Ring-shaped corneoscleral lamellar keratoplasty for Terrien's marginal corneal degeneration

Authors

Joao Quadrado Gil's picture
Author title: 
MD
Author name: 
Joao Quadrado Gil
Author affiliation: 
Centro de Responsabilidade Integrada em Oftalmologia - Centro Hospitalar e Universitário de Coimbra
Pathology: 
Degeneration & Dystrophies
History of Present Illness (HPI): 

The patient is a 30 year old male who was followed on our clinic, on a outpatient basis, with a diagnosis of Terrien's marginal corneal degeneration.

He complained of progressive, painless, diminished visual acuity of his left eye.

Past Medical History and Review of Systems (If relevant): 

No relevant personal or familiar medical history

Ophthalmologic examination: 

Uncorrected visual acuity was 12/10 on the right eye and counting fingers on the left eye. With a spectacle correction of 0,50 (-4,00 x 90º), visual acuity of the left eye improved to 5/10.

slit-lamp examination of the right eye was unremarkable.
On the left eye the cornea presented a crescent shaped superior thining, reaching from 10h to 2h, with extensive deep and superficial neovascularization. The remaining anterior segment presented no significant changes.

Stereoscopic view of the fundus showed no signs of retinal disorders bilaterally.

Composite image of the superior corneal thining noted on the left eye. Neovscularization can be observed
Ancilliary tests: 

Anterior segment OCT exam was performed using the SL-OCT device (Heidelberg Engineering).
Topographic evaluation was performed with the Orbscan II device (Bausch & Lomb).

Anterior segment OCT depicting the irregular thining of the superior cornea (top and medium images). Thickness and shape of the remainding left cornea is normal (lower image)
Treatment: 

Partial Lamellar Keratoplasty

The edited video displaying the surgery can be assessed in the Video Gallery section, under the title "Ring-shaped corneoscleral lamellar keratoplasty for Terrien's marginal corneal degeneration"

Evolution: 

On the first post-operative day, firm attachment of the graft and a formed anterior chamber were noted.
Best corrected visual acuity was 7/10 with a correction of (-4.00 x 105º).

After a follow-up of 4 months, corneo-scleral graft remains in position. No episode of acute rejection ocurred.
Best corrected visual acuity remains at 7/10 with a correction of -1.00 (-2.50 x 85º).

Anterior chamber photography on the first post-operative day
Corneal topography (Orbscan II) on the first post-operative day
Corneal topography (Orbscan II) on the first post-operative month
Anterior chamber photography on the second post-operative month
Anterior chamber photography on the fourth post-operative month
Corneal topography (Orbscan II) on the fourth post-operative month
Suggested reading / references: 

Wang T et al. Ring-shaped corneoscleral lamellar keratoplasty guided by high-definition optical coherence tomography and Scheimpflug imaging for severe Terrien’s marginal corneal degeneration. Graefes Arch Clin Exp Ophthalmol (2012) 250:1795–1801

Gao H et al. Partial lamellar keratoplasty for peripheral corneal disease using a graft from the glycerin-preserved corneoscleral rim. Graefes Arch Clin Exp Ophthalmol. Published online: 6 May 2014

Submitted by Joao Quadrado Gil on 03/27/2015 - 19:37.