cornea clinic interactive part 2.ppt

8/18/2019 Cornea Clinic Interactive Part 2.ppt

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PART II


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Via Paccagnella 1130174 Zelarino-VENEZIA

(ITALY)

http://www.fbov.it/it_index-1.html


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CORNEAL Y!TROP"IE! #E$ENERATION!

%&'ro %( *ro+ $ree, υστροϕ ´ )

./a e elo +en'2 !'r c' raleca% In ce 5% an INTERNAL

( $ENETIC ) *ac'or


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egenera'ion( *ro+ La'in Degenerare )

. erail+en'2 !'r c' ral C angeIn ce 5% E6TERNAL *ac'or



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Y!TROP"Y

E$ENERATION


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PELL CI ;AR$INALE$ENERATION

egenera'ion

%&'ro %

CORNEAL Y!TROP"IE! #

E$ENERATION!


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E$ENERATION Y!TROP"Y

NILATERAL /ILATERAL



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A!Y;;ETRIC !Y;;ETRIC



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PO!TOPERATIVE !PONTANEO !



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PERIP"ERAL CENTRAL

( & all%) ( & all%)



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VA!C LARIZE AVA!C LAR



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LATE ON!ET EARLY ON!ET



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< IC8 !LO= PRO$RE!!ION PRO$RE!!ION



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!ECON ARY PRI;ARY



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NON "ERE ITARY "ERE ITARY(A 'o&o+: o+:)



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CLA!!IC ;ORP"OLO$IC(ANATO;IC) CLA!!I*ICATIONE i' eli + (e:g: +a - o'->inger rin')

/o?+an@& La%er (e:g: Rei&-/ c,ler)

!'ro+a - e o&i'ion (e:g: $raeno ?)!'ro+a - Ec'a&ia (e:g: 8era'ocon &)

En o' eli + (e:g: g ''a'a * c &)

CORNEAL Y!TROP"IE!


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E i' elial /a&e+en' ;e+5rane

%&'ro %• T e +o&' co++on %&'ro % &een in

clinical rac'iceB A 5 ' ?i' inco+ le'e ene'rance & all%

& ora ic

B 5ila'eral +ore co++on in ?o+enB On&e' in ' e Dn eca eB 10 e elo rec rren' e i' elial ero&ion&


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. Most patients withepithelial basementmembrane dystrophyhave only the map

changes whichrepresent basementmembrane within theepitheliumMap changes in

epithelialbasementmembrane

dystrophy.

E i' elial /a&e+en' ;e+5ran%&'ro %


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/o' +icroc%&'ic c ange& o>Cogan an+a li,e c ange& 'oge' er:

& all% ' e +icroc%&'& are in

' e area o> 5a&e+en'+e+5rane an no' in ' eclear lac na a& no'e ere:



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• Map-dot-fngerprint,

• Cogan’smicrocysticdystrophy

•

The intraepithelialmicrocysts in theslit just at thein erior margin othe visual a is.



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Re'roill +ina'ion o>ig lig 'e 5a&e+en'

+e+5rane %&'ro % &eena& >inger rin' line& an +a

a''ern& .

Parallel line& an

>inger rin' line&



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$leb pattern isseen inretroilluminationagainst the undusred re%e .

The blebli&edeposits beneaththe basal

epithelium are seen



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'luorescein stainsThe lac& o epithelialintegrity !"#,which leads tocontinued symptoms

rom recurrentcorneal erosion.

E i' elial 5a&e+en' +e+5rane%&'ro % an rec rren' corneal

ero&ion in ' e lo?er ' ir o> ' e cornea:



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A5nor+al + l'ila+inar 5a&e+en' +e+5rane (/;)in nor+al loca'ion (1)in'rae i' eliall% (2)

/; ' ic,en& an 5loc,& nor+al +igra'ion o> e i' elial cell& 'o?ar

' e & r>ace:Tra e e i' elial cell& egenera'e 'o >or+in'rae i' elial +icroc%&'& (3)' a' &lo?l% +igra'e 'o ' e & r>ace (4)

