<p>Salzmann nodular degeneration: prevalence, impact, and management strategies</p>

Abstract

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 epithelial–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, photokeratectomy, 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.

Atypical Presentation of Salzmann Nodule: A Case Report and Literature Review

“…SND usually presents as symmetrical bilateral nodules located more commonly in the periphery of the cornea [4,5]. Our patient had asymmetric nodules bilaterally with an atypical central, visually significant nodule in the left eye.…”

“…Superficial keratectomy alone or with alcohol, mitomycin-C, or amniotic membrane transplant were documented in the literature as surgical options. Lamellar keratoplasty is rarely needed [5]. Around 90% of patients will have an improvement in visual acuity after surgical intervention [14].…”

“…Salzmann nodule develops following corneal trauma or inflammation. However, it can present idiopathically [1,[3][4][5].…”

Post-LASIK keratectasia in the context of a thicker than intended flap detected by anterior segment optical coherence tomography

“…Very-high-frequency(VHF) ultrasound scanning system (Artemis 2; Ultralink LLC), OCT system, and high-frequency ultrasound biomicroscopy have been introduced for the measurement of CCT, corneal flap thickness created by microkeratomes, femtosecond IntraLase, and even detection of post-LASIK pathologies such as Salzmann-like nodular corneal degeneration with good correlation between them. [18][19][20][21][22] Both mechanical microkeratome and femtosecond laser for LASIK flap cutting were reported as effective and safe methods to myopia correction with stable refractive outcomes for both groups. In the concept of flap thickness predictability, the femtosecond laser has benefits over mechanical microkeratome such as better contrast sensitivity function, fewer induced higher order aberrations, and longer tear breakup time.…”

Degeneración nodular de Salzmann en paciente mujer de 20 años de edad: un reporte de caso

“…La localización y ubicación de los nódulos son determinantes para la elección del tratamiento. En los casos donde los nódulos interrumpen el eje visual, la queratectomía fototerapéutica con láser es considerada la mejor opción terapéutica; si la lesión produce infiltración de las membranas profundas, se puede realizar una queratoplastia [12,14] . Empero, cualquiera sea el método elegido, la frecuencia de recidivas es alta [5] .…”