Current issues of differential diagnosis and treatment of congenital corneal opacities in children

Purpose. To analyze the literature on the topic of congenital corneal opacities, their diagnosis, differential diagnosis, as well as the choice of optimal treatment tactics. Congenital corneal opacities (CCO), when effective treatment is delayed, usually lead to permanent loss of visual function. This diagnosis requires urgent measures. On the other hand, the rarity of neonatal corneal pathology and difficulties associated with evaluation of newborns yield the situation when more or less defined clinical practice patterns in such cases remain unclear for most pediatric ophthalmologists. Based on our own experience and the literature data, we describe the main issues of differential diagnosis and management of CCO in newborns. A broad range of developmental anomalies, congenital hereditary corneal dystrophies and metabolic diseases as the main causes of CCO are reviewed. In addition to this diagnostic paradigm, the prognosis in every particular pathology as well as treatment recommendations are given. Conclusion. Based on the presented review, the prognosis and therapeutic recommendations for a particular congenital pathology of the cornea are given. Key words: congenital malformations of the eye, children, corneal opacity, keratoplasty, low vision.

Download Full-text

Peripheral vestibular syndrome. Etiologic differential diagnosis algorithm and therapeutic recommendations

ORL ro ◽

10.26416/orl.34.1.2017.465 ◽

2017 ◽

Vol 1 (34) ◽

pp. 28

Author(s):

Mădălina Georgescu

Keyword(s):

Differential Diagnosis ◽

Therapeutic Recommendations ◽

Diagnosis Algorithm

Download Full-text

Differential Diagnosis of Seborrheic Dermatitis

Pediatrics in Review ◽

10.1542/pir.7.7.204 ◽

1986 ◽

Vol 7 (7) ◽

pp. 204-211

Author(s):

Mary L. Williams

Keyword(s):

Atopic Dermatitis ◽

Differential Diagnosis ◽

Metabolic Diseases ◽

Fungal Infections ◽

Seborrheic Dermatitis ◽

Local Therapy ◽

Skin Condition ◽

Unknown Etiology ◽

Common Skin ◽

Nutritional And Metabolic Diseases

Seborrheic dermatitis is a common skin condition of infancy of unknown etiology. The disorder is usually mild and responsive to therapy. In severe or atypical cases, a variety of other entities should be considered in the differential diagnosis. Atopic dermatitis, psoriasis, psoriasiform-id reaction, fungal infections, and irritant contact dermatitis can be differentiated on clinical grounds. Less common but more serious disorders, such as histiocytosis X, immunodeficiency disorders, and nutritional and metabolic diseases, may be considered in the child whose disease does not spontaneously resolve or respond satisfactorily to local therapy. Laboratory studies including skin biopsy may be helfpul in these cases. Seborrheic dermatitis is uncommon in children after infancy and before puberty. In this age group, scalp scaling is likely to be due to other causes, such as tinea capitis, atopic dermatitis, or psoriasis.

Download Full-text

Indications for keratoplasty in Nepal: 2005 - 2010

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i2.8730 ◽

2013 ◽

Vol 5 (2) ◽

pp. 207-214 ◽

Cited By ~ 6

Author(s):

Leena Bajracharya ◽

R Gurung ◽

EH DeMarchis ◽

M Oliva ◽

S Ruit ◽

...

Keyword(s):

