Those excrescences on Descemet's membrane

We read with interest the recent report, “Screening human donor corneas during organ culture for the presence of guttae.”¹ Even the title made us question whether we were the only ones still using the original name for the condition cornea guttata. A quick perusal of Medline reveals a trend away from guttata, and towards guttae (Fig 1). This trend may be even more pronounced, as the literature tends to be conservative. The next generation of cornea specialists, or at least the small sample that goes through our training programme, tends to fall into three categories: those who say guttae, those who correct others for saying guttata, and those who try their best not to mention the term for fear they're saying the wrong thing. Many of our faculty have now entered this last group.

Figure 1.

References to guttata and guttae over the past 40 years in Medline. Some articles use both terms.¹

When asked what is so bad about guttata, some insist that it is not the plural for gutta, the Latin word for drop. We're not sure that anyone ever said it was. More erudite dissenters recognise that not only is guttata not a plural, it is not even a noun—it's an adjective. The closest English counterpart to guttata is probably guttate, drop-like, or speckled,² so it's incorrect to use guttata alone as a noun, or so the thinking goes. Some have chosen to use cornea guttata when referring to the condition, and guttae when referring to the excrescences themselves.¹

“Guttata were present” may well have grated the ears of an ancient Roman, since guttata is feminine singular, and Romans liked their subjects to agree with their verbs in number as much as the rest of us. However, it is not so clear that “Flavia's guttata is impressive” would be at all offensive, particularly since blonde Flavia herself was named after an adjective, as were Augustus and, some say, even Caesar himself. In fact, early Roman grammarians barely distinguished between adjectives and nouns, using them interchangeably any chance they could.³ The learned still do, at least when they refer to themselves as the learned. Those particularly offended by using an adjective substantively (as a noun) should be careful not to slip up with words like cornea. Both cornea and conjunctiva started out their ophthalmological careers as adjectives, modifying tunica (coat, feminine singular), which is why cornea and, in turn, guttata are feminine singular in the first place.

What then should we call those excrescences on Descemet's membrane? Well, if you think they are drops, then by all means call them drops, although you probably don't need to invent yet another term from a dead language. Vogt called them “tropfige” (drop-like) Prominenzen der Hornhautrückfläche before he coined cornea guttata (his quotes, not ours).⁴ If, like Dr Vogt, you want to convey that the cornea looks speckled with drop-like excrescences, then you could use the substantive adjective guttata as a singular noun, or the English guttate as an adjective. You could even use guttata as a plural noun—if criticised just say you were referring to the many drop-like excrescentia (neuter plural), not a single speckled tunica cornea (feminine singular). A resident on our service recently wrote in a chart note guttatae (feminine plural). We certainly found no fault. In fact, it may be a reasonable compromise for those who have sworn never to use guttata. We find no reference to it yet in Medline.