|Year : 1984 | Volume
| Issue : 5 | Page : 378-381
Study of elastotic degeneration of the cornea
IS Jain, Jagat Ram, Sandeep Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
I S Jain
Department of Ophthalmology. Postgraduate Institute of Medical Education and Research, Chandigarh-160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jain I S, Ram J, Jain S. Study of elastotic degeneration of the cornea. Indian J Ophthalmol 1984;32:378-81
The term elastotic degeneration of the cornealo covers a variety of clinical entities variably described as nodular band shaped keratopathy, Labrador keratopathy, keratinoid degeneration. spheroidal degeneration, chronic actinic keratopathy and climatic droplet keratopathy., This keratopathy showed similar hyaline deposits on histopathology., Cases of corneal elastosis have also been reported in association with lattice dystrophy. Fuch's endothelial dystrophy and with other intra ocular diseases.
This study presents clinical and histopathological characteristics of elastotic degeneration of the cornea as seen in this part of the country.
| Material and methods|| |
105 patients who were diagnosed as climatic droplet keratopathy or nodular band shaped keratopathy in the cornea clinic over a period of 10 years were reviewed in retrospect. The records were scanned for any information regarding age, sex, locality and degree of corneal lesion and for any ocular disease association. Biomicroscopy examination was performed in every case. Singh's criteria were used to classify the corneal lesions.
Histopathology of 36 keratectomy specimens obtained from patients undergoing corneal grafting reported as elastotic degeneration of cornea were reviewed fot clinical picture.Of36 keratectomy specimens, 34 were lameblar and 2 penetrating. Histopathological characteristics were noted in each specimen. The sections of keratectomy specimens were stained with haematoxylin, Verhoeffs Van Gieson, PAS, Congo-red, Alizarin red and Von Kossa Stains. Detailed examination and final visual status was recorded in 36 patients at the end of follow up.
| Observations|| |
Clinical study: There were 61 males and 44 females. Patient's age varied from 25 years to 90 years. 55% of patients were in the 5th and 6th decades. Distribution of patients in various age groups is shown in [Table - 1]. 88% of patients belonged to the rural areas. Corneal elastosis was bilateral in 98 patients (93.3%) and unilateral in 7 patients (6.7%). The grade of corneal involvement is shown in [Table - 2]. 83% of the patients had grade III to grade IV corneal lesions [Figure - 1][Figure - 2]. The corneal lesion associated were Fuch's endothelial dystrophy in 9 patients, herpetic corneal opacity in 2 eyes and keratoconus in 2 patients.
Histopathological study: 36 corneal buttons removed at the time of corneal grafting were studied histopathologically. The clinical diagnosis in these eyes was climatic droplet keratopathy 22(61.2%), band shaped keratopathy 10(2'Y.7%), 7%), herpetic corneal . scars 2(5.6%) and Salzman nodular degeneration with trachoma grade N 2(5.6%). Two specimens each showed histopathological characteristics of lattice corneal dystrophy and calcific degeneration in addition to elastotic degeneration. The epithelium was irregular in thickness in 32(88.8%) specimens. It showed attenuation in 28(77.7%) and hyperplastic foci in 4(11.2%). There were areas of intra cellular oedema of the basal layer of the epithelium in 5(13.9%). Intra epithelial hyaline deposits were seen in 2(5.6%) [Figure - 3]. The Bowman's membrane was absent or focally destroyed in 28(77.7%) and fibrotic in 6(14%). Elastotic deposits were seen only in 4(11.2%) in the Bowmans membrane [Figure - 4]: The= superficial stroma showed elastotic deposits [Figure - 5] in 34(96.1%) of corneal buttons.
The visual acuity in 36 eyes before corneal grafting was 6/60 or less. Final visual outcome at the last visit is shown in [Table - 3]. 19(52.8%) eyes had 6/12 or better vision whereas 12 eyes (33.3%) had 6/24 to 6/18. 20(55.5%) eyes showed senile cataractous changes of variable severity. Poor visual outcome in 5(13.9%) eyes was mainly due to advanced cataractous changes.
| Discussion|| |
In this study of elastotic degeneration of the cornea 93.3% of the patients showed bilateral corneal involvement Of these 88% were from rural areas. These rural people are exposed to excessive sunlight. Excessive exposure to climatic extremes especially sunlight is known to predispose to corneal degeneration.,, Majority of the keratectomy specimens which were subjected to histopathology had stromal involvement with elastotic deposits. It is difficult to comment on the exact site of origin of these deposits. It is believed that elastotic degeneration possibly starts in the stroma.,, Bowmans membrane and epithelium may be affected secondarily. Majority of specimens in our study had also shown alteration of overlying epithelium and focal destruction or absence of Bowmans membrane. But elastotic deposits in the Bowmans membrane and epithelium are uncommon. Association of elastotic degeneration with Fuch's endothelial dystrophy, lattice corneal dystrophy, herpetic corneal scar may be incidental or secondary to primary process.
As a preventive measure we suggest sun shades and sun glasses to people who are exposed to excessive sunlight. We have found good visual outcome in patients where corneal grafting was done inspite of senile cataractous changes in the majority. This study shows that -sub lamellar corneal grafting [Figure - 6] gives good visual results in grade III and grade IV corneal elastosis.
| Summary|| |
105 patients of elastotic corneal degeneration seen in the corneal clinic over a period of 10 years were reviewed. There were 61 males and 44 females. Age varied from 30th to 85 years. 88% of patients were rural. Elastotic degeneration were divided into 4 groups, grade I, 8%, grade II; 9%, grade III, 53%. grade IV, 30%. Corneal diseases associated were Fuch's endothelial dystrophy 9 cases, lattice dystrophy 2 cases. Herpetic keratitis 2 cases. Histopathology report of 36 corneal buttons showed elastotic - deposits, in stroma in 34 (96.1%). Good visual result was obtained in majority of cases in spite of senile cataractous changes after lamellar corneal grafting.
| Acknowledgements|| |
We gratefully acknowledge the reporting on the histopathological findings by the Director, AFIP, Washington DC, -U.S.A.
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]
[Table - 1], [Table - 2], [Table - 3]