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| PHOTO ESSAY |
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| Year : 2022 | Volume
: 2
| Issue : 3 | Page : 796-797 |
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Corneal stromal barricade: An effective guard
Prateek Jain1, Poulami Pal2, Anshuman Pattnaik2
1 Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan, India
2 Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Sirohi, Rajasthan, India
| Date of Submission | 07-Oct-2021 |
| Date of Acceptance | 09-Mar-2022 |
| Date of Web Publication | 16-Jul-2022 |
Correspondence Address:
Dr. Prateek Jain
Department of Community Ophthalmology, Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan - 307 510
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_2591_21
Keywords: Corneal hysteresis, corneal stroma, ocular trauma
How to cite this article:
Jain P, Pal P, Pattnaik A. Corneal stromal barricade: An effective guard. Indian J Ophthalmol Case Rep 2022;2:796-7 |
An eight-year-old girl presented with complaint of mild blurring of vision in left eye (LE) since one month. Her father gave history of intense fist blow by her younger brother. On slit-lamp examination, LE showed a linear corneal scar. The scar had limbus-to-limbus extension from 11 to 5 o'clock involving visual axis and was confined to the anterior stroma [Figure 1]a. Corneal surface was regular with no epithelial defect [Figure 1]b. Examination of anterior and posterior segment was normal. Her UCVA was 20/30 which was improving to 20/20 after refraction. The contrast sensitivity was reduced to 1.85 on Pelli-Robson chart. Right eye examination was unremarkable. | Figure 1: Diffuse slit-lamp image of LE. (a) At presentation, showing linear corneal scar extending from 11 o'clock limbus to 5 o'clock limbus involving visual axis; (b) Fluorescein staining showing no epithelial defect and negative Seidel test; (c) At follow-up, showing faint corneal scar with good corneal luster
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Anterior segment optical coherence tomography (ASOCT) of LE revealed hyper-reflective linear band of varied thickness in the anterior corneal stroma. Central corneal thickness was 536 μm and central radius of curvature was 6.61 mm horizontally and 6.95 mm vertically [Figure 2]a. On subsequent follow-ups, gradual fading of corneal scar was observed [Figure 1]c and [Figure 2]b. | Figure 2: ASOCT image of LE. (a) At presentation, showing hyper-reflective linear band of varied thickness in the anterior corneal stroma; (b) At follow-up, showing thinner hyper-reflective linear band
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| Discussion | |  |
Cornea, specifically the stroma, comprises of collagens, proteoglycans and glycosaminoglycans which enable it to protect the inner ocular contents from accidental impact. Thus, the stroma has maximum contribution in the mechanical strength of the cornea.[1] The bio-mechanical properties of cornea are depth- as well as age-dependent. Anterior stroma, comprised of more interwoven collagen, is stiffer than the posterior stroma.[2] With age, the progressive increase in non-enzymatic cross-linking enhances the corneal stiffness.[3] Also, the peripheral cornea, owing to the differing orientation of collagen fibrils, is stiffer than the central cornea.[4] Studies have shown that corneal stress-strain behaviour is non-linear and visco-elastic. Elasticity confers the cornea the ability to deform reversibly under stress whereas viscosity enables the cornea not to regain its original shape when the force is removed.[5]
Our case is noteworthy because the intense blunt trauma experienced by the eye fractured only the anterior corneal stroma averting a globe rupture. Anterior stroma being stiffer withstood most of the applied force and spared the weaker posterior corneal layers.
Acknowledgements
The authors acknowledge the guidance of Dr V C Bhatnagar, Head of Department and Medical Superintendent, Global Hospital Institute of Ophthalmology.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Meek KM, Knupp C. Corneal structure and transparency. ProgRetin Eye Res 2015;49:1-16.  |
| 2. | Dias JM, Ziebarth NM. Anterior and posterior corneal stroma elasticity assessed using nanoindentation. Exp Eye Res 2013;115:41-6. |
| 3. | Elsheikh A, Wang D, Brown M, Rama P, Campanelli M, Pye D. Assessment of corneal biomechanical properties and their variation with age. Curr Eye Res 2007;32:11-9. |
| 4. | Vellara HR, Patel DV. Biomechanical properties of the keratoconic cornea: A review. Clin Exp Optom 2015;98:31-8. |
| 5. | Garcia-Porta N, Fernandes P, Queiros A, Salgado-Borges J, Parafita-Mato M, González-Méijome JM. Corneal biomechanical properties in different ocular conditions and new measurement techniques. ISRN Ophthalmol 2014;2014:724546. |
[Figure 1], [Figure 2]
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