施奈德角膜营养不良症:病例报告

M. Israel, Keerti Wali
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摘要

施奈德角膜营养不良症(SCD)是一种罕见的常染色体显性遗传性角膜营养不良症,影响角膜前基质。它是由位于染色体 1p36 上的 UBIAD1 基因的局部代谢缺陷引起的。据了解,由于磷脂和胆固醇在角膜中的异常积聚,该病会导致进行性双侧角膜不透明。在我们的病例中,一名 22 岁的男性患者视力下降并伴有眼部不适,在裂隙灯下双眼多发灰色浸润或圆盘样翳,呈环状排列,累及上皮下和基质。在前段光学视网膜断层扫描(OCT)上,整个基质都受到了影响,基质前 1/3 部分的沉积物增多。沉积区域的角膜中央厚度也有所增加,而全身评估则显示出血脂异常。临床和前段 OCT 检查结果表明,基质内沉积物呈环状,提示为施奈德角膜营养不良症。AS-OCT 对此类病例至关重要,有助于区分上皮和基质受累情况,从而改变治疗方法。如果患者的视力受到影响,可计划进行穿透性角膜移植术。
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Schnyders corneal dystrophy: A case report
Schnyder corneal dystrophy (SCD) is a rare, autosomal dominant inherited dystrophy affecting the anterior stroma of the cornea. It is caused by a local metabolic defect mapped on the UBIAD1 gene chromosome 1p36. It is known to causes progressive bilateral opacification of the cornea due to an abnormal accumulation of phospholipids and cholesterol in the cornea. In our case a 22-year-old male with vision loss and ocular discomfort revelled multiple grey, infiltrates or disc like opacities in both eyes arranged in circinate manner on slit-lamp, involving the sub-epithelium and stroma. On anterior segment OCT, involvement of the entire stroma was noted with Increased deposits seen in the anterior 1/3rd of the stroma. Central corneal thickness was also increased in the areas of depositions, while systemic evaluation showed dyslipidemia. Clinical as well as anterior segment OCT findings suggest of intrastromal deposits in a ring like pattern, suggestive of schnyders corneal dystrophy. AS-OCT is vital in such cases to help differentiate epithelial involvement from stromal, thus altering the therapeutic approach. Patients can be planned for penetrating keratoplasty if visual acquits is affected.
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