SALZMANN NODULE DEGENERATION IN A FORM OF SUBEPITHELIAL CORNEAL MEMBRANE. A CASE REPORT

Published 2023 - 27th ESCRS Winter Meeting

Reference: CR26 | Type: Case Report (Cornea Day) | DOI: 10.82333/x8pp-gp30

Authors: Anya Grinberg* ¹ , Daniel Wasserman ² , Beatrice Tiosano ³

¹Ophthalmology,Hillel Yaffe Medical Center,Hadera,Israel;Rappaport Faculty of Medicine,Technion Institute of Technology,Haifa,Israel, ²Ophthalmology,Hillel Yaffe Medical Center,Hadera,Israel, ³Ophthalmology,Hillel Yaffe Medical Center,Hadera,Israel;Rappaport Faculty of Medicine,Technion Institute of Technology,Hadera,Israel

Purpose

The purpose of this case is to present a patient with a particular elongated appearance of salzmann nodule degeneration (SND) in a form of a “subepithelial corneal membrane”, and to describe the management and the surgical technique that were used

Setting

Cornea unit, Department of Ophthalmology, Hillel Yaffe Medical Center, Hadera, Israel

Report of case

A 60-years-old male patient with a history of pterygium excision 4 years ago in his Left eye (LE), was examined in our cornea clinic due to complaints of decreased vision and eye discomfort in the same eye.

Visual Acuity in his LE was 6/24. Upon examination, a central corneal whitish grey nodule with subepithelial opacity extending until the periphery (Fig1).

Corneal topography (Fig2a) showing flattening of the cornea and irregular astigmatism.

AC- OCT (Fig2b): Irregular and thinned epithelium, sub-epithelial hyper-reflective nodular lesion that extends in a form of a membrane.

A Superficial keratectomy was performed, the membrane was peeled using fine forceps with a circular hand movement “Membranorhexis” (Fig3), polishing with a diamond burr and dual application of MMC 0.04% for 10 sec.

Histology of the specimen (Fig3): subepithelial hyaloid tissue with irregular collagen bundles and epithelium of variable thickness, consistent with Salzmann nodule.

One month after surgery, marked decrease in corneal opacity (Fig4), with significant Improvement of the visual acuity and astigmatism (Fig5).

In OCT, absence of the “subepithelial membrane” and SND with normalization of the epithelium (Fig6).

Conclusion / Take home message

Patients with SND may also present with a form of subepithelial corneal elongated membrane, decreased visual acuity and irregular astigmatism.

Superficial keratectomy and Membranectomy is recommended in such cases and may yield good results with improvement of visual acuity and reduced astigmatism.