Keratomalacia and corneal perforation in vitamin A deficiency: Anterior-segment optical-coherence-tomography and histological findings
Purpose: To describe the histological findings and results of anterior-segment optical-coherence-tomography (AS-OCT) in patients with severe keratomalacia and corneal perforation due to vitamin-A deficiency (VAD). Observations: Four patients (3 female, 1 male) with moderate to severe VAD were includ...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-12-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993624001798 |
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| Summary: | Purpose: To describe the histological findings and results of anterior-segment optical-coherence-tomography (AS-OCT) in patients with severe keratomalacia and corneal perforation due to vitamin-A deficiency (VAD). Observations: Four patients (3 female, 1 male) with moderate to severe VAD were included in this single-center case series. Keratomalacia/corneal perforation was diagnosed by slit-lamp examination. The findings were documented using photographs and AS-OCT imaging (CASIA-2, Tomey corporation, Nagoya, Japan). Ocular and general medical findings including causes of VAD are reported. VAD was severe (<20 ng/ml) in two patients with chronic alcoholism, and moderate (205/231 ng/ml) in two patients with cachexia. Corneal perforation occurred in 3 out of 4 patients. One patient had severe keratomalacia with impending perforation and massive conjunctival folds with Bitot's spots, which vanished soon after initiation of vitamin A supplementation. In three cases, corneal specimens obtained during anterior lamellar keratoplasty were assessed histologically by light-microcopy. The histological specimens showed massive epithelial thickening and a pronounced granular layer of the corneal epithelium. Conclusions and importance: Keratomalacia leading to corneal perforation is a rare, but possible complication also in countries with sufficient general food supply. The clinico-pathological correlation between AS-OCT and histological findings in patients with VAD is shown in this case series. Typical Bitot's spots were present only in one patient and can be visualized by AS-OCT. |
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| ISSN: | 2451-9936 |