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. 2025 Aug 12;45(1):331.
doi: 10.1007/s10792-025-03703-2.

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

Dara R Baker  1 , Dilip Kumar Misra  2 , Divya Sree Ramya Achanta  3 , Deepak Paul Edward  1   4 , Muralidhar Ramappa  5   6
Affiliations

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

Dara R Baker et al. Int Ophthalmol. .

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.

Keywords: Cornea; Histology; Pathology; Vitamin A deficiency.

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Conflict of interest statement

Declarations. Competing interest: The authors declare no competing interests.

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