A5nor+al 5a&e+en' +e+5rane ro ce& +a an >inger rin'c ange& +icroc%&'& ro ce ' e o' a''ern &een clinicall%


26/151e5ri e+en' & eci+en o> e i' eli +

in'rae i' elial +icroc%&'(Cogan)



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;ANA$E;ENTB Na' ral 'ear&

B E i' elial e5ri e+en'B Pa'c ingB /CLB P o'o' era e 'ic ,era'ec'o+%B D0$ Nee ling 'o .anc or2 ' e e i' eli +



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Re'roill +ina'ion

Management( )ubrication, $C), or

*T+

• Ver% rare- 5ila'eral-e i' elial %&'ro %

B A ?i' gene loc & on

1DF13 or 17F1DB E i' elial +icroc%&'& con&i&'ing o> e i' elial

cell e5ri& concen'ra'ecen'rall%

;ee&+ann %&'ro %


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• ;icro ac ole& inre'roill +ina'ion:• T e&e are >ine ac ol

c ange& in ' ee i' eli +• In'rae i' elial c%&'&• T ic,ening o> e i' elial 5a&e+en' +e+5rane

;ee&+ann %&'ro %


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NOR;AL EN OT"ELI ; GGG

;ee&+ann %&'ro %


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Li&c Corneal %&'ro %

B 6-lin,e on 6 DD:3• $ra% 5an & o> en&el%

cro? e clear +icroc%&'&in a ? orl con>ig ra'ion

!%+ 'o+&H VA No ainTrea'+en'

e5ri e+en' (i>


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Rei&-/ c,ler %&'ro %

B A c ro+o&o+e JF31 (&a+ea& gran larla''ice an A ellino)

B On&e' in &econ eca e

B Rec rren' ero&ion& ecrea&eVA (an'erior &carring)

B $ra%-? i'e >ine ro ncen'ral o aci'ie& in/o?+an@& la%er


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• Progre&&e& ?i' ageB La%ing o?n o> irreg lar

5an & o> collagenre lacing /o?+an@&la%er

B .!a?'oo' 2 >a& ioncorre& on ing 'o& 5e i' elial o aci'ie&



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odli&egranules, seen

by transmissionelectronmicroscopy inthe superfcialstroma and inthe region o$owman’s layer,



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TREAT;ENT K ! er>icial ,era'ec'o+% K La+ellar ,era'o la&'% K PT8 K Rarel% P8 Rec rrence in ' e gra>' (in'er>ace >or L8) i& er%

co++on



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Rec rrence D

%ear& a>'ereMci+er la&era5la'ion (areao> 'rea'+en' GGG)



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T iel-/e n,e %&'ro %

B A C ro+o&o+e 10FD4B !i+ilar 'o Rei&-/ c,ler one%co+5 a''ern

.c rl% >i5er&2B Trea'+en' &a+e


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C rl% >ila+en'&(TE;) in ' eregion o>

/o?+an ’&la%er



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!e eral %ear& a>'ercorneal

'ran& lan'a'ion ' erei& rec rrence o> ' ea' olog% in ' e

region o> /o?+an ’&

la%er an & er>icialcornea:

Ring li,e or one%co+5 a earance



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T iel-/e n,e%&'ro %

re-!AL8

T iel-/e n,e%&'ro %o&'-!AL8


L ''i %&' %


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• A c ro+o&o+e JF31• Linear a+%loi e o&i'&

concen'ra'e in an'erior&'ro+a an & 5e i' elialarea&

• !'ain& orange-re ?i'Congo Re %e

La''ice %&'ro %("aa5- i++er)

L ''i %&' %


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B Re>rac'ile line& or .la''iceline& 2 5e&' &een onre'roill +ina'ion

B Cen'ral an & 5e i' elial? i'e o'&

B i>> &e an'erior &'ro+ala e

B Clear cornea in5e'?een line&


L ''i %&' %


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B Cla&&ic la''ice %&'ro %B C ro+o&o+e JF31

