J Korean Ophthalmol Soc.  2017 Apr;58(4):467-472. 10.3341/jkos.2017.58.4.467.

C-type Anterior Lamellar Keratoplasty Using Cryopreserved Leftover Cornea for Terrien's Marginal Degeneration

• Shim KY
• Jun JH

• KMID: 2376605
• DOI: http://doi.org/10.3341/jkos.2017.58.4.467

Abstract

PURPOSE
To report a case of Terrien's marginal degeneration treated with C-type anterior lamellar keratoplasty using cryopreserved leftover cornea.
CASE SUMMARY
A 63-year-old female visited our clinic because of left ocular discomfort and visual deterioration over several years. The patient had +2.25 Dsph = -5.00 Dcyl × 111° of astigmatism, and best corrected visual acuity was 20/20. Microscopic slit lamp examinations revealed an approximately 10.0 mm width semilunar shaped stromal opacity with surrounding stromal lipid deposit, as well as superficial neovascularization with thinning at superior perilimbal cornea. Anterior segment optical coherence tomography confirmed extreme thinning at the opacified cornea. The patient was diagnosed with Terrien's marginal degeneration. To prevent corneal perforation, C-type anterior lamellar keratoplasty using cryopreserved leftover cornea was performed. After 18 months after operation, donor graft was successfully attached via the anterior segment optical coherence tomography and microscopic slit lamp examination and graft rejection was not observed.
CONCLUSIONS
C-type anterior lamellar keratoplasty using a cryopreserved cornea can be an effective therapeutic strategy for Terrien's marginal degeneration.

Keyword

Anterior lamellar keratoplasty; Cryopreserved; C-type; Leftover cornea; Terrien's marginal degeneration

MeSH Terms

Astigmatism
Cornea*
Corneal Perforation
Corneal Transplantation*
Female
Graft Rejection
Humans
Middle Aged
Slit Lamp
Tissue Donors
Tomography, Optical Coherence
Transplants
Visual Acuity

Figure

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  Figure 1. Preoperative evaluations. (A) Semilunar shaped stromal opacity with lipid depositions and neovascularization at superior perilimbal area was observed on slit lamp examination (arrowheads). The size of opacified lesion is 10.0 mm in width and 2.0 mm in maximum height. (B) Thin angled slit beam revealed severe peripheral corneal thinning at superior perilimbal area (arrow). (C) Anterior segment optical coherence tomography showed extremely thinned cornea tissue. Measurement of the corneal thickness at the thinnest area was 80 μ m (arrow).

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  Figure 2. The serial surgical steps of anterior lamellar keratoplasty using a cryopreserved leftover cornea. (A) Recipient area was marked with surgical marking pen and incised with No 15 blade. Marked edge was 0.5 mm apart from thinned area of cornea. (B) Corneal stroma was carefully dissected with crescent knife not to perforate descemet’s membrane. (C, D) Cryopreserved leftover cornea was placed and trimmed in the same size of the dissected area. (E) The trimmed anterior lamellar graft was positioned and sutured at each apex. (F) Multiple interrupted sutures were placed at a lamellar graft and recipient bed using 10-0 nylon.

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  Figure 3. Postoperative evaluations. (A) A slit lamp microscopic photograph at 18 months after the surgery. The corneal graft was well attached (arrowheads). (B) Scheimpflug pachymetric image at 10 months after the surgery showed no recurrence of corneal thinning of the graft. (C) At 18 months after the surgery, anterior optical coherence tomography showed well attached graft and cor-neal thickness was well maintained after the c-shape graft. Measurement of the corneal thickness was 634 μ m (arrow). OS = oculus sinister; N = nasal; T = temporal.

Reference

References

1. Duke-Elder S. . System of Ophthalmology. 1st ed.Vol. 8. London: Kimpton;1965; 909–14.

2. Austin P, Brown SI. . Inflammatory Terrien's marginal corneal disease. Am J Ophthalmol. 1981; 92:189–92.

3. Beauchamp GR. . Terrien's marginal corneal degeneration. J Pediatr Ophthalmol Strabismus. 1982; 19:97–9.

4. Wang T, Shi W, Ding G. . Ring-shaped corneoscleral lamellar keratoplasty guided by high-definition optical coherence tomog-raphy and Scheimpflug imaging for severe Terrien's marginal cor-neal degeneration. Graefes Arch Clin Exp Ophthalmol. 2012; 250:1795–801.

5. Huang D, Qiu WY, Zhang B. . Peripheral deep anterior la-mellar keratoplasty using a cryopreserved donor cornea for Terrien's marginal degeneration. J Zhejiang Univ Sci B. 2014; 15:1055–63.

6. Shimmura S, Tsubota K. . Deep anterior lamellar keratoplasty. Curr Opin Ophthalmol. 2006; 17:349–55.

7. Panda A, Vanathi M, Kumar A. . Corneal graft rejection. Surv Ophthalmol. 2007; 52:375–96.

8. Jang JH, Chang SD. . Tectonic deep anterior lamellar keratoplasty in impending corneal perforation using cryopreserved cornea. Korean J Ophthalmol. 2011; 25:132–5.

9. de Farias CC, Allemann N, Gomes JÁ. . Randomized trial comparing amniotic membrane transplantation with lamellar corneal graft for the treatment of corneal thinning. Cornea. 2016; 35:438–44.

10. Cheng CL, Theng JT, Tan DT. . Compressive C-shaped lamellar keratoplasty: a surgical alternative for the management of severe as-tigmatism from peripheral corneal degeneration. Ophthalmology. 2005; 112:425–30.

11. Brunette I, Le François M, Tremblay MC, Guertin MC. . Corneal transplant tolerance of cryopreservation. Cornea. 2001; 20:590–6.

12. Armitage WJ, Hall SC, Routledge C. . Recovery of endothelial function after vitrification of cornea at −110 degrees C. Invest Ophthalmol Vis Sci. 2002; 43:2160–4.

13. Schultz RO, Matsuda M, Yee RW. . Long-term survival of cry-opreserved corneal endothelium. Ophthalmology. 1985; 92:1663–7.

14. Yao YF, Zhang YM, Zhou P. . Therapeutic penetrating kerato-plasty in severe fungal keratitis using cryopreserved donor corneas. Br J Ophthalmol. 2003; 87:543–7.

15. Han JY, Jun JH. . A case of therapeutic keratoplasty using cryo-pres-ervative cornea in candida albicans keratitis. J Korean Ophthalmol Soc. 2016; 57:1170–5.