Salzmann nodular degeneration: prevalence, impact, and management strategies

Vikram Paranjpe,1 Anat Galor,1,2 Pedro Monsalve,1 Sander R Dubovy,1 Carol L Karp11Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; 2Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL 33125, USAPurpose: This r...

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Autores principales:	Paranjpe V, Galor A, Monsalve P, Dubovy SR, Karp CL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	Salzmann nodular degeneration cornea diagnosis imaging treatment Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/e29c8a9cfc04449dbec55e1cad43f64b
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spelling	oai:doaj.org-article:e29c8a9cfc04449dbec55e1cad43f64b2021-12-02T07:24:22ZSalzmann nodular degeneration: prevalence, impact, and management strategies1177-5483https://doaj.org/article/e29c8a9cfc04449dbec55e1cad43f64b2019-07-01T00:00:00Zhttps://www.dovepress.com/salzmann-nodular-degeneration-prevalence-impact-and-management-strateg-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Vikram Paranjpe,1 Anat Galor,1,2 Pedro Monsalve,1 Sander R Dubovy,1 Carol L Karp11Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; 2Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL 33125, USAPurpose: 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. Keywords: Salzmann nodular degeneration, cornea, diagnosis, imaging, treatmentParanjpe VGalor AMonsalve PDubovy SRKarp CLDove Medical PressarticleSalzmann nodular degenerationcorneadiagnosisimagingtreatmentOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 1305-1314 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Salzmann nodular degeneration cornea diagnosis imaging treatment Ophthalmology RE1-994
spellingShingle	Salzmann nodular degeneration cornea diagnosis imaging treatment Ophthalmology RE1-994 Paranjpe V Galor A Monsalve P Dubovy SR Karp CL Salzmann nodular degeneration: prevalence, impact, and management strategies
description	Vikram Paranjpe,1 Anat Galor,1,2 Pedro Monsalve,1 Sander R Dubovy,1 Carol L Karp11Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; 2Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL 33125, USAPurpose: 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. Keywords: Salzmann nodular degeneration, cornea, diagnosis, imaging, treatment
format	article
author	Paranjpe V Galor A Monsalve P Dubovy SR Karp CL
author_facet	Paranjpe V Galor A Monsalve P Dubovy SR Karp CL
author_sort	Paranjpe V
title	Salzmann nodular degeneration: prevalence, impact, and management strategies
title_short	Salzmann nodular degeneration: prevalence, impact, and management strategies
title_full	Salzmann nodular degeneration: prevalence, impact, and management strategies
title_fullStr	Salzmann nodular degeneration: prevalence, impact, and management strategies
title_full_unstemmed	Salzmann nodular degeneration: prevalence, impact, and management strategies
title_sort	salzmann nodular degeneration: prevalence, impact, and management strategies
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/e29c8a9cfc04449dbec55e1cad43f64b
work_keys_str_mv	AT paranjpev salzmannnodulardegenerationprevalenceimpactandmanagementstrategies AT galora salzmannnodulardegenerationprevalenceimpactandmanagementstrategies AT monsalvep salzmannnodulardegenerationprevalenceimpactandmanagementstrategies AT dubovysr salzmannnodulardegenerationprevalenceimpactandmanagementstrategies AT karpcl salzmannnodulardegenerationprevalenceimpactandmanagementstrategies
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Salzmann nodular degeneration: prevalence, impact, and management strategies

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