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

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.