Terrien's Marginal Degeneration : Contribution Of Anterior Segment Tomography

to describe anterior segment OCT (AS- OCT) findings of Terrien's marginal degeneration (TMD) 

The patient was examined clinically after consulting our clinic for a degradation of his visual acuity, the diagnosis was suspected and confirmed after doing an AS-OCT, optical correction was done for the right eye of the patient.

We present an 85-year-old patient with bilateral, progressive visual acuity decline over ten years, no noteworthy medical history.

Examination revealed limited visual acuity and central corneal opacification in the right eye, and finger counting visual acuity and dense cataract in the left eye. Examination revealed no epithelial defect or ocular inflammation. Both eyes exhibited peripheral corneal thinning, negative fluorescein test, and circumferential ectasia, with lipid deposits and neovascularization. The posterior segment was inaccessible.  Anterior Segment Optical Coherence Tomography showed thinning and lipid deposition. The diagnosis of TMD was made, and the patient underwent optical correction with scleral lenses in the right eye.

TMD progresses slowly through five phases, characterized by peripheral corneal thinning and lipid deposition. Central corneal opacification, observed