Posters

Cataract surgery in terrien's marginal degeneration: a case report

Poster Details

First Author: S.Neary IRELAND

Co Author(s): C. Hurley                    

Abstract Details

Purpose:

The purpose of this case report is to highlight the uncommon clinical entity of Terrien's marginal degeneration (TMD) and considerations to make when patient with TMD undergo cataract surgery.  TMD is a slowly progressive, bilateral and asymmetric degenerative disease of the peripheral cornea.  Males over the age of 40 are most commonly affected.  Clinical signs include peripheral stromal thinning, lipid deposition, opacification and vascularisation.  It is typically non-inflammatory, although an inflammatory form exists in about one-third of cases.  Vision loss is usually from against-the-rule astigmatism, which may be present to high degrees.

Setting:

An 86 year old gentleman was referred by his optometrist with bilateral painless progressive blurred vision.  A diagnosis of bilateral TMD and cataract was made based on asymmetric inferior corneal thinning, with an intact epithelium.  Oblique pseudopterygium was present, which helped in differentiating from Mooren's ulcer or pellucid marginal degeneration.

Methods:

The patient underwent left phacoemulsification with insertion of intraocualr lens under local anaesthetic.  The surgical view was compromised due to the extensive inferior corneal thinning, opacification, vascularisation and presence of pseudopterygium.  A Malyugin Ring and intracameral acetylcholine was used for intraoperative floppy iris syndrome.  The surgery was technically challenging but uncomplicated.

Results:

The patient made a successful post operative recovery with left visual acuity improving to 6/9 (0.00/-0.50 x 180).  Post operative corneal topography (figure 1) revealed flattening of the inferior peripherally thinned cornea, with steepening at 90 degrees away from this.  The corneal epithelium remained intact and there was no further progression of the inferior corneal thinning on anterior segment optical coherence tomography (figure 2).  The patient was prescribed ocular lubrication as required, and scheduled for a 6 month review.

Conclusions:

1. TMD is a rare peripheral corneal disease, characterised by peripheral thinning, lipid deposition, opacification and vascularisation.  It can result in large degrees of astigmatism and even perforation in advanced cases. It usually occurs in middle-aged men. 2. The diagnosis of TMD is clinical, and It is important to distinguish it from other peripheral corneal diseases such as Mooren's ulcer and pellucid marginal degeneration. 3. Pseudopterygium is a useful sign in diagnosing TMD. 4. It is important to consider location of wound placement and optimisation of surgical view in patients with TMD undergoing cataract surgery.

Financial Disclosure:

None