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Riedl JC, Misirkhanova A, Musayeva A, Wasielica‐Poslednik J, Pfeiffer N, Gericke A. Risk factors for peripheral hypertrophic subepithelial corneal opacification. Acta Ophthalmol 2022; 101:443-448. [PMID: 36464930 DOI: 10.1111/aos.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/22/2022] [Accepted: 11/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND To evaluate the phenotype, tear secretion and refractive changes of patients diagnosed with peripheral hypertrophic subepithelial corneal opacification (PHSCO). METHODS This is a retrospective, interventional case series conducted at the Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz. Medical records of patients diagnosed with PHSCO were analysed. Sex, age, fluorescein tear film breakup time (FTBUT), Schirmer Test II, iris colour and hair colour were assessed. Objective refraction was evaluated at different time points and, in case of surgery, 1 month and 1 year postoperatively. RESULTS One hundred ninety-five eyes of 112 patients (78.6% female, 21.4% male; mean age 56.2 ± 14.3) were included. The median FTBUT was 6 sec. (Q1: 4/Q3: 8.75; range 1-20 s) (measured in 70 eyes of 36 patients), the median Schirmer Test II was 8 mm (Q1: 5/ Q3:15; range 1-35 mm). In 83 patients (74.1%) both eyes were involved. In 86 eyes of 64 patients (55.3%) superficial keratectomy was performed. Sphere and cylinder changed significantly 1 month and 1 year postoperative compared to the pre-operative objective refraction, while there was no significant change between 1 month and 1 year postoperatively. CONCLUSION We found that PHSCO occurs mostly bilaterally in middle-aged women and appears to be associated with decreased tear production and reduced tear film stability.
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Affiliation(s)
- Jana C. Riedl
- Department of Ophthalmology University Medical Center, Johannes Gutenberg‐University Mainz Mainz Germany
| | - Aminat Misirkhanova
- Department of Ophthalmology University Medical Center, Johannes Gutenberg‐University Mainz Mainz Germany
| | - Aytan Musayeva
- Department of Ophthalmology University Medical Center, Johannes Gutenberg‐University Mainz Mainz Germany
| | - Joanna Wasielica‐Poslednik
- Department of Ophthalmology University Medical Center, Johannes Gutenberg‐University Mainz Mainz Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology University Medical Center, Johannes Gutenberg‐University Mainz Mainz Germany
| | - Adrian Gericke
- Department of Ophthalmology University Medical Center, Johannes Gutenberg‐University Mainz Mainz Germany
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Salari F, Beikmarzehei A, Liu G, Zarei-Ghanavati M, Liu C. Superficial Keratectomy: A Review of Literature. Front Med (Lausanne) 2022; 9:915284. [PMID: 35872789 PMCID: PMC9299356 DOI: 10.3389/fmed.2022.915284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
Superficial keratectomy (SK) is the manual dissection of the superficial corneal layers (epithelium, Bowman's layer, and sometimes superficial stroma). SK is done using a surgical blade or diamond burr. Some surgeons use intraoperative mitomycin C 0.02% or amniotic membrane transplantation to improve surgical outcomes. This literature review shows that SK remains an effective method for different indications, including tissue diagnosis, excision of corneal degenerations, dystrophies, scarring, recurrent corneal erosions, and retained corneal foreign body.
