SMOOTHING THE EDGES IN SALZMANN NODULAR DEGENERATION: A CASE REPORT
Published 2023 - 27th ESCRS Winter Meeting
Reference: CR28 | Type: Case Report (Cornea Day) | DOI: 10.82333/kmxa-cd62
Authors: Inês Ludovico* 1 , Patrícia Barros da Silva 1 , Edgar Lopes 1 , Carlos Batalha 1 , Vítor Maduro 1
1Centro Hospitalar e Universitário de Lisboa Central,Lisbon,Portugal
Purpose
Our purpose is to report a case of a patient referred to our Ophthalmology Department with Salzmann nodular degeneration, that was submitted to superficial keratectomy conjugated with amniotic membrane transplantation on her right eye, prior to cataract surgery.
Setting
Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
Report of case
A 62-year-old Caucasian female with no relevant past history of chronic ocular surface disease is referred to our Ophthalmology Department with complaints of decreased visual acuity. She presented with a BCVA of 20/50 in both eyes. On slit-lamp examination she was found to have four temporal gray/white corneal subepithelial opacities on her right eye and three superior nodular corneal lesions on her left eye, all peripherally located. Fundoscopic examination showed no alterations. Anterior segment photography allowed us to obtain more detailed images of the biomicroscopic findings. PENTACAM Tomography showed an irregular astigmatism of 8.4 Diopters in her right eye and 14.6 Diopters on her left eye. Specular microscopy showed an endothelial cell count of 1495 cells/mm2 and hexagonality of 44 ± 3% in both eyes. Anterior segment swept-source optical coherence tomography (AS-OCT) ANTERION depicted hyper-reflective subepithelial lesions with an overlying thinned epithelium and a fragmented Bowman’s layer underneath the nodules. The patient underwent right eye superficial keratectomy followed by amniotic membrane transplantation, in order to make the corneal surface as regular as possible for an accurate IOL calculation prior to cataract surgery.
Conclusion / Take home message
SND ranges from asymptomatic to more severe symptoms such as decreased BCVA due to irregular astigmatism. Most of the time a conservative approach is enough. Surgical management is reserved for specific situations. It includes superficial keratectomy or excimer laser phototherapeutic keratectomy, conjugated with amniotic membrane transplantation or intraoperative mitomycin C administration.