Case Series ◽

Corneal Opacity ◽

Corneal Dystrophy ◽

Bullous Keratopathy ◽

Infectious Keratitis ◽

Eye Health ◽

Corneal Scar ◽

Recipient Age ◽

Corneal Opacities ◽

Corneal Blindness

Introduction: Corneal disease, especially infective keratitis, is one of the major causes of visual impairment and blindness in developing countries. Objective: To find out the current indications for keratoplasty, how these indications have changed over time as well as how they are different from those in other parts of the world. Materials and methods: A retrospective study of a case series of 645 keratoplasty surgeries (589 patients) was conducted at the Tilganga Institute of Ophthalmology from January 2005 to December 2010. Outcome measures: The cases were evaluated in terms of demographic parameters, preoperative diagnosis and the type of surgery performed. Results: The most common indication for surgery was active infectious keratitis (264 eyes, 40.9 %), followed by corneal opacity (173 eyes, 26.8 %), regraft (73 eyes, 11.2 %), bullous keratopathy (58 eyes, 9.0 %), keratoconus (45 eyes, 7.0 %) and corneal dystrophy (11 eyes, 1.7 %). The mean recipient age was 41.7 ± 19.9 years with over a half of the patients between 15 to 49 years of age. More men (64.1 %) underwent keratoplasty than women (35.8 %). 59.8 % of the eyes with infectious keratitis had a perforated corneal ulcer. 49.7 % of corneal opacities were due to previous infectious keratitis. 72 % of regrafts were for endothelial failure of various causes. In older patients (> 50 years), bullous keratopathy was an important indication, after infectious keratitis. Keratoconus and corneal scar were major causes of keratoplasty in children of 14 years or less. Four percent of the patients had keratoplasty in both the eyes. 17.1 % of the patients who had one eye operated on had a blind fellow eye with a vision of less than 3/60. Conclusion: Currently, keratitis, either active or healed, is the major indication for keratoplasty, suggesting that improved primary eye health care is necessary to decrease the prevalence of corneal blindness. Nepal J Ophthalmol 2013; 5(10): 207-214 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8730

Download Full-text

Corneal Dystrophy in Dutch Belted Rabbits as a Possible Model of Thiel-Behnke Subtype of Epithelial-Stromal TGFβ-Induced Corneal Dystrophy

Toxicologic Pathology ◽

10.1177/0192623320968092 ◽

2020 ◽

pp. 019262332096809

Author(s):

JoAnn C. L. Schuh ◽

Dana L. Holve ◽

Karen E. Mundwiler

Keyword(s):

Transforming Growth Factor ◽

Transforming Growth Factor Β ◽

Corneal Opacity ◽

Corneal Dystrophy ◽

International Committee ◽

Corneal Dystrophies ◽

Transmission Electron ◽

Oct Imaging ◽

Small Clusters

The International Committee for Classification of Corneal Dystrophies (IC3D) categorized corneal dystrophies in humans using anatomic, genotypic, and clinicopathologic phenotypic features. Relative to the IC3D classification, a review of the veterinary literature confirmed that corneal dystrophy is imprecisely applied to any corneal opacity and to multiple poorly characterized histologic abnormalities of the cornea in animals. True corneal dystrophy occurs in mice with targeted mutations and spontaneously in pet dogs and cats and in Dutch belted (DB) rabbits, but these instances lack complete phenotyping or genotyping. Corneal dystrophy in DB rabbits can be an important confounding finding in ocular toxicology studies but has only been described once. Therefore, the ophthalmology and pathology of corneal dystrophy in 13 DB rabbits were characterized to determine whether the findings were consistent with or a possible model of any corneal dystrophy subtypes in humans. Slit lamp and optical coherence tomography (OCT) imaging were used to characterize corneal dystrophy over 4 months in young DB rabbits. The hyperechoic OCT changes correlated with light microscopic findings in the anterior stroma, consisting of highly disordered collagen fibers and enlarged keratocytes. Histochemical stains did not reveal abnormal deposits. Small clusters of 8 to 16 nm diameter curly fibers identified by transmission electron microscopy were consistent with Thiel-Behnke (TBCD) subtype of epithelial-stromal transforming growth factor β-induced dystrophies. Sporadic corneal dystrophy in DB rabbits appears to be a potential animal model of TBCD, but genotypic characterization will be required to confirm this categorization.

