Corneal Transplant And Cataract Surgery In Terrien Marginal Degeneration

Describe the management of a difficult case of a patient with Terrien marginal degeneration (TMD) and cataract. TMD described as a marginal corneal ectasia described by Terrien in 1990, is a rare disease, more common in men, located in the superior or superonasal region of the cornea. The superior thinning and flattening causes a relative steepening of the perpendicular meridian and astigmatism against the rule.

Clinica de Ojos Larco Vision, Quito, Ecuador.

A 72 years old male, with a history of progressive loss of vision in the left eye, user of contact lenses for several years and presenting intolerance in recent months associated with a greater decrease in vision in his left eye. During examination, best corrected visual acuity of hand motion at 10 cm, corneal protrusion and superior thinning, lipid deposition, superficial superior vascularization and nuclear opacity of the lens.

Managing cataract surgery and penetrating corneal transplantation as a triple procedure in a patient with TMD could be challenging. The importance of performing cataract surgery under a closed system is highlighted, surgical steps as dislocating the nucleus to the anterior chamber for phacoemulsification and then implanting the intraocular lens in the bag could decrease the rates of complications. Performing the cornea transplant in this type of patients could require more than sixteen simple sutures, usually performed during penetrating keratoplasty.