Peripheral Hypertrophic Subepithelial Corneal Degeneration: A Case Report With A Focus On Differential Diagnosis.

To describe the management of a case of Peripheral Hypertrophic Subepithelial Corneal Degeneration (PHSCD).

Humanitas San Pio X Hospital, Milan, Italy.

A 45-years old female Caucasian patient presented with decreased vision and mild chronic ocular discomfort in both eyes, in particular itching and burning, prevalently in the right eye. The patient was previously diagnosed with pterigium in both eyes since 2006.

She reported a negative history for ocular trauma or any other health condition, but a positive family history for glaucoma.
Anterior segment examination was remarkable for the presence of superficial corneal neovascularization, confluent subepithelial perilimbal fibrosis associated with corneal thickening, without involvement of the central cornea in both eyes, and for the presence of a pseudopterygium in the righ eye. No signs of limbal deficit on fluorescein staining were noted.

MS-39 AS-OCT; Costruzione Strumenti Oftalmici, Florence, Italy) illustrated the presence of bilateral irregular keratoscopic images, with involvement of the optical zone in the right eye.

A diagnosis of bilateral PHSCD (Peripheral Hypertrophic Subepithelial Corneal Degeneration) was made and surgery for the right eye was planned.

Scheduled surgery included the three following procedures: superficial keratectomy, pseudopterygium excision and apposition of human amniotic membrane (HAM). Nasal, inferior and temporal limbal hypertrophic degeneration excision with conjunctival opening at 4 mm from the limbus was performed. Finally, HAM was apposed on 210° (nasal, inferior and temporal) and fibrin glue was fixed.

This case reports illustrates a rare case of PHSCD.

The patient was successfully managed surgically, followed by placement of an amniotic graft. On successive post-op follow-up, the patient showed mild conjunctival hyperemia, adherent limbal amniotic membrane, centrally transparent cornea, round pupil normoreactive to light, and crystalline lens perfectly in place. The subepithelial corneal fibrotic tissue was managed with topical treatment. No evidence of relapse was observed.