B On&e' a' en o> >ir&' eca e?i' rec rren' ero&ion&rece ing &'ro+al c ange&

B Trea'+en' P8 or AL8& all% nee e 5% &iM'eca e


L ''i %&' %


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B $la&&% o'& in an': &'ro+aB *ine la''ice line& &een on

re'roill +ina'ionB Pro+inen' la''ice line& an &'ro+al a e

B Congo re &'ainingB $reen 5ire>ringence ?i'

olari e lig '

/ranc ing o 5l% rel cen' line&

i>> &el% in ol e cornea


La''ice %&'ro %


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La''ice %&'ro %(;ere'o a !%n ro+e)

• A&&ocia'e ?i' &%&'e+ica+%loi o&i&

B C ro+o&o+e F34B On&e' ' ir eca e ?i'

rec rren' ero&ion&B ;ore elica'e & ar&e

ra iall% orien'ela''ice line&

L ''i %&' %


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B !%&'e+ic >ea' re& K rogre&&i e / cranial an

eri eral ne ro a' % K %&ar' ia K r% an laM i'c % &,in +a

li,e >acie& K ro'r ing li & K en lo & ear&

La''ice %&'ro %(;ere'o a !%n ro+e)

$ l %&' %


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$ran lar %&'ro %

B A c ro+o&o+e JF31

B Corneal &'ro+a clearin5e'?een o aci'ie&

B"%aline e o&i'& ' a' &'ainre ?i' ;a&&on'ric ro+e &'ain

$ l %&' %


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B !ee & ar l% e+arca'ee o&i'& re&e+5lingcr +5&

or &no?>la,e& in ' e cen'ralan'erior &'ro+a o>'en

i&'ri5 'e in a ra ial>a& ion

B In 'i+e n +5er &i e ane ' o> e o&i'& increa&e&

?i' gra al con>l ence ani>> &e o aci'%

$ran lar %&'ro %

$ l %&' %


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B Trea'+en' P8 or AL8 5% age40-J0

B Rec rrence& >reF en'O NOT 'rea'

?i' eMci+er la&er GGG• "i&'olog% & o?& a+or o &

%aline e o&i'& ' a' &'ain re?i' ;a&&on 'ric o+e

$ran lar %&'ro %

$ran lar %&'ro %


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Co+5ina'ion o>a''ern& (5rea

cr +5& +ore& er>icial &no?>la,e& ee er)

$ran lar %& ro %(T% e II K A ellino)


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Q9- ! ' re&1-;on' "ealing

;ini+al Po&'o

Re>r: Error

!AL8 Co+ are& 'o LA!I8

;8-A!!I!TE ANTERIOR L8


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CO;PLICATION!

%&'ro % Rec rrence49D3 (17 )

Pre-!AL8 Po&'-!AL8 4-%ear&

Po&'-!AL8


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! er>icialReci ien'!'ro+a

GGG(In'racorneal)

Y!TROP"Y REC RRENCE


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A>'er PT8 an P8 Rec rrencei& ! /EPIT"ELIALGGG

Y!TROP"Y REC RRENCE


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"I!TOLO$Y O* REC RRENCE

PA! Tric ro+e ;a&&on

l %&' %


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;ac lar %&'ro %

B Lea&' co++on a+ong &'ro+al%&'ro ie&

B AR C ro+o&o+e 1 FDD

B In ol e& ' e ? ole cornea(&'ro+a o aF e in5e'?eeno aci'ie&) incl ingen o' eli +

B Pa' ogene&i& $A$& ' a'acc + la'e in ' e en o la&+re'ic l + &'ain ?i' colloi aliron an Alcian 5l e

l %&' %


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B T% e I K +ore re alen' K nor+al &%n' e&i& o> er+a'an & l>a'e-

ro'eogl%can K Erroneo & &%n' e&i& o> ,era'an & l>a'eB T% e II

K nor+al ra'io o> ,era'an & l>a'e aner+a'an & l>a'e 5 'ecre&e o erall &%n' e&i&

B Tra'+en' Trea' rec rren' ero&ion&P8

B Rec rrence rela'i el% rare

DeepPeriferal

Lesions

;ac lar %&'ro %

! % %&' lli l


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!c n% er cr%&'alline corneal%&'ro %

