Baker Dara R, Misra Dilip Kumar, Achanta Divya Sree Ramya, Edward Deepak Paul, Ramappa Muralidhar
Department of Ophthalmology and Visual Sciences and Pathology, University of Illinois College of Medicine, Chicago, IL, USA.
Ophthalmic Pathology Lab, L V Prasad Eye Institute, Hyderabad, India.
Int Ophthalmol. 2025 Aug 12;45(1):331. doi: 10.1007/s10792-025-03703-2.
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.
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.
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.
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.
描述印度一大群患有与维生素A缺乏（VAD）相关眼前节病变的儿童的临床和组织学表现谱。本研究展示了接受穿透性角膜移植术（PK）的VAD患儿的临床发现，并检查了角膜植片的组织学特征。
这项回顾性研究确定了在印度一家三级眼科护理中心接受穿透性角膜移植术的VAD患儿。该研究分析了人口统计学、诱发因素以及角膜的临床和病理表现。
从机构数据库中识别出21名（中位年龄2.78岁）有记录的VAD患儿的41只眼睛。临床上，41只眼睛中有25只（60%）出现角膜混浊和粘连性角膜白斑，7只眼睛（16.7%）发生角膜穿孔或浸润伴前房浅和虹膜脱出，5只眼睛（12%）表现为前葡萄肿，3只眼睛（7.1%）眼球痨，1只眼睛（2.4%）有假角膜。组织学上，22只接受PK的角膜中有15只（100%）显示严重的基质瘢痕形成和新生血管，2例（13.3%）观察到表面角化，2例（13.3%）有局灶性上皮向下生长，1例（6.7%）有上皮增生，1例（6.7%）有带状角膜病变。中位随访0.35年（四分位间距0.09 - 2.5），22只眼睛中有12只（54%）植片透明。
这些发现表明，在三级眼科机构接受角膜移植术的VAD患儿表现出长期、严重且不可逆的角膜损伤的临床和组织学迹象。针对VAD相关疾病的角膜手术通常长期效果不佳。
