE syndrome– In both conditions,

endothelial cells may be multilayered and express cytokeratins

– However, PPMD presents with wide-spaced collagen while ICE shows normal anterior banded and posterior nonbanded layersBromley et al. 2012

Differential Diagnoses

• Fuchs endothelial dystrophy– Guttata in endothelial layer– Thickened Descemet’s

http://www.mrcophth.com

Other Clinical Pearls

• Important to check intraocular pressure given the association with PPMD and glaucoma

• Elevated pachymetry also associated with endothelial function

• Examination of family may aid in diagnosis

References• AAO website, Feb 2013.• BCSC Section 8, External Disease and Cornea.American Academy of

Ophthalmology 2011-2013.• Bromley JG, Randleman JB, Stone D, Stulting RD, Grossniklaus HE.

Clinicopathologic Findings in Iridocorneal Endothelial Syndrome and Posterior Polymorphous Membranous Dystrophy After Descemet Stripping Automated Endothelial Keratoplasty. Cornea. 2012 Sept; 31(9):1060-1064.

• Héon E, Greenberg A, Kopp KK, Rootman D, Vincent AL, Billingsley G, Priston M, Dorval KM, Chow RL, McInnes RR, Heathcote G, Westall C, Sutphin JE, Semina E, Bremner R, Stone EM. VSX1: a gene for posterior polymorphous dystrophy and keratoconus. Hum Mol Genet. 2002 May 1;11(9):1029-36.

• http://www.mrcophth.com

CPC PHS12-38442

Documents

CPC Manager Premium Plus - Social CPC / GoldenLine.pl

1 PEDIATRIC CPT® CODING Materials by: Jacqueline J. Stack, CPC, CPC-I, CEDC Presented by: Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC

QUADRO COMPARATIVO ENTRE O CPC/1973 E O …esmec.tjce.jus.br/.../2015/06/Comparativo-CPC-1973-2015.pdfQUADRO COMPARATIVO ENTRE O CPC/1973 E O CPC/2015 CPC/1973 CPC/2015 Lei nº 5.869,

EDITAL DE AUDIÊNCIA PÚBLICA SNC Nº 01/2015 REVISÃO … · cpc 22, cpc 26 (r1), cpc 27, cpc 28, cpc 29, cpc 31, cpc 33 (r1), cpc 36 (r3), cpc 37 (r1), cpc 40 (r1) e cpc 45. introdução

Cooperative Patent Classification (CPC): General … Patent Classification (CPC): General Introduction into CPC CPC Outreach Group Alexandria, 10 July 2012 USPTO User Day 2012 CPC

CPC Compact Professional Charger - leab.eu · CPC Compact Professional Charger Microprocessor controlled battery charger CPC 1215 CPC 1220 CPC 1230 CPC 1260 CPC 2415 CPC 2420 CPC

Reconfigurable Systems for Cryptography and …cdn.intechopen.com/pdfs/38442/InTech-Reconfigurable...Reconfigurable Systems for Cryptography and Multimedia Applications 5 will emerge

José Carlos Bezerra Superintendente Superintendência de ... 2015/2- Jose Carlos-XXXI... · CPC 33 (R1), CPC 36 (R3), CPC 37 (R1), CPC 40 (R1) e CPC 45 . Revisão 08 CPC Ativo Intangível

NOVO CPC QUADRO COMPARATIVO CPC/1973 …...Grupo de Pesquisa do Prof. José Miguel Garcia Medina NOVO CPC QUADRO COMPARATIVO – CPC/1973 > CPC/2015 elaborado pelo grupo de pesquisa

Modifier Mania Presented by: Pat Cox, COC, CPC, CPMA, CPC-I, CEMC Lisa Deel, CPC, CEMC, COBGC Denise Taylor, CPC, CEMC, CGSC

DEANNA DENNIS, CPC, CPC- H, CPC- I · DEANNA DENNIS, CPC, CPC- H, CPC- I . DISCLAIMER. This presentation is a general summary for audit requirements. OVERVIEW - Discuss Purpose of

CPC Classic Lessons for CPC+ - milbank.org · CPC Classic Lessons for CPC+ ... ROI of CPC at the employer level. 26 Helping Practices Transform in CPC. 27

NOVO CPC QUADRO COMPARATIVO CPC/1973 CPC/2015Grupo de Pesquisa do Prof. José Miguel Garcia Medina NOVO CPC QUADRO COMPARATIVO – CPC/1973 > CPC/2015 elaborado pelo grupo de pesquisa

Central Auto...HONDA CPC "Ass COAT CPC aine Sealant CPC Sealant

NOVO CPC UADRO COMPARATIVO CPC/2015 CPC/1973 · PDF fileGrupo de Pesquisa do Prof. José Miguel Garcia Medina NOVO CPC QUADRO COMPARATIVO – CPC/2015 > CPC/1973 elaborado

LDC Services: Geneva Practitioners Seminar€¦ · 4. C. Retailing Services - Other supporting services not covered by 11. H: CPC 8676 CPC 7512 CPC 621 CPC 622 CPC 631, 632, 6111,

Novo CPC quadro comparativo – CPC 1973 - CPC 2015

Cooperative Patent Classification (CPC) CPC Workshop … · Cooperative Patent Classification (CPC) CPC Workshop for external users. ... • The International patent classification

Semin rio ITG 2002 04 Hs Impress o) - crc-ce.org.br · Aplicabilidade do CPC PME ou Full e do CPC 07R1 2. ... • BENEFÍCIOS A EMPREGADOS ... CPC 20 (R1) CPC 10 (R1) CPC 01 CPC 33

CPC NIVEL 5: CPC NIVEL 9: ATRIBUTOS ESPECÍFICOS GENERAL