B Rare &lo?l% rogre&&i eB A c ro+o&o+e 1 3B On&e' a& earl% a& >ir&' %ear

o> li>e 5 ' iagno&i&& all% no' +a e n'il

&econ or ' ir eca eB i&or er o> corneal li i

+e'a5oli&+B A&&ocia'e ?i' increa&e

c ole&'erol in J0 o> a'ien'&:

Cen'ral cr%&'al e o&i'iononl% in J0 o> ca&e&

! % %&' lli l


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B Cen'ral o al & 5e i' elialo aci'ie& (c ole&'erol)

B Cen'ral cornealo aci>ica'ion arc &

B ecrea&e corneal &en&a'ionB ;anage+en' C ec, li i

anel P8 B Rec rrence can occ r

Cen'ral Cri&'alline

e o&i'

!c n% er cr%&'alline corneal%&'ro %


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* c & %&'ro %

B Ver% co++onB ;a% 5e A 5 ' gene'ic&

no' cleare %e'

B *e+ale re on eranceB On&e' a>'er age J0B Range& >ro+

a&%+ 'o+a'ic g ''a'a 'oa eco+ en&a'e cornea(/ llae)


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B Pa' ogene&i& re c'ionin Na 8-ATPa&e +&i'e& an 9or > nc'ion

B Increa&e corneal e e+aan e o&i'ion o>collagen aneM'racell lar +a'riM in

e&ce+e'@& +e+5rane

Corneal guttaewith melaningranulepigmentation

* c & %&'ro %

* & %&' %


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B !'age 1 gra al increa&e incornea g ''a'a ?i'

eri eral & rea - .5ea'en

+e'al2B !'age D en o' elial

eco+ en&a'ion lea ing 'o

&'ro+al e e+a an 5l rrei&ion ini'iall% ?or&e ? en?a,ing

* c & %&'ro %

* & %&' %


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!'age 3 Per&i&'en'e i' elial e e+alea ing 'o +icroc%&'&an 5 llae ? icca &e ain onr ' re

* c & %&'ro %

* & %&' %


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B C ec, ac %+e'r% an & ec lar+icro&co % ( eri eral cell co n' GGG)

B TREAT;ENT K Re ce e e+a ?i' NaCl ro & K Lo?er IOP (ri ic lo & GGG)

K /CL 'o en ance e a ora'ion K In ' e a&' P8- NO= !AE8

* c & %&'ro %

Po&'erior Pol%+or o &


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Po& erior Pol%+or o &%&'ro % (PP )

B nco++on &lo?l%rogre&&i e

B A (AR) C ro+o&o+e D0F1B On&e' 5ir' or &oon ' erea>'eB Area& ?i' en o' elial cell&

' a' 5e a e li,e e i' elialcell& (+icro illi )

Po&'erior Pol%+or o &


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Po& erior Pol%+or o &%&'ro % (PP )

B T e&e cell& K & o? +icro illi K &'ain o&i'i e >or ,era'i K ra i l% gro? K a e in'racell lar

e&+o&o+e&B e&ce+e'@& +e+5rane i&

' ic,eneLinear /an

Le&ion

i>> &e

O aci'ie&

!AE8 i PP


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1S %: o&'- !AE8/!CVA 10910Re>: Q1:00 & :

-0:7J c%l: U 170

PP (Age 1D)/!CVA 1910Re>: QD:00 & :

!AE8 in PP

Congeni'al "ere i'ar% En o' elial


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A 'o&o+al Rece&&i e( o+inan')

Earl% On&e'

/ila'eral Clo ing

A+5l%ogenic H

NOR;AL ANATO;Y GGG

Congeni al ere i ar% En o elial%&'ro % (C"E )

!AE8 in C"E


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3 % o&'- !AE8/!CVA W910Re>: QD:DJ & :

-D:DJ c%l: U 1J0

Age %ear& /!CVA D910

Re>: QD:00 & :-1:00 c%l: U J

!AE8 in C E



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/AN 8ERATOPAT"Y

E TA A/RA!ION

(?i' nor+al en o' eli +G)

CORNEAL Y!TROP IE! #E$ENERATION!



