| Part1. Clinical Characteristics of Terrien’s Marginal DegenerationPurpose:To report the clinical characteristics of Terrien’s marginal degeneration (TMD).Methods:The charts of123eyes (77cases) with TMD in the past16years were retrieved. Age, gender, laterality, symptoms, location of foci, perforation, best-corrected visual acuity (BCVA) and prognosis were reviewed retrospectively. All cases were divided into four stages:early stage, progressive stage, ectasia stage and perforation stage. According to whether experience episodic ocular inflammation, all cases were divided into inflammatory and non-inflammatory type.Results:79%patients came from Zhejiang province,72%patients were farmers and workers, male:female1:1.4, mean age was47.8±16.4(12-78) years, most found in41-60years.41.6%eyes were inflammatory type and58.4%eyes were non-inflammatory type, with no statistical different in age. Disease duration was14.1±16.0(1-60) years. Unilateral:bilateral1.5:1. The cornea of superonasal, inferonasal, inferotemporal, superotemporal was involved in86%、47%、51%、81%of eyes,87.5%descemetocele and55.6%perforation were noted in superior cornea. Compared with non-inflammatory cases, inflammatory cases were tended to involve more quadrants (P=0.004). Clinically, TMD had specific features including peripheral corneal thinning, opacification, vascularization, lipid deposition with intact epithelium. Early stage, progressive stage, ectasia stage and perforation stage account for1.4%,27.6%,53.7%and7.3%, respectively.11.4%eyes had pseudopterygium. Compared with non-inflammatory cases, inflammatory cases were more obvious in lipid deposition. Inflammatory TMD was often misdiagnosed as Mooren’s ulcer or phlyctenular keratoconjunctivitis. After ectasia stage, BCVA was significantly affected and perforation may occur, and surgical treatment was needed.42eyes of38cases underwent operations. Corneal structures of all eyes were reconstructed and postoperative BCVA of71%eyes was equal to or more than0.5.Conclusions:This study mainly represented the clinical characteristics of TMD of Zhejiang Province. Our data showed that TMD was an uncommon disease. It occured more often in middle-aged women, was commonly bilateral. It generally began superonasally, marginal thinning with opacification, superificial vascularization and lipid deposition were the dominant features. Pseudopterygium could be observed in some cases,7.3%perforation occurred spontaneously or after minor trauma. Compared with non-inflammatory cases, inflammatory cases were more obvious in lipid deposition and quadrant involvement, and needed to be indentified with Mooren’s ulcer or phlyctenular keratoconjunctivitis. Surgery was the only treatment when lesion progressed to ectasia stage. Part2. Surgical Outcomes of Peripheral or Total Deep Lamellar Keratoplasty using Cryopreserved Donor Cornea for Terrien’s Marginal DegenerationPurpose:To evaluate the clinical efficacy of peripheral or total lamellar keratoplasty using cryopreserved donor tissue for Terrien’s marginal degeneration.Methods:There were42eyes of38patients included. Surgery indications included ectasia stage and perforation stage. According to the shape of the lesion, ring-shaped, D-shaped and total deep lamellar keratoplasty were performed. All grafts were stored at-20℃. Cryopreserved corneoscleral rims were prepared for ring-shaped grafts and cryopreserved whole eyeballs were prepared for D-shaped and total grafts. General condition, intraoperative performance, postoperative corneal reconstruction, astigmatism, best corrected visual acuity (BCVA), and complications were analysed.Results:Ring-shaped deep lamellar keratoplasty was performed in30eyes, D-shaped deep lamellar keratoplasty was performed in three eyes and total deep lamellar keratoplasty was performed in nine eyes. Postoperative follow-up time was28.4±24.8months. There was evidence of inflammation in22eyes (52.3%) and intraoperative perforation occurred in16eyes (38.1%). Corneal structures of all eyes were reconstructed. No allograft rejection was observed. Postoperative astigmatism and best corrected visual acuity improved (both P=0.00) except for cases that underwent D-shaped lamellar keratoplasty.11eyes (36.6%) of ring-shaped group developed transient ocular hypertension, high IOP was related with quadrant of the graft (P=0.039),80%of whole ring-shaped deep lamellar keratoplasty occurred postoperative high IOP and1eye developed secondary glaucoma. The advantages of total deep lamellar keratoplasty included that the graft was transparent, Postoperative astigmatism and BCVA statistically improved (both P=0.02), and intraoperative perforated rate was lower than ring-shaped deep lamellar keratoplasty (P=0.045). Conclusions:Peripheral corneoscleral lamellar keratoplasty for Terrien’s marginal degeneration using cryopreserved donor tissue is an effective technique that eliminates rejection. For cases that the lesion was in the peripheral and less that2quadrants, ring-shaped deep lamellar keratoplasty was recommended with the advantages of easy and saving donors; if the lesion progresses centrally or more than2quadrants involved, total deep lamellar keratoplasty was recommended to replace D-shaped deep lamellar keratoplasty or ring-shaped deep lamellar keratoplasty. |
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