Prevalencia de pacientes con queratocono en la Clínica Barraquer en Bogotá, Colombia / Prevalence of keratoconus patients at the Barraquer Clinic in Bogotá, Colombia

Introducción: Queratocono es un término clínico amplio, que describe un estado de la córnea derivado de su adelgazamiento focal y protrusión secundaria central, paracentral y/o periférica. Los reportes epidemiológicos globales revelan un amplio rango en cifras de prevalencia e incidencia que se podría explicar por las diferencias geográficas, factores de riesgo, tipo de población, métodos y criterios diagnósticos utilizados. En Colombia no hay estudios epidemiológicos que evalúen esta enfermedad de manera integral por lo que su frecuencia aún no ha podido ser determinada. Objetivo: identificar la prevalencia de Queratocono y Degeneración Marginal Pelucida (DMP) en el centro oftalmológico privado Clínica Barraquer, durante el periodo de tiempo comprendido entre enero de 2014 y enero de 2019. Diseño del estudio: estudio transversal de fuentes secundarias. Método: revisión de los registros médicos electrónicos de todos los pacientes que consultaron por primera vez; posteriormente, se filtraron por el diagnóstico de Ectasia Corneal y/o Queratocono. Cada una de las historias clínicas fue analizada por un oftalmólogo teniendo en cuenta los diagnósticos preestablecidos. Resultados: del grupo de 91.426 pacientes, 2.647 tenían Queratocono o DMP. Se estableció una prevalencia de Queratocono y DMP del 2.84%. La edad promedio al momento del diagnóstico fue de 29.7±12 años. El 42.8% eran mujeres y el 57.2% hombres. Conclusión: la ectasias corneales de tipo Queratocono y DMP, son enfermedades con una prevalencia significativa en la población colombiana evaluada en la clínica Barraquer; consideramos se requiere de programas de tamizaje visual para su detección y tratamiento oportunos.

Background: Keratoconus is a wide clinical term used to describe a corneal disease characterized by thinning and secondary central, paracentral or peripheral protrusion of the cornea. The global epidemiological reports reveal a wide range of prevalence and incidence, that may be explained by geographical differences, risk factors, kind of population, and methods and diagnostic criteria employed. There are no epidemiological studies to evaluate globally this disease in Colombia, therefore, its frequency has not been determined yet. Objective: to identify the prevalence of Keratoconus and Pellucid Marginal Degeneration (PMD) from January 2014 to January 2019 at the private ophthalmological center Clínica Barraquer. Study Design: cross-sectional study using secondary data. Method: a review of the electronic medical records of all patients who consulted for the first time was performed, and then, filtered by the initial diagnosis of Corneal Ectasia or Keratoconus. Each one of the medical records was analyzed by an ophthalmologist taking into account a series of pre-established diagnostic criteria. Results: of 91.426 patients, 2.647 had Keratoconus or PMD within the time interval of the study. A prevalence of 2.84% was determined in first time patients. The average age at the time of diagnosis was 29.7±12 years. 42.8% were female patients and 57.2% male patients. Conclusion: Keratoconus and PMD are diseases with significant prevalence in the Colombian population evaluated at the Barraquer clinic, thus, visual screening programs are required for accurate detection and treatment.

Corneal perforation during scleral indentation in a patient with pellucid marginal degeneration.

An observational case report of corneal perforation following scleral indentation in a patient with previously undiagnosed pellucid marginal degeneration is presented. Clinical examination, investigations, and subsequent management of this unwarranted and rare complication are described and discussed. The case highlights the need for thorough anterior segment examination before indirect ophthalmoscopy particularly in the presence of ectatic corneal pathology in which case scleral indentation should be avoided.

Collagen cross-linking in the treatment of pellucid marginal degeneration.

Pellucid marginal degeneration (PMD) is an uncommon cause of inferior peripheral corneal thinning disorder, characterized by irregular astigmatism. We analyzed a case of bilateral PMD patient and treated one eye with corneal collagen cross-linking (CXL) therapy. Corneal topography was characteristic for PMD. Visual acuity, slitlamp examinations, tonometry, and corneal thickness were observed. Simulated keratometric and topographic index values were detected with corneal topography. Uncorrected, LogMAR visual acuity has improved from +0.8 to +0.55 during the 6 months and +0.3 during the 8 months followup after CXL. Pachymetry values and intraocular pressure showed no changes. Keratometric values and topografic indexes disclosed no progression of the disease. CXL may postpone or eliminate the need of corneal transplantation in cases with PMD.

A Case of Unilateral Pellucid Marginal Corneal Degeneration Diagnosed by Computerized Topography

Pellucid marginal degeneration is a noninflammatory peripheral corneal thining disorder, which progresses slowly, affects inferior cornea bilaterally, occurs usually between twenties and fifties. Protrusion of the cornea with normal corneral thickness occurs above a band of thinning which is located 1 to 2mm from the limbus and measures 1 to 2mm in width and the patient complaints of progressive visual disturbance due to high irregular astigmatism. Topographically, the lowest corneal power is located along a narrow corridor of the central and peracental cornea and corneal power is highest along the inferior peripheral cornea and in the mid-peripheral cornea along the inferior oblique corneal meridian in a band-like fashion and is decreased slowly superior to that meridian. We experienced a case of pellucid marginal degeneration who had a history of progressive visual loss due to high irregular astigmatism. A 67 year-old woman had the characteristic topographic pattern and clinical feature of pellucid marginal degeneration only in her righ eye and we report it as the first case of unilateral pellucid marginal degeneration in Korea.

A Case of Unilateral Pellucid Marginal Corneal Degeneration Diagnosed by Computerized Topography

Pellucid marginal degeneration is a noninflammatory peripheral corneal thining disorder, which progresses slowly, affects inferior cornea bilaterally, occurs usually between twenties and fifties. Protrusion of the cornea with normal corneral thickness occurs above a band of thinning which is located 1 to 2mm from the limbus and measures 1 to 2mm in width and the patient complaints of progressive visual disturbance due to high irregular astigmatism. Topographically, the lowest corneal power is located along a narrow corridor of the central and peracental cornea and corneal power is highest along the inferior peripheral cornea and in the mid-peripheral cornea along the inferior oblique corneal meridian in a band-like fashion and is decreased slowly superior to that meridian. We experienced a case of pellucid marginal degeneration who had a history of progressive visual loss due to high irregular astigmatism. A 67 year-old woman had the characteristic topographic pattern and clinical feature of pellucid marginal degeneration only in her righ eye and we report it as the first case of unilateral pellucid marginal degeneration in Korea.

Two Cases of Pellucid Marginal Corneal Degeneration

Pellucid marginal degeneration is an uncommon, idiopathic, non-inflammatory, peripheral thinning disorder affecting the inferior cornea bilaterally. Protrusion of the cornea occurs above a band of thinning which is located 1 to 2mm from the limbus and measures 1 to 2mm in width. The disease is diagnosed usually between 20 and 50 years of age and its etiology remains obscure. We experienced two cases of pellucid marginal degeneration who had a histories of progressIve visual disturbance due to high irregular astigmatism. A 32 year old female(case.1) had the characteristic feature of pellucid marginal corneal degeneration with marked endothelial cell loss(OD. 624 +/- 32 cells/mm2, OS. 596 +/- 52 cells/mm2) in polymorphism. A 30 year old male(Case. 2) showed pellucid marginal corneal degeneration associated with rheumatoid athritis, but corneal endothelial cells appeared within normal ranges(OD. 2764 +/- 26, OS. 2812 +/- 34) with slight polymorphism. The Vision in these two cases improved to 20/20 with hard contact lens(Case. 1) and glasses(Case.2)