Anterior Segment Optical Coherence Tomography Assessment In Salzmann’S Nodular Degeneration Before And After Surgical Management: Case Report
Published 2023 - 41st Congress of the ESCRS
Reference: PO0222 | DOI: 10.82333/ez73-2d61
Authors: Laura Modamio-Gardeta* 1 , Hugo Santiago-Balsera 1 , Beatriz Galan-Garcia 1 , Elena Casas-Maroto 1 , Ana Maria Guadilla-Borras 1 , Carmen Fatima Rodriguez-Hernandez 1 , Nadia Minguez-Caro 1
1Ophthalmology,Hospital Universitario Infanta Cristina,Madrid,Spain
To present the clinical course and medical and surgical management of a patient with symptomatic Salzmann’s nodular degeneration (SND) and to highlight the clinical features revealed by anterior segment optical coherence tomography (AS-OCT) and slit lamp images before and after the surgical removal of the nodular tissue.
Hospital Infanta Cristina Department of Ophthalmology. Madrid, Spain.
A 68 year old female with SND in her left eye came to our Department complaining about worsening symptoms of foreign body sensation, pain and tearing. The patient presented 3 periferal whitish gray corneal opacities in the superior-temporal quadrant with sectorial limbal stem cell deficiency and superficial punctate keratitis.
Medical treatment with eyelid higiene, topic steriods, topic cyclosporine 0.05% and ocular lubrication was iniciated. After 4 months without improvement, a superficial keratectomy with manual excision of nodules using 25% ethanol solution to loosen the epithelium, intra-operative mitomycin-C application and amniotic membrane transplantation was performed.
Image control with AS-OCT and slit lamp images were performed.
The patient presented an adequate response to treatment with symptomatic improvement after surgery with no recurrence of the nodular lesions to date, 8 months after surgery. The patient is currently on treatment with ocular lubricants and eyelid hygiene.
Post-surgical AS-OCT showed the disappearance of the bright white subepithelial deposits corresponding to the nodular lesions.
Although SND may present asymptomatically or with mild symptoms that respond to medical treatment, surgery is necessary in some cases. Superficial alcohol-assisted keratectomy with or without intraoperative mitomycin C can be performed to remove nodules with amniotic membrane transplantation (AMT) as an adjunct.
AS-OCT is a useful adjunctive tool for the assessment of SND lesions, which appear as bright white subepithelial deposits in the cornea between Bowman's layer and the epithelium, which appears to be thinned over the nodules.
This could be a useful tool for postoperative follow-up and monitoring after surgical removal of the lesions.