Keratomalacie (keratomalacia — the softening and melting away of the cornea in severe vitamin A deficiency) was, in the account of Dr. C. E. Gomperts, the severe form of xerophthalmie and, together with it, the most probable leading cause of blindness among the children of Groot-Atjeh.
The dispute over the definition
At a demonstration by Dr. J. H. de Haas of six non-European children with xerophthalmia at a clinical evening in the C.B.Z. at Batavia, Professor Mulock Houwer remarked that not every corneal ulceration in xerophthalmia might be called keratomalacia, since keratomalacia was a very typical clinical picture in which the cornea melted away entirely in a few days. “Bij de xerophthalmie,” he continued, “ziet men dikwijls minder ernstige hoornvliesprocessen, die waarschijnlijk op infectie van buiten berusten, wat voor de keratomalacie niet vaststaat. Het zal van belang zijn deze verschillende aandoeningen te scheiden en te trachten vast te stellen, wat de oorzaak der verschillende typen is.”
Gomperts declined to share this view. The cases he had been able to observe over two years in the Militair Hospitaal te Koetaradja gave him reason to see in the lesser corneal changes nothing other than a vóórstadium — a preliminary stage — of keratomalacia. When circumstances changed favourably through the administration of levertraan (cod-liver oil) and a vitamin-A-rich diet, the corneal changes often disappeared; when circumstances remained unfavourable, the corneal changes appeared as in keratomalacia.
The eighteen hospital cases of 1937
Gomperts tabulated eighteen xerophthalmia patients with corneal changes — twelve boys and six girls — nursed in the Militair Hospitaal during 1937. The outcomes ranged widely. Case 1 (girl), both eyes dull with small superficial ulcers, healed with small maculae. Case 3 (girl), both eyes hazy with a small ulcer near the limbus in one, healed with a small macula. Case 4 (boy), ulcus corneae in both eyes with hypopyon, died shortly after admission. Case 5 (boy), corneas already melted away on admission, discharged shortly after admission at his own request. Case 6 (boy), a large central ulcer with staphylomatous distension, both eyes lost. Case 7 (girl), the lower half of both corneas with the aspect of Bitôt’s spots, with staphylomatous distension and anterior synechia with pupil distortion, discharged with satisfactory vision in both eyes. Case 13 (boy), atrophia bulbi in one eye and severe staphyloma in the other, treated with conjunctival plastic surgery after excision of the staphyloma and optical iridectomy: “Kind kon zich goed oriënteeren,” and on re-examination some months after the operation the vision proved to have improved further. Case 16 (boy), a large superficial ulcer covering the whole corneal surface, both eyes lost.
Cases 15 and 18 showed corneal complications of very different degree in the two eyes of the same child: on the badly affected eye the process could without doubt be called keratomalacia, while on the other, which healed satisfactorily, it could not be so qualified on Mulock Houwer’s view. Cases 11, 12, 13, 14, 16 and 17 likewise showed the two corneas very differently affected. Cases 15 and 16 presented virtually the same corneal picture, yet in 16 both eyes were lost while in 15 one eye came out well.
Among these keratomalacia cases two children had framboesia, one had measles and one a bowel complaint; the general condition of the keratomalacia children was as a rule bad.
Prospects of treatment
“Volgens verslaggever’s ervaring is er in gevallen van keratomalacie nog heel veel te bereiken” — in the reporter’s experience much can still be achieved in cases of keratomalacia, provided the children are brought in at not too late a stage, the food administered is well absorbed, and the children do not run a high fever too long. One child of about four, with bilateral staphylomatous distension of the lower corneal segment with opacity, was admitted to the Militair Hospitaal, the corneal process was favourably influenced by the changed circumstances, and the child was discharged with very satisfactory vision in both eyes.
Two degrees
Gomperts concluded that in keratomalacia two degrees were to be distinguished: a pre-keratomalacie-stadium and a stage in which the cornea wholly or partly melted away, the speed of the corneal process depending in all probability on the constitution. He held that keratomalacia did not necessarily lead to complete melting of the cornea, and that the process could affect the two corneas of one and the same child differently.
Age limits
Against Tijssen’s proposition that keratomalacia was a disease of infants up to two years, Gomperts’s statistics indicated otherwise: it occurred certainly among kleuters (toddlers) as well, though after the fifth year he saw no certain case. He held that the condition could lead to blindness up to the fifth year and not after.
See Also
- Xerophthalmie
- Blindheid in Groot-Atjeh
- Militair Hospitaal te Koetaradja
- Mulock Houwer
- Levertraan
- Methode-Tijssen
- C. E. Gomperts
Source
Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937 (“Orienting Ophthalmological Survey among the Atjehnese Population of Groot-Atjeh during 1937”), by Dr. C. E. Gomperts, offprint from the Geneeskundig Tijdschrift voor Nederlandsch-Indië, Afl. 19, Deel 80 (1940), pp. 1191-1238 (Batavia-Centrum: G. Kolff & Co.). Received by the editors 25 October 1939. Offprint DLP-157, Bibliotheek KITLV.