Resolution of Kayser–Fleischer ring in Wilson disease

A 6-year-old child with Wilson disease and autoimmune hepatitis presented to cornea clinic for routine ocular examination with unaided vision of 20/20 OU. Microscopic slit lamp examination revealed bilateral thick, circumferential green copper deposition on Descemet's membrane of the cornea suggestive of Kayser–Fleischer (KF) ring [Fig. 1a]. After being treated with penicillamine, oral steroids, and immunosuppression for 1 year, KF ring had decreased significantly [Fig. 1b]. KF ring is most commonly seen in Wilson disease[¹] but can also be seen in chronic active hepatitis, primary biliary cirrhosis, hepatocellular disorders, and intraocular foreign body containing copper.[²]

Figure 1: (a) Kayser–Fleischer ring, seen as circumferential green pigment deposition at the level of Descemet's membrane, before treatment. (b) Decrease in KF ring after treatment

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