Clinical and histologic characterization of vitamin A deficiency in children undergoing penetrating keratoplasty.

IF 1.4 4区医学 Q3 OPHTHALMOLOGY

International Ophthalmology Pub Date : 2025-08-12 DOI:10.1007/s10792-025-03703-2

Dara R Baker, Dilip Kumar Misra, Divya Sree Ramya Achanta, Deepak Paul Edward, Muralidhar Ramappa

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Abstract

Purpose: To characterize the spectrum of clinical and histologic findings in a large cohort of children in India with anterior segment findings associated with vitamin A deficiency (VAD). This study presents the clinical findings of children with VAD who underwent penetrating keratoplasty (PK) and examines the histological features of corneal buttons.

Methods: This retrospective review identified children with VAD who underwent penetrating keratoplasty at a tertiary eye care center in India. The study analyzed demographics, inciting factors, and clinical and pathological corneal findings.

Results: A total of 41 eyes from 21 children (median age 2.78 years) with documented VAD were identified from an institutional database. Clinically, 25 out of 41 eyes (60%) presented with corneal opacity and adherent leucoma, 7 eyes (16.7%) had corneal perforation or infiltrate with shallow anterior chamber and iris prolapse, 5 eyes (12%) showed anterior staphyloma, 3 eyes (7.1%) were phthisical, and 1 eye (2.4%) had a pseudo-cornea. Histologically, 15 out of 22 corneas that underwent PK displayed severe stromal scarring and neovascularization (100%), with surface keratinization observed in 2 cases (13.3%), focal epithelial down growth in 2 cases (13.3%), epithelial hyperplasia in 1 case (6.7%), and band keratopathy in 1 case (6.7%). At a median follow-up of 0.35 years (IQR 0.09-2.5), 12 of 22 eyes (54%) had a clear graft.

Conclusions: These findings indicate that children with VAD who underwent keratoplasty at a tertiary eye institute showed clinical and histologic signs of long-standing, severe, and irreversible corneal damage. Corneal surgery for VAD-related morbidity generally had poor long-term outcomes.

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儿童穿透性角膜移植术中维生素A缺乏的临床和组织学特征。

目的：描述印度一大批儿童前段与维生素a缺乏症（VAD）相关的临床和组织学表现。本研究报告了VAD患儿行穿透性角膜移植术（PK）的临床表现，并检查了角膜按钮的组织学特征。方法：本回顾性研究确定了在印度三级眼科保健中心接受穿透性角膜移植术的VAD儿童。该研究分析了人口统计学、刺激因素以及临床和病理角膜发现。结果：从一个机构数据库中确定了21名患有VAD的儿童（中位年龄2.78岁）的41只眼睛。临床41眼中有25眼（60%）出现角膜混浊伴贴附性白眼，7眼（16.7%）出现角膜穿孔或浸润伴浅前房及虹膜脱垂，5眼（12%）出现前葡萄肿，3眼（7.1%）出现溃疡，1眼（2.4%）出现假性角膜。组织学上，22例接受PK的角膜中有15例（100%）表现出严重的间质瘢痕和新生血管形成，其中2例（13.3%）观察到表面角化，2例（13.3%）观察到局灶性上皮向下生长，1例（6.7%）观察到上皮增生，1例（6.7%）观察到带状角膜病变。中位随访0.35年（IQR为0.09-2.5），22只眼中有12只（54%）有清晰的移植物。结论：这些研究结果表明，在三级眼科研究所接受角膜移植术的VAD儿童表现出长期、严重和不可逆的角膜损伤的临床和组织学迹象。角膜手术治疗vad相关疾病的长期预后通常较差。

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来源期刊

International Ophthalmology OPHTHALMOLOGY-

CiteScore

3.20

自引率

0.00%

发文量

451

期刊介绍： International Ophthalmology provides the clinician with articles on all the relevant subspecialties of ophthalmology, with a broad international scope. The emphasis is on presentation of the latest clinical research in the field. In addition, the journal includes regular sections devoted to new developments in technologies, products, and techniques.