PMID- 31686959
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220411
IS  - 1319-4534 (Print)
IS  - 2542-6680 (Electronic)
IS  - 1319-4534 (Linking)
VI  - 33
IP  - 3
DP  - 2019 Jul-Sep
TI  - Successful Treatment of Corneal Opacification with Associated Thickened 
      Epithelium by Simple Peeling: Acquired Corneal Subepithelial Hypertrophy (ACSH).
PG  - 203-208
LID - 10.1016/j.sjopt.2019.02.002 [doi]
AB  - PURPOSE: To study clinical and histopathological findings of corneal 
      opacification caused by thickened epithelium leading to reduced vision and 
      topographical changes and to evaluate the outcome of its removal. METHODS: Twelve 
      patients (17 eyes) with central, paracentral or peripheral corneal opacification 
      were reviewed to obtain their visual acuity, describe their slit lamp (SL) 
      appearance (depth, extent and density) and document their topographic changes 
      before and after peeling of the epithelium under SL or surgical removal under the 
      microscope. Specimens of six cases were available for histopathological 
      examination and immunohistochemical staining. RESULTS: Most of the eye 
      opacifications were secondary to corneal procedures in 10 [Penetrating 
      keratoplasty (PKP) in 7 for congenital glaucoma, keratoconus or adherent leukoma 
      - usually over graft-host junction -, Photorefractive keratectomy (PRK) in 2 and 
      Phototherapeutic keratectomy in one], chronic inflammation following trachoma or 
      non-specific causes (3), and herpetic scar (1). Three cases were considered to be 
      idiopathic. All cases presented with decreased vision, astigmatism or changes in 
      topography or refraction. Their vision, clinical symptoms and topography improved 
      after treatment. Histopathologically, all six cases shared findings that are 
      similar to what have been described as peripheral hypertrophic subepithelial 
      corneal degeneration (PHSCD) rather than Salzmann's nodular degeneration. None of 
      the cases showed inflammation or subepithelial pannus formation in the excised 
      tissue. However, our cases did not fit into the diagnosis of PHSCD because of the 
      location of the corneal opacification (being peripheral in 41% of the corneas, 
      the presence of underlying primary etiologic factors in 82% of the eyes and the 
      bilateral occurrence in 5 patients. CONCLUSIONS: Meticulous SL examination aided 
      by corneal imaging may accurately diagnose and determine the depth of corneal 
      opacification as a cause for reduced vision. Histopathologically, the removed 
      tissue is similar to PHSCD, but cases differ in their clinical profile. Peeling 
      the thickened epithelial/subepithelial tissue is curative in most patients, 
      improves visual and clinical outcome and avoids unnecessary corneal grafting.
CI  - (c) 2019 Production and hosting by Elsevier B.V. on behalf of Saudi 
      Ophthalmological Society, King Saud University.
FAU - Al-Rajhi, A A
AU  - Al-Rajhi AA
AD  - Ophthalmology Resident, PSMMC, Riyadh, Saudi Arabia.
FAU - Helmi, H A
AU  - Helmi HA
AD  - Alfaisal University, Riyadh, Saudi Arabia.
FAU - Alkatan, H M
AU  - Alkatan HM
AD  - Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, 
      Saudi Arabia.
AD  - Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi 
      Arabia.
FAU - Al-Obailan, M
AU  - Al-Obailan M
AD  - Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, 
      Saudi Arabia.
FAU - Al-Rajhi, A
AU  - Al-Rajhi A
AD  - Specialized Experts Center, Riyadh, Saudi Arabia.
AD  - College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
LA  - eng
PT  - Journal Article
DEP - 20190213
PL  - India
TA  - Saudi J Ophthalmol
JT  - Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological 
      Society
JID - 9425601
PMC - PMC6819717
OTO - NOTNLM
OT  - Peripheral hypertrophic subepithelial corneal degeneration
OT  - Peripheral hypertrophic subepithelial corneal opacification
OT  - Salzmann's nodular degeneration
EDAT- 2019/11/07 06:00
MHDA- 2019/11/07 06:01
PMCR- 2019/02/13
CRDT- 2019/11/06 06:00
PHST- 2019/01/30 00:00 [received]
PHST- 2019/02/10 00:00 [accepted]
PHST- 2019/11/06 06:00 [entrez]
PHST- 2019/11/07 06:00 [pubmed]
PHST- 2019/11/07 06:01 [medline]
PHST- 2019/02/13 00:00 [pmc-release]
AID - S1319-4534(19)30005-0 [pii]
AID - 10.1016/j.sjopt.2019.02.002 [doi]
PST - ppublish
SO  - Saudi J Ophthalmol. 2019 Jul-Sep;33(3):203-208. doi: 10.1016/j.sjopt.2019.02.002. 
      Epub 2019 Feb 13.