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Affiliation(s)
- Farhad Salari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - George Liu
- School of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
- Tongdean Eye Clinic, Brighton, United Kingdom
| | - Mehran Zarei-Ghanavati
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Mehran Zarei-Ghanavati
| | - Christopher Liu
- Tongdean Eye Clinic, Brighton, United Kingdom
- Sussex Eye Hospital, Brighton, United Kingdom
- Brighton and Sussex Medical School, Brighton, United Kingdom
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Riedl JC, Schuster AK, Musayeva A, Wasielica-Poslednik J, Marx-Gross S, Gericke A. Effects of Superficial Keratectomy in Peripheral Hypertrophic Subepithelial Corneal Opacification on Front and Back Corneal Astigmatism. Curr Eye Res 2020; 46:284-289. [PMID: 32687418 DOI: 10.1080/02713683.2020.1798466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate changes of anterior and posterior corneal astigmatism after superficial keratectomy in peripheral hypertrophic subepithelial corneal opacification (PHSCO). METHODS Patients with PHSCO, who had received superficial keratectomy with mitomycin C 0.02%, were included in this retrospective study. Scheimpflug imaging of the cornea (Pentacam®, Oculus, Wetzlar, Germany), best-corrected visual acuity (BCVA) and objective refraction were determined preoperatively and 3 months after superficial keratectomy. RESULTS Fifteen eyes of 15 patients (age: 55 ± 16 years; range: 36-82 years) were included. The mean preoperative BCVA was logMAR 0.4 ± 0.2 and improved to logMAR 0.21 ± 0.3 (p < .01) postoperatively. The median preoperative astigmatism of the anterior corneal surface was 4.67 ± 2.4 D (range: 0.9-13.2 D) and decreased to 1.4 ± 0.4 D (range: 0.8-2.3 D) 3 months after surgery. The median astigmatism of the posterior corneal surface was 0.6 ± 0.5 D (range: 0.1-2.2 D) before surgery and decreased to 0.3 ± 0.2 D (range: 0-0.7 D) 3 months after surgery. CONCLUSION Superficial keratectomy reduces anterior corneal astigmatism more than posterior corneal astigmatism in patients with PHSCO. Furthermore, a myopic shift and corneal steepening in the peripheral and mid-peripheral cornea was observed after removal of the subepithelial corneal opacification spots.
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Affiliation(s)
- Jana C Riedl
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz , Mainz, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz , Mainz, Germany
| | - Aytan Musayeva
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz , Mainz, Germany
| | - Joanna Wasielica-Poslednik
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz , Mainz, Germany
| | - Susanne Marx-Gross
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz , Mainz, Germany
| | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz , Mainz, Germany
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Al-Rajhi AA, Helmi HA, Alkatan HM, Al-Obailan M, Al-Rajhi A. Successful Treatment of Corneal Opacification with Associated Thickened Epithelium by Simple Peeling: Acquired Corneal Subepithelial Hypertrophy (ACSH). Saudi J Ophthalmol 2019; 33:203-208. [PMID: 31686959 PMCID: PMC6819717 DOI: 10.1016/j.sjopt.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/10/2019] [Indexed: 11/27/2022] Open
Abstract
Purpose To study clinical and histopathological findings of corneal opacification caused by thickened epithelium leading to reduced vision and topographical changes and to evaluate the outcome of its removal. Methods Twelve patients (17 eyes) with central, paracentral or peripheral corneal opacification were reviewed to obtain their visual acuity, describe their slit lamp (SL) appearance (depth, extent and density) and document their topographic changes before and after peeling of the epithelium under SL or surgical removal under the microscope. Specimens of six cases were available for histopathological examination and immunohistochemical staining. Results Most of the eye opacifications were secondary to corneal procedures in 10 [Penetrating keratoplasty (PKP) in 7 for congenital glaucoma, keratoconus or adherent leukoma – usually over graft-host junction –, Photorefractive keratectomy (PRK) in 2 and Phototherapeutic keratectomy in one], chronic inflammation following trachoma or non-specific causes (3), and herpetic scar (1). Three cases were considered to be idiopathic. All cases presented with decreased vision, astigmatism or changes in topography or refraction. Their vision, clinical symptoms and topography improved after treatment. Histopathologically, all six cases shared findings that are similar to what have been described as peripheral hypertrophic subepithelial corneal degeneration (PHSCD) rather than Salzmann’s nodular degeneration. None of the cases showed inflammation or subepithelial pannus formation in the excised tissue. However, our cases did not fit into the diagnosis of PHSCD because of the location of the corneal opacification (being peripheral in 41% of the corneas, the presence of underlying primary etiologic factors in 82% of the eyes and the bilateral occurrence in 5 patients. Conclusions Meticulous SL examination aided by corneal imaging may accurately diagnose and determine the depth of corneal opacification as a cause for reduced vision. Histopathologically, the removed tissue is similar to PHSCD, but cases differ in their clinical profile. Peeling the thickened epithelial/subepithelial tissue is curative in most patients, improves visual and clinical outcome and avoids unnecessary corneal grafting.
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Affiliation(s)
- A A Al-Rajhi
- Ophthalmology Resident, PSMMC, Riyadh, Saudi Arabia
| | - H A Helmi
- Alfaisal University, Riyadh, Saudi Arabia
| | - H M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M Al-Obailan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Al-Rajhi
- Specialized Experts Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Serra HM, Holopainen JM, Beuerman R, Kaarniranta K, Suárez MF, Urrets-Zavalía JA. Climatic droplet keratopathy: an old disease in new clothes. Acta Ophthalmol 2015; 93:496-504. [PMID: 25626588 DOI: 10.1111/aos.12628] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 11/13/2014] [Indexed: 01/25/2023]
Abstract
Climatic droplet keratopathy (CDK) is an acquired and potentially handicapping cornea degenerative disease that is highly prevalent in certain rural communities around the world. It predominantly affects males over their forties. It has many other names such as Bietti's band-shaped nodular dystrophy, Labrador keratopathy, spheroidal degeneration, chronic actinic keratopathy, oil droplet degeneration, elastoid degeneration and keratinoid corneal degeneration. CDK is characterized by the haziness and opalescence of the cornea's most anterior layers which go through three stages with increasing severity. Globular deposits of different sizes may be histopathologically observed under the corneal epithelium by means of light and electron microscopy. The coalescence and increased volume of these spherules may cause the disruption of Bowman's membrane and the elevation and thinning of the corneal epithelium. The exact aetiology and pathogenesis of CDK are unknown, but they are possibly multifactorial. The only treatment in CDK advanced cases is a corneal transplantation, which in different impoverished regions of the world is not an available option. Many years ago, the clinical and histological aspects of this disease were described in several articles. This review highlights new scientific evidence of the expanding knowledge on CDK's pathogenesis which will open the prospect for new therapeutic interventions.
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Affiliation(s)
- Horacio M Serra
- Department of Clinical Biochemistry, Faculty of Chemical Sciences, CIBICI, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Juha M Holopainen
- Helsinki Eye Laboratory, Department of Ophthalmology, University of Helsinki, Helsinki, Finland
| | - Roger Beuerman
- Singapore Eye Research Institute, Singapore City, Singapore.,Duke-NUS, Singapore City, Singapore.,Ophthalmology, Yong Loo Lin School of Medicine, NUS, Singapore City, Singapore
| | - Kai Kaarniranta
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - María F Suárez
- Department of Clinical Biochemistry, Faculty of Chemical Sciences, CIBICI, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Julio A Urrets-Zavalía
- Department of Ophthalmology, University Clinic Reina Fabiola, Universidad Católica de Córdoba, Córdoba, Argentina
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Järventausta PJ, Tervo TMT, Kivelä T, Holopainen JM. Peripheral hypertrophic subepithelial corneal degeneration - clinical and histopathological features. Acta Ophthalmol 2014; 92:774-82. [PMID: 24655442 DOI: 10.1111/aos.12394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/15/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To refine the diagnostic criteria for peripheral hypertrophic subepithelial corneal degeneration (PHSD) and characterize its clinical phenotype, histopathology and immunohistochemical features. METHODS Diagnostic criteria were refined on the basis of literature data. Fourteen patients (13 women and one man; median age 52 years, range 33-66) were identified based on these criteria. Keratectomy specimens were evaluated via routine and immunohistochemical stainings. The main outcome measures were symptoms, clinical phenotype, immunological status and histopathologic results. RESULTS We defined the diagnostic criteria of typical PHSD as elevated circumferential and perilimbal subepithelial fibrosis with focal superficial corneal neovascularization, which were supported by female sex (93%), bilaterality (86%), the centre being in the upper quadrants (81%) and irregular astigmatism of two dioptres or more. The typical symptoms were reduced vision (86%) and the symptoms of ocular surface disease (64%). Light microscopy showed fibrosis with abundant collagen deposition but no inflammation in all patients. An immunohistochemical analysis of nine patients showed uniform staining for vimentin in three distinct types of fibroblasts in variable proportions: keratocyte-like cells that were positive for CD34, myofibroblasts that were positive for smooth muscle actin (SMA) and fibroblasts that were negative for CD34 and SMA. Small numbers of CD68-positive macrophages were also found. CONCLUSIONS Peripheral hypertrophic subepithelial degeneration is characteristic of middle-aged women, in whom it is typically a bilateral idiopathic degeneration of the cornea associated with ocular surface disease and reduced vision. The fibrotic lesions probably undergo remodelling, inducing changes in corneal contour. A smouldering low-grade inflammation favouring low TGF-β1 concentrations is postulated as the primary pathological process leading to PHSD.
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Affiliation(s)
| | | | - Tero Kivelä
- Helsinki University Eye Hospital; Helsinki Finland
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