Download Full-text

Population-based assessment of visual impairment and pattern of corneal disease: results from the CORE (Corneal Opacity Rural Epidemiological) study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314720 ◽

2019 ◽

Vol 104 (7) ◽

pp. 994-998

Author(s):

Ritika Mukhija ◽

Noopur Gupta ◽

Praveen Vashist ◽

Radhika Tandon ◽

Sanjeev K Gupta

Keyword(s):

General Population ◽

Visual Impairment ◽

Epidemiological Study ◽

Age Groups ◽

Corneal Opacity ◽

Population Based ◽

Cross Sectional ◽

Population Based Study ◽

Corneal Disease ◽

Corneal Opacities

ObjectiveTo characterise types of corneal diseases and resulting visual impairment (VI) in a rural North Indian population.DesignCross-sectional, population-based study.MethodsThe Corneal Opacity Rural Epidemiological study included 12 899 participants from 25 random clusters of rural Gurgaon, Haryana, India to determine the prevalence of the corneal disease in the general population. Sociodemographic details, presence and type of corneal morbidity, laterality, VI (presenting visual acuity (PVA) <6/18 in the better eye) and characteristics of corneal opacities were noted.ResultsOverall, 12 113 participants of all ages underwent detailed ophthalmic examination and prevalence of corneal opacity was found to be 3.7% (n=452) with bilateral involvement in 140 participants (31%) during the house-to-house visits. Of the total 571 eyes of 435 patients presenting with corneal opacity at the central clinic, PVA was <3/60 in 166 (29.1%), 3/60 to <6/60 in 14 (2.5%), 6/60 to <6/18 in 164 (28.7%), 6/18 to ≤6/12 in 85 (14.9%) and 6/9 to 6/6 in 142 eyes (24.9%), respectively. Further, there were a total of 115 eyes (20.1%) with nebular corneal opacity, 263 (46.1%) with macular, 162 (28.4%) with leucomatous and 31 (5.4%) with an adherent leucoma. The odds of having VI due to corneal disease were greater for the illiterate (OR:4.26; 95% CI: 2.88 to 6.31; p<0.001) and elderly (OR:11.05; 95% CI: 7.76 to 15.74; p<0.001).ConclusionThe data from this study give an insight into the characteristics of various corneal pathologies and resulting VI in the general population. This is a pioneer study involving all age groups on the burden of VI due to corneal diseases.

Download Full-text

Use of Fourier-Domain Optical Coherence Tomography to Evaluate Anterior Stromal Opacities in Donor Corneas

Journal of Ophthalmology ◽

10.1155/2013/397680 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Matthew R. Bald ◽

Christopher Stoeger ◽

Joshua Galloway ◽

Maolong Tang ◽

Jeffrey Holiman ◽

...

Keyword(s):

Optical Coherence Tomography ◽

High Resolution ◽

Corneal Opacity ◽

Fourier Domain ◽

Optical Coherence ◽

Slit Lamp ◽

Eye Bank ◽

Slit Lamp Examination ◽

Corneal Opacities ◽

Donor Corneas

Purpose. To evaluate Fourier-domain optical coherence tomography (FD-OCT) as an adjunct to traditional slit lamp examination of donor corneas with suspected Anterior Stromal Opacities.Methods. Seven corneas suspected of having anterior stromal opacities by slit lamp examination were evaluated with FD-OCT. Each cornea was evaluated to confirm the presence of opacity and, if present, the depth of opacity was measured.Results. The opacity depth ranged from 82 μm to 624 μm. The initial slit lamp impressions of five of the seven corneas were confirmed by OCT. In two corneas, the OCT findings were different from the initial slit lamp impressions. Slit lamp examination of the first cornea gave the impression of anterior stromal scarring, but OCT showed that the opacity was limited to the epithelium. Slit lamp examination of the second cornea suggested opacity limited to the epithelium, but OCT identified significant sub-Bowman's scarring. In all cases, the Eye Bank Technicians reported that the location and depth of corneal opacity were more sharply defined by OCT than by slit lamp.Conclusion. The high resolution of OCT makes it easier to determine the location of corneal opacities compared to slit lamp examinations. This enhanced visualization can improve decisions regarding transplant suitability of donor corneas.

