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Xiao Lin, Yen-Chiao Wang, Hao Zhou; Granular corneal opacities in workers of BCMP manufacturing factory: a suspicious occupational eye injury. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5178.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal opacities are a common sign of corneal dystrophies. We report two cases of granular opacities in the corneas of two patients, after one year exposure to 4,4'-Bis(chloromethyl)-1,1'-biphenyl(BCMP), which was produced in the factory where the patients worked. To the best of our knowledge, this is the first report of granular corneal opacities that may be due to long term exposure in an occupational setting.
At presentation, they were examined with a slitlamp examination, confocal microscopy, anterior segment OCT and Pentacam. Refractive surgery was not acceptable for one patient, while another one had LASEK and PTK on her right eye in our hospital. Follow-up examinations were scheduled for 1 week, 2 week and 3 months after surgery, including UCVA, BCVA and slit-lamp biomicroscopy.
Both patients denied any family history of corneal opacities. They had symptoms of gradual visual reduction, mild conjunctival congestion and corneal opacities. The upper eyelids were everted to exclude the presence of a foreign body. The opacities were in the subepithelium, Both confocal microscopy (Fig. 2A, B) and anterior segment OCT (Fig. 2C, D) demonstrated large amounts of round, hyper-reflective spots deposited in the subepithelium, Bowman layer and antierior stroma in both eyes of the cases. The patient who was without surgery had UCVA of 0.05 in both eyes. The one who had refractive surgery on her right eye had BCVA of 0.6 in the right eye and 0.5 in the left eye before surgery. Post-operatively, BCVA of the right eye was to 0.3, 0.3 and 0.5 at two weeks, six weeks and three months respectively. The BCVA of left eye was 0.25 at three months. Corneal topography was performed at 1 week. Slit-lamp biomicroscopy showed a significant decrease in total amount of the granular opacities, especially around the optic zone(Fig. 1C). The vision recovery process was slow but stable.
Corneal granular opacities may appear not only in corneal dystrophies, but the opacities may be associated with exposure to BCMP overtime, and therefore, may have prognostic significance and contribute to the study of the mechanism of corneal dystrophy. Workers in BCMP production factories should be aware of such potential occupational disease.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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