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!ALZ;ANN;AP- OT-*IN$ERPRINT

EPIT"ELIAL E/RI E;ENT

(PT8)




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! PER*ICIAL !TRO;AL Y!TROP"IE!

! PER*ICIAL ANTERIOR LA;ELLAR8ERATOPLA!TY (!AL8)

PT8




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CORNEA $ TTATA PP

CAVE GGG




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Peri eral

T inning"ig - egreee

.again&' ' e R le2Progre&&i e Irreg lar

A&'ig+a'i&+

PELL CI ;AR$INAL E$ENERATION




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PELL CI ;AR$INAL E$ENERATION


=E $E RE!ECTION #

RELA6IN$ INCI!ION!

E6TRE E P C


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E6TRE;E P;C•

7 %X Lo? Vi&ion !inceYear&• HD70 A ance Peri eral

T inning ?i' Ec'a&iaormalThinning

"Y ROP! IN P;


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Y ROP! IN P;

Rare e&ce+e'@& /rea, in ' e Area o> ! eriorT inning

AF eo & In>l M in'o Corneal !'ro+a

ormal

Thinning

Trea'+en'


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Trea +enPeri eral Corneal T c, GGG


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Re& l'& 1


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Re& l'& 1No Ec'a&ia/!CVA 0 4(-4 00 c%l:U100 )

Re& l'& D


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Re& l & D

No Ec'a&ia

No E e+a

/!CVA 0

a% 1Po&'o



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8era'ocon &E$ENERATION!



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8era'ocon & ;or olog%Cen'ral (Ni le)

Peri eral (/roa /a&e)

E$ENERATION!



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CAVE !!!8C ! o l /e ! & ec'e i>

"ig 8-Rea ing&

A&%++e'r%

D09D0 /!CVA No' Po&&i5le GGG

E$ENERATION!

8ERATOCON !


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8ERATOCON !

"ig 8-Rea ing& A&%++e'r%

8ERATOCON !


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8C .>r &'e2or

&'ig+a'i&+

8ERATOCON !

8ERATOCON !


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8C .*r &'e2 Preooro&'-LA!I8 Ec'a&ia

*lei&c erRing GG

G

8ERATOCON !

8ERATOCON !


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3W-Year Ol Pa'ien' &9 ICR! M 8C

Preo Re>rac'ion -W J0 & : -7 00 c%l: U 1W0

8ERATOCON !

8ERATOCON !


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17-Year Ol Pa'ien' &9 R8 M 8C GGGPreo Re>rac'ion - 1 00 & : - 1 7J c%l: U 17J

Po&'-R8 Re>rac'ion Q 1 00 & : -1 J0 c%l: U 170

8ERATOCON !

CORNEAL Y!TROP"IE!


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CLA!!IC ;ORP"OLO$IC(ANATO;IC) CLA!!I*ICATIONE i' eli + (e:g: +a - o'->inger rin')

/o?+an@& La%er (e:g: Rei&-/ c,ler)

!'ro+a - e o&i'ion (e:g: $raeno ?)

!'ro+a - Ec'a&ia (e:g: 8era'ocon &)

En o' eli + (e:g: g ''a'a * c &)

CORNEAL Y!TROP IE!

Jayne S Weiss, ChairMichaelWBelin, Vice-Chair


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IC3

DInternational Committee onC lassification of Corneal ystrophiesSponsored by The CORNEA Society

Cornea Vol +e D7

! l: D ece+5erD00W

Michael W Belin,Members

Anthony Aldave (US)Massimo Busin (Italy)

Cecile Bredrup (Norway )Gordon Klintworth (US)Walter Lisch (Germany)

Shigeru Kinoshita (Japan)Terho Kivela (Finland)

Eung Kim (Korea)Hans Ulrik Moller (Denmark)Francis Munier (France)

Berthold Seitz (Germany)John Sutphin (US)

Gabriel Van Rij (Netherlands)

Rasik Vaajpayee (Australia) ConsultantsTony Bron (UK)

Joseph Frucht-Pery (Israel)Mark J Mannis (US)Chris Rapuano (US)

CORNEAL Y!TROP"IE!