Download Full-text

Case Report of Myopia Correction by ReLEx SMILE in a Patient with Superficial Corneal Opacity

Ophthalmology in Russia ◽

10.18008/1816-5095-2020-2-295-299 ◽

2020 ◽

Vol 17 (2) ◽

pp. 295-299

Author(s):

N. V. Maychuk ◽

I. A. Mushkova ◽

A. M. Mayorova ◽

A. A. Shpak

Keyword(s):

Visual Acuity ◽

Case Report ◽

Anterior Segment ◽

Corneal Opacity ◽

Optical Center ◽

Interface Zone ◽

Uncorrected Visual Acuity ◽

Corneal Opacities ◽

Different Depths ◽

The Right

Introduction. Reduced corneal transparency leads to dissipation of energy of the femtosecond laser (FSL), which may complicate the formation of the intrastromal incision and limits the use of FSL in eyes with corneal opacities and scars. The purpose of this work is to demonstrate the possibility of successful ReLEx SMILE in a patient with superficial corneal opacity located in the paracentral zone. Case report. Patient R., 29 years old, complained of decreased vision in both eyes since childhood. Visual acuity OD = 0.1 sph –2.75D = 1.0; OS = 0.1 sph –3.50 D cyl –0.75D ax 165° = 1.0. Biomicroscopy of the right eye visualized a superficial semi-transparent corneal opacity of 5 x 3 mm located at 5.30–6 hours at a distance of 1.3 mm from the optical center. According to the anterior segment optical coherence tomography (AS-OCT) the depth of the opacity was 73–78 microns and was limited by the Bowman’s membrane. ReLEx SMILE for myopia correction was performed on both eyes with 6.7 mm lenticule diameter at a depth of 120 µm, which covered the opacity area by 1.1 mm. The surgery was standard and uncomplicated. Seven days postoperatively the patient did not complain. Uncorrected visual acuity (UCVA) was 1.0 for both eyes (and binocularly it was 1.2). According to the AS-OCT data, a hyperreflective line of the interface zone was visualized on the right eye at the depth of 141–147 µm; the opacified superficial corneal layers were detected in the lower paracental zone over the interface line. In one month after the surgery the visual acuity did not change: UCVA = 1.0 in both eyes (binocularly 1.2). Conclusion. ReLEx SMILE technology can be considered as one of the options for myopia correction in patients with superficial corneal opacity located in the paracental zone. More observations are required to evaluate the effectiveness of this technology on corneas with paracentral opacities different in sizes and located at different depths.

Download Full-text

Changes in Patient Visits and Diagnoses seen in an Academic Ophthalmology Department during the COVID-19 pandemic

10.21203/rs.3.rs-51869/v2 ◽

2020 ◽

Author(s):

Meghan K Berkenstock ◽

Paulina Liberman ◽

Peter J McDonnell ◽

Benjamin C Chaon

Keyword(s):

Practice Patterns ◽

Low Vision ◽

The United States ◽

Viral Transmission ◽

Pediatric Ophthalmology ◽

Face To Face ◽

Diagnostic Codes ◽

Before And After ◽

Icd 10 ◽

The Impact

Abstract BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face to face encounters to only patients with urgent and emergent ophthalmic conditions, in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the six weeks before and after the changes in clinical practice associated with COVID-19.RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

Download Full-text

Slit-beam retro-illumination assisted phacoemulsification for cataract with coexisting corneal opacity

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v12i1.22039 ◽

2020 ◽

Vol 12 (1) ◽

pp. 153-157

Author(s):

Rakhi Kusumesh ◽

Bibhuti Prassan Sinha ◽

Anita Ambastha ◽

Gyan Bhasker ◽

Nilesh Mohan

Keyword(s):

Surgical Technique ◽

Cataract Surgery ◽

Corneal Opacity ◽

Corneal Opacities

Introduction: We describe a novel surgical technique of slit-beam retro-illumination assisted phacoemulsification for cataract with coexisting corneal opacity. Cases: We present two cases with cataract and coexisting opacity, who underwent slitbeam retro-illumination assisted phacoemulsification and further application of same process in 12 patients. Conclusion: This technique is safe and provides excellent visualization during cataract surgery in patients with corneal opacities.

Download Full-text