TY - JOUR
T1 - Salzmann nodular degeneration
T2 - Prevalence, impact, and management strategies
AU - Paranjpe, Vikram
AU - Galor, Anat
AU - Monsalve, Pedro
AU - Dubovy, Sander R.
AU - Karp, Carol L.
N1 - Funding Information:
This study was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research EPID-006-15S (Dr. Galor), R01EY026174 (Dr. Galor), NIH Center Core Grant P30EY014801 and Research to Prevent Blindness Unrestricted Grant. This study was also supported by the Dr. Ronald and Alicia Lepke Grant, the Lee and Claire Hager Grant, the H. Scott Huizenga Grant, the Grant and Diana Stanton-Thornbrough, the Robert Baer Family Grant, the Emilyn Page and Mark Feldberg Grant, the Jose Ferreira de Melo Grant, the Richard and Kathy Lesser Grant, the Ted and Michele Kaplan Grant and the Richard Azar Family Grant (institutional grants).
PY - 2019
Y1 - 2019
N2 - Purpose: This review will summarize the clinical and histological presentation of Salzmann nodular degeneration (SND), its prevalence and risk factors, potential underlying mechanisms, diagnostic tools, management options, and impact on cataract surgery and co-morbid ocular surface diseases. Method: PubMed review of 44 articles published between 1976 and 2018. Results: SND is a corneal disease characterized by whitish gray or bluish nodules on the peripheral or central cornea. The clinical presentation of SND is variable and the nodules can be asymptomatic or cause foreign body sensation and/or blurred vision. Histologically, SND appears as subepithelial nodules with thin overlying epithelium, disrupted or absent Bowman’s layer, and activated fibroblasts within the nodule. SND pathogenesis is not fully understood but is thought to involve poor epithelial protection and disruption of the epithe-lial–stromal interface, allowing for penetration of epithelially derived growth factors into the stroma and subsequent activation of stromal fibroblasts, eventually leading to sub-epithelial deposition of disorganized extracellular membrane components. SND most commonly occurs in Caucasian females in a bimodal distribution, occurring in the fifth or eighth and ninth decades of life. Risk factors for SND include ocular surface diseases and surgery. Surgical intervention is recommended in individuals with symptomatic nodules – primarily superficial keratectomy performed with or without intraoperative mitomycin C, photokera-tectomy, and/or amniotic membrane transplantation. These procedures have been successful in removing the lesion and reducing corneal irregularity, but have variable recurrence rates (0–31%). Conclusion: The pathogenesis of SND is complex and multifactorial. Advances in diagnostic and treatment modalities have allowed for earlier and more accurate diagnosis and effective treatment of SND.
AB - Purpose: This review will summarize the clinical and histological presentation of Salzmann nodular degeneration (SND), its prevalence and risk factors, potential underlying mechanisms, diagnostic tools, management options, and impact on cataract surgery and co-morbid ocular surface diseases. Method: PubMed review of 44 articles published between 1976 and 2018. Results: SND is a corneal disease characterized by whitish gray or bluish nodules on the peripheral or central cornea. The clinical presentation of SND is variable and the nodules can be asymptomatic or cause foreign body sensation and/or blurred vision. Histologically, SND appears as subepithelial nodules with thin overlying epithelium, disrupted or absent Bowman’s layer, and activated fibroblasts within the nodule. SND pathogenesis is not fully understood but is thought to involve poor epithelial protection and disruption of the epithe-lial–stromal interface, allowing for penetration of epithelially derived growth factors into the stroma and subsequent activation of stromal fibroblasts, eventually leading to sub-epithelial deposition of disorganized extracellular membrane components. SND most commonly occurs in Caucasian females in a bimodal distribution, occurring in the fifth or eighth and ninth decades of life. Risk factors for SND include ocular surface diseases and surgery. Surgical intervention is recommended in individuals with symptomatic nodules – primarily superficial keratectomy performed with or without intraoperative mitomycin C, photokera-tectomy, and/or amniotic membrane transplantation. These procedures have been successful in removing the lesion and reducing corneal irregularity, but have variable recurrence rates (0–31%). Conclusion: The pathogenesis of SND is complex and multifactorial. Advances in diagnostic and treatment modalities have allowed for earlier and more accurate diagnosis and effective treatment of SND.
KW - Cornea
KW - Diagnosis
KW - Imaging
KW - Salzmann nodular degeneration
KW - Treatment
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U2 - 10.2147/OPTH.S166280
DO - 10.2147/OPTH.S166280
M3 - Review article
AN - SCOPUS:85073397359
VL - 13
SP - 1305
EP - 1314
JO - Clinical Ophthalmology
JF - Clinical Ophthalmology
SN - 1177-5467
ER -