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NE= IC3 CLA!!I*ICATION ;or ologic (Ana'o+ic)

E i ence Ca'egorie& (1 'o 4)

%&'ro ie& ?i' co++ongene'ic& gro e 'oge' er

CORNEAL Y!TROP IE!

CORNEAL Y!TROP"IE!


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1: =ell- e>ine%&'ro %

8no?n

Loca'ion$ene #

; 'a'ion

CORNEAL Y!TROP IE!

EVI ENCE CATE$ORIE!

CORNEAL Y!TROP"IE!


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D: =ell- e>ine%&'ro %8no?nLoca'ion($ene )

CORNEAL Y!TROP IE!

EVI ENCE CATE$ORIE!

CORNEAL Y!TROP"IE!


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3: =ell- e>ine%&'ro %No 8no?n$ene'ic&

CORNEAL Y!TROP IE!

EVI ENCE CATE$ORIE!

CORNEAL Y!TROP"IE!


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4: ! & ec'eNe? or < er%i&'inc'%&'ro %

CORNEAL Y!TROP IE!

EVI ENCE CATE$ORIE!

CORNEAL Y!TROP"IE!


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One i&ea&e i>>eren' $ene&

CORNEAL Y!TROP IE!

CORNEAL Y!TROP"IE!


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One $ene i>>eren' i&ea&e&

CORNEAL Y!TROP IE!

CORNEAL Y!TROP"IE!


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/e'a-Tran&>or+ing $ro?'*ac'or In ce $ene " +an

Clone(/ig"3 or 8era'oe i' elin)

(C ro+o&o+e JF31)

CORNEAL Y!TROP IE!

CORNEAL Y!TROP"IE!


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/ig"3 (8era'oe i' elin)

*ro+ *inger' # !'one in 8rac +er ;anni& # "ollan Cornea

CORNEAL Y!TROP IE!

CORNEAL Y!TROP"IE!


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Non - /ig"3

*ro+ *inger' # !'one in 8rac +er ;anni& # "ollan Cornea

CORNEAL Y!TROP IE!

CORNEAL Y!TROP"IE!


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="Y I ENTI*Y RE!PON!I/LE$ENE!

To e elo & eci>ic iagno&'ic 'e&'&

(&i+ilar i&or er& clinical co r&e) To e elo eM eri+en'al +o el&

To e elo gene'ic 'rea'+en'&( ar+a gene re lace+en' gene& re&&ion)

CORNEAL Y!TROP"IE!


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eli er% o> Reco+5inan' $ene&

(Tran&gene&) 'o Corneal Ti&& e E>>icienc% o> Tran&gene eli er%

ra'ion o> Tran&gene Ac'i i'%

! > '% GGG

$ENETIC TREAT;ENT

CORNEAL Y!TROP"IE!


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$ENETIC TREAT;ENT

&CONVENTIONAL

TREAT;ENT(! R$ERY)

CORNEAL Y!TROP"IE!


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PENETRATIN$ 8ERATOPLA!TY

CORNEAL Y!TROP"IE!


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PETER!

ANO;ALY

Congeni'al! ora ic!'a5le

CORNEAL E;/ROLO$Y


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CORNEAL E;/ROLO$Y

VI =ee,

T e O 'ic CReac e& ' eCr%&'allineLen&

CORNEAL E;/ROLO$Y


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3 =a e& o>

n i>>eren'ia'eEc'o er+ic

Ti&& e

CORNEAL E;/ROLO$Y

1st = Endothelium

2nd = Stroma

3rd = Angle + Iris

CORNEAL E;/ROLO$Y


110/151

.!'e la er2Cla&&i>ica'ion

=aring1 7J

CORNEAL E;/ROLO$Y

CON$ENITAL


111/151

Ano+alie&

Onl%Oc lar

!%n ro+e&

Oc lar Q!%&'e+ic

($l + )

CON$ENITAL

CON$ENITAL ANO;ALIE!


