Lipid Keratopathy: A Review of Pathophysiology, Differential Diagnosis, and Management

Abstract

Lipid keratopathy is a disease in which fat deposits accumulate in the cornea, leading to opacification and decrease of visual acuity. This condition can be idiopathic without signs of previous corneal disease or secondary to ocular or systemic diseases. Lipid keratopathy is usually associated with abnormal vascularization of the cornea, and the lipid classically deposits adjacent to these vessels. Treatment of this condition usually aims to eliminate or prevent abnormal vessel formation, and several modalities have been described. In this review we summarize the etiology, pathophysiology, and clinical presentation of lipid keratopathy and describe current and emerging treatment regimens.

Initial outcomes of mitomycin intravascular chemoembolization (MICE) for corneal neovascularization

“…It has been proposed that this is due to residual subclinical inflammation and rebound release of VEGF after cessation of treatment [ 8 ]. Furthermore, other growth factors and cytokines have been proposed as potential target of therapies [ 24 ]. An additional treatment modality, fine needle diathermy, has been reported as a useful and inexpensive technique for the treatment of established corneal vessels.…”

“…With MICE, the vessels endothelial cells are obliterated, and existing abnormal corneal vessels are occluded and subsequently ablated. We speculate that targeting of the vessel and its endothelium by means of chemotherapeutic embolization not only halts and destroys existing vessels but also prevents further vascularization [ 24 ]. Mitomycin is a bifunctional alkylating agent that is known to have direct cytotoxic effects on cultured pulmonary artery endothelial cells and umbilical vein endothelial cells [ 11 , 12 ].…”

Lipid Keratopathy Management With Therapeutic Scleral Lens Wear

“…In the setting of diffuse corneal neovascularization, lipid deposition will be more dispersed and leads to greater visual acuity reduction when concentrated in or adjacent to the visual axis. 3 Corneal neovascularization therapeutics aim to prevent angiogenesis or induce regression. 1,4 Current treatment modalities include topical anti-inflammatory medications, laser photocoagulation therapy, and antiangiogenic treatments.…”

Crystalline lipid keratopathy in anterior sclerokeratitis

“…2 3 Neovascularisation is considered pathognomonic in secondary lipid keratopathy, as lipoproteins leaking from new vessels cause it. 2 Topical and subconjunctival injection of anti-vascular endothelial growth factor (VEGF) has demonstrated positive results. 4 Fine-needle diathermy and intravascular mitomycin C injections are important future therapies.…”

“…4 Fine-needle diathermy and intravascular mitomycin C injections are important future therapies. 2 Crystalline lipid deposit is seen in primary lipid keratopathy (Schnyder's crystalline dystrophy), its pathophysiology being unclear. 5 Unilateral crystalline keratopathy in infectious keratitis is well described.…”