ESCRS - PO172 - Benefits Of Removing Salzmann's Nodular Degeneration

Benefits Of Removing Salzmann's Nodular Degeneration

Published 2024 - 42nd Congress of the ESCRS

Reference: PO172 | Type: Case Report | DOI: 10.82333/e47w-by44

Authors: Pablo Infiesta Madurga* 1 , Teresa Torrent Solans 1

1Althaia Xarxa Assistencial Universitaria de Manresa,Barcelona,Spain

Purpose

 

Present the benefits obtained after the removal of Salzmann's nodular degeneration.

Setting

Salzmann's nodular degeneration is characterized by nodular lesions in the corneal periphery. It's interesting to observe in this case the relationship between the corneal periphery and its center, i.e. the Barraquer thickness law: "whenever tissue is either added to the periphery of the cornea or removed from its central part, a corresponding flattening is obtained and vice versa". Consequently, the presence of the nodule ultimately induces central corneal flattening, contributing to hyperopia.

Report of case

 

A 65-year-old female patient presents with ocular surface discomfort. Her medical history includes a diagnosis of rheumatoid arthritis, managed solely with NSAIDs (Celecoxib). Her corrected decimal visual acuity is 0.85 in both eyes, with notable anisometropia. The refractive correction is as follows:

 

OD: 70 -3.00 +5.00

OS: 55 -0.25 +2.00

 

Superficial punctate keratitis is observed in both eyes, along with Salzmann's nodular degeneration in the right eye. The corneal topography reveals a difference in corneal power between both eyes, justifying the anisometropia. This difference is not attributed to axial length discrepancy or crystalline lens origin due to varying cataract maturity levels. In the right eye, peripheral curvature alteration is evident in the area affected by Salzmann's nodular degeneration, influencing central corneal flattening. The lesion is surgically removed in the operating room using manual dissection (short video included), guided by intraoperative OCT to ensure the dissection is confined to the Bowman's membrane plane and prevent inadvertent stromal dissection, which could result in overcorrection. The refractive correction for the right eye is subsequently adjusted as follows:

 

OD: 40 -0.25 +2.00

 

Additionally, the patient reported a significant improvement in her ocular discomfort.

 

With appropriate keratometry measurements now attainable, cataract surgery can be considered, allowing for the implantation of a "real" lens power for the right eye.

 

Conclusion/Take home message

 

Salzmann's nodular degeneration is characterized by peripheral corneal curvature, resulting in central corneal flattening and, consequently, hyperopia.

 

The decision to remove lesions should be carefully considered for each individual case, taking into account the potential benefits.

 

Of particular interest is lesion removal before cataract surgery to ensure accurate surgical planning with corrected keratometry and thus precise lens power calculation.

 

Manual surgical dissection, while appearing as a simple procedure, encounters difficulty in achieving the correct dissection plane at the level of Bowman's membrane. Intraoperative OCT assistance helps to avoid stromal dissection and overcorrection.