112/151

$ ;

E i5 l5ar er+oi # $ol en ar !%n ro+e



113/151

E+5rio'oMon

$ ;



114/151

AMen>elAno+al%

(!%n ro+e)

$ ;



115/151

$ ;

RiegerAno+al%

(!%n ro+e)



116/151

8era'ocon &Po&'ic &

;



117/151

8era'ocon & Po&'ic &

;

HNor+alEn o' eli + (H1 00 cell9++ D)

VA D09D0



118/151

;

Pe'er& IAno+al%

(!%n ro+e)



119/151

;

Pe'er& IIAno+al%

(!%n ro+e)



120/151

;

Pe'er& IIAno+al%

(!%n ro+e)



121/151

;

Pe'er& IIAno+al%

(!%n ro+e)



122/151

Pe'er& IIAno+al%

(!%n ro+e)



123/151

;icrocornea

(Nano ' al+o&)

(;icro ' al+o&)



124/151

;egalocornea



125/151

/ ' al+o&

HaabStriae

!TE; CELL E*ICIENCY


126/151

YT"

CORNEAL NEOVE!!EL! !C

!TE; CELL E*ICIENCY


127/151

CORNEAL NEOVE!!EL!

In>ec'ion&C ronic

n>la++a'ion(/8 Loo&e! ' re& CL

ear e'c:)

CLINICAL CA!E


128/151

C C C !

VA LP i>> &e Pann &

J-Year "i&'or% lcer

In>l ++ 'ion Q

WJ-Year-Ol =o+an No ! rger%

CLINICAL CA!E


129/151

O' er E%eRela'i el%Nor+al!+all Pann &$oo VA (0: )

WJ-Year-Ol =o+an No ! rger%

CLINICAL CA!E


130/151

Trea' Ro&aceaGGG!%&'e+ic # To ical

TETRACYCLINE!

To ical!TEROI !

WJ-Year-Ol =o+an Ro&acea

CLINICAL CA!E


131/151

J Year& .; & roo+2 P8

!TE; CELL E*ICIENCY


132/151

*ACT !C E6TRE;ELY RARE GGG

CON$ENITAL !C


133/151

ANIRI IA

"ere i'ar%(PA6 )

! ora ic(=il+& T +or)

CON$ENITAL !C


134/151

PA6 !C

IRI! ;AY/E

NOR;AL GGG

AC< IRE !C


135/151

C"E;ICALTRA ;A!(al,ali aci &e'c:)

AC< IRE !C


136/151

A TOTRAN!PLANTIN NILATERAL

LE!ION!T o>' 1 77

"er+an 1 W38en%on 1 W

/ &in 1 4

AC< IRE !C


137/151


138/151

AC< IRE !C


139/151

A TOTRAN!PLANTATIONAY 1

AC< IRE !C


140/151

A TOTRAN!PLANTATION;ONT" 1

AC< IRE !C


141/151

A TOTRAN!PLANTATION

PREOP

VA LP

;on' 1

VA "

;on' 4

VA 0 1

AC< IRE !C


142/151

A TOTRAN!PLANTATION

4 ;ONT"! PO!T !AL8

VA 0 W GGG

AC< IRE !C


143/151

A TOTRAN!PLANTATION

PREOP

VA LP

;on' 1

VA 0 D

;on' 4

VA 0 4

AC< IRE !C


144/151

A TOTRAN!PLANTATION

PREOP

VA LP

Year 1

VA 0 4

AC< IRE !C


145/151

A TOTRAN!PLANTATION

PREOP

VA LP

Year 1

VA 0 1

AC< IRE !C


146/151

A TOTRAN!PLANTATION

PREOP

VA LPH

Year 1 19D

VA D09D00

AC< IRE !C


147/151

/ILATERAL LE!ION!

RECOVERY *RO;

ONOR

TRAN!PLANTATION

! RVIVAL

CORNEAL I!EA!E!


148/151

LTI;ATE ;YT"PER*ECT VI!ION I! T"E $OAL

CORNEAL I!EA!E!


149/151

LTI;ATE *ACTCO;PRO;I!E ;AY /E /ETTER


150/151


151/151

/REA8 GGG

cornea clinic interactive part 2.ppt

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