First Author: M.Figueras-Roca SPAIN
Co Author(s): R. Quintana J. Torras M. Morral M. L A. Leszczynska M. Latasiewicz
Purpose:
To describe a case of Terriens corneal degeneration at risk of perforation because of important peripheral thinning that was surgically treated with a 12mm diameter anterior lamellar keratoplasty with 6 months of follow-up
Setting:
Hospital Clķnic of Barcelona, Ophthalmology department
Methods:
A 38 year old Latin-American man was referred to the Cornea department for a bilateral long-term peripheral superior corneal degeneration. The patient described a history of 20 years of left eye visual impairment. His visual acuity was 20/20 in his right eye and " counting fingers at 1 meter" in his left eye (best-corrected visual acuity of 20/50 in his left eye with a refraction of 80ŗ -17.00 -3.00). Corneal topography and manual and automated refraction were performed. Biomicroscopy of the anterior segment showed bilateral corneal degeneration with stromal thinning and subepitelial fibrosis affecting the superior peripheral cornea of his right eye and the superior hemicornea of his left eye (with involvement of visual axis). Intraocular pressure was normal, no inflammatory signs were found and funduscopy was reported normal. He was diagnosed of bilateral Terrien corneal degeneration. We found risk of spontaneous perforation because of stromal thinning and therefore indicated keratoplasty surgery.
Results:
A big diameter (12mm) deep anterior lamellar keratoplasty was manually performed. The recipient bed underwent dissection with a blunt spatula and the Descemet membrane was stripped from the donnor button. The edges of the graft were excised with scissors. Neither punch nor trephine was required and 16 Nylon 10-0 simple sutures were used to fix the graft. Postoperative treatment included topical tobramycin, dexamethasone and ofloxacin. Postoperative biomicroscopy showed good graft apposition with residual fibrosis of the superior corneal deep stroma. After 6 months of follow-up no complications were found, non-corrected visual acuity was 20/125 and BCVA was 20/60 (105 ŗ -3.00 -0.25 refraction) and the patient is intended to begin refraction-based sutures extraction.
Conclusions:
Peripheral corneal degeneration can be surgically managed in cases of perforation risk or refractive defects that cannot be solved with spectacles. Some of the proposed surgical treatments for these types of degenerations are: anterior llamellar semi lunar keratoplasty, that can be associated with a central penetrating keratoplasty, or large diameter anterior lamellar keratoplasty. This last procedure enables restitution of corneal normal integrity with reduced risk of graft rejection and less residual astigmatism than other techniques. To our experience in this case, such keratoplasty was effective and notably reduced the needed refraction with no complications this far. FINANCIAL DISCLOSURE?: No
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