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Corona sign: manifestation of peripheral corneal epithelial edema as a possible marker of the progression of corneal endothelial dysfunction

  • Clinical Investigation
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Abstract

Purpose

To describe a characteristic form of the corona sign and its clinical relevance to the degree of corneal endothelial decompensation and investigate the underlying mechanism using a rabbit model.

Methods

These observational cases include 31 patients undergoing penetrating keratoplasty (PKP) and 15 patients undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) with special attention to the circumferentially developed corneal epithelial edema. We also conducted a laboratory observation of horizontal water flow in the rabbit cornea.

Results

We consistently observed the corona sign at the superior periphery during the initial stage of corneal endothelial decompensation after PKP. With progressive corneal endothelial cellular loss, the epithelial edema gradually expanded circumferentially in the periphery. The endothelial cellular density associated with the corona sign significantly (P < 0.01) decreased compared with that without the sign. The endothelial cellular density decreased significantly (P < 0.05) in cases with a circumferential corona sign compared with a superior corona sign. After DSAEK, however, the corneal epithelial edema subsided from the center but persisted peripherally as a corona sign in all cases. By 3 months postoperatively, the epithelial edema was confined to the superior periphery along with uneventful corneal endothelial healing. Rabbit experiments showed that total corneal endothelial decompensation decreased the horizontal intracorneal water migration (Inoue–Ohashi phenomenon) in the corneal periphery and induced peripheral corneal edema.

Conclusions

The slit-lamp microscopic findings of the corona-like epithelial edema in the peripheral cornea are associated with the stage of corneal endothelial function. To support this, the developmental mechanism of the corona sign was demonstrated experimentally.

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Acknowledgments

The authors would like to thank Medical International for the English language review.

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Authors and Affiliations

  1. Tane Memorial Eye Hospital, 1-1-39 Sakaigawa, Nishi-ku, Osaka, 550-0024, Japan

    Tomoyuki Inoue

  2. Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan

    Tomoyuki Inoue, Yuko Hara, Takeshi Kobayashi, Xiaodong Zheng, Takashi Suzuki, Atsushi Shiraishi & Yuichi Ohashi

Authors
  1. Tomoyuki Inoue
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  2. Yuko Hara
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  3. Takeshi Kobayashi
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  4. Xiaodong Zheng
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  5. Takashi Suzuki
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  6. Atsushi Shiraishi
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  7. Yuichi Ohashi
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Corresponding author

Correspondence to Tomoyuki Inoue.

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Conflicts of interest

T. Inoue None; Y. Hara None; T. Kobayashi None; X. Zheng None; T. Suzuki None; A. Shiraishi None; Y. Ohashi None.

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Inoue, T., Hara, Y., Kobayashi, T. et al. Corona sign: manifestation of peripheral corneal epithelial edema as a possible marker of the progression of corneal endothelial dysfunction. Jpn J Ophthalmol 60, 349–356 (2016). https://doi.org/10.1007/s10384-016-0459-8

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  • DOI: https://doi.org/10.1007/s10384-016-0459-8

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