Successful Treatment of Corneal Opacification with Associated Thickened Epithelium by Simple Peeling: Acquired Corneal Subepithelial Hypertrophy (ACSH).

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.

Models for infant mortality in developed and developing countries with application to A.R.E.

PIP: Mathematical models developed in the course of the article try to simulate the types of infant mortality in the U.A.R. and in developed areas such as the U.S.A., England, and Wales. Calculations are performed using the derived formulas. While the mathematical manipulations are rather involved and confusing, an introductory portion discusses the rationale for the use of such procedures. Use of the derived formulas attempts to produce indices of socioeconomic development of the areas and to provide predictive power for future planning. The article cites infant mortality rates for 1960-1964 in Sweden as 15.4%, in Africa as "200%," and in the U.A.R. as "117.4%." It states that infant mortality in the U.A.R. occupies an intermediate position between the developed nations and the very underdeveloped nations. It fails to explain the source of its percentages or to comment on how an infant mortality rate of 200% or 117.4% is possible. According to the mathematical results of the study, infant mortality due to environmental rather than strictly physiological conditions is the primary factor contributing to the discrepancy between infant mortality rates of the U.A.R. and the developed nations.^ieng