Xerophthalmia: Findings from the Eye Lead to Diagnosis of a Fatal Intestinal Disease

Self-Restricted Diet in Pediatric Autism Leading to Vitamin A Deficiency and Severe Photophobia

In developed countries, vitamin A deficiency (VAD) remains rare but is a leading cause of global blindness. We describe the case of a 10-year-old girl with autism spectrum disorder (ASD) initially presenting mild VAD symptoms, escalating to severe photophobia and reluctance to leave a darkened room due to a self-restricted diet of fast-food french fries. A timely examination revealed severe VAD and vitamin A supplementation resolved her symptoms in three weeks. This case highlights the challenge of obtaining accurate patient history in ASD, emphasizing the need for routine dietary discussions and micronutrient testing, especially at ages nine and 13 when the United States Department of Agriculture (USDA) recommends increased vitamin A intake. Early intervention can prevent micronutrient deficiencies in pediatric patients, particularly those with ASD.

Multimodal Imaging Study of Patients With Vitamin A Deficiency Retinopathy

OBJECTIVES

To describe multimodal imaging findings of vitamin A deficiency retinopathy.

METHODS

A retrospective study of patients with serum retinol < 0.3 mg/L. Fundus color photos, spectral domain-optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) were reviewed and, when available, electrophysiological tests were analyzed.

RESULTS

Forty-five eyes (63.9 ± 15.7 years) were included. Ultra-widefield fundus photography showed drusen-like deposits (53.3%) and macular retinal pigment epithelium (RPE) mottling (40%). The deposits were hypoautofluorescent, and a perifoveal hyperautofluorescent ring was present in 8.9%. By SD-OCT, the ellipsoid zone had an irregular appearance (100%) and conical deposits anterior to the RPE (33.3%). Electroretinogram (ERG) (66.7%) showed a decrease in b-wave in the scotopic registers, and microperimetry (4.4%) showed decreased foveal sensitivity. After vitamin A supplementation, SD-OCT and FAF showed resolution of all findings. Forty percent of eyes had restoration of the scotopic registers in ERG and improved macular sensitivity by microperimetry (4.4%).

CONCLUSIONS

Vitamin A deficiency causes a mild cone dysfunction in addition to the more severe absent rod response. [Ophthalmic Surg Lasers Imaging Retina 2023;54:330-336.].

Effects of Recombinant Human Epidermal Growth Factor Eye Drops Combined with Phacoemulsification on Short- and Long-Term Visual Acuity Recovery and Related Dry Eye Complications in Patients with Senile Cataract

Objective

To investigate the effects of recombinant human epidermal growth factor eye drops combined with phacoemulsification on short- and long-term visual acuity recovery and related dry eye complications in patients with senile cataract.

Methods

Sixty patients with senile cataract cured from January 2019 to January 2021 were enrolled in our hospital. The patients in the control group were arbitrarily assigned into the control and the research group. The former group received phacoemulsification, and the latter group received recombinant human epidermal growth factor (RhEGF) eye drops combined with phacoemulsification. The curative effect, the incidence of xerophthalmia, short-term and long-term vision improvement, changes of corneal endothelial cells, serum factors, and life quality scores were compared.

Results

The effective rate of the research group was 90.00%, and the effective rate of the control group was 66.67%; the curative effect of the research group was higher than that of the control group (P < 0.05). The incidence of dry eye in the research group was lower than that in the control group (P < 0.05). The short-term and long-term visual acuity improvement effect of the research group was better than that of the control group (P < 0.05). After treatment, the density of corneal endothelial cells in the research group was higher than that in the control group, while the proportion of hexagonal cells and the coefficient of variation of corneal endothelial cells in the research group were lower than those in the control group (P < 0.05). After treatment, IL-6 and TNF-α in the research group were lower than those in the control group (P < 0.05). Compared with the control group, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower (P < 0.05).

Conclusion

Cataract is the leading cause of blindness in the world. With the continuous improvement of cataract phacoemulsification technology, the incidence of some serious complications has gradually lessened. Xerophthalmia is one of the most obvious and predictable complications after cataract surgery and may affect the recovery of postoperative visual acuity. Recombinant human epidermal growth factor eye drops can effectively enhance the visual acuity of patients, promote the curative effect, and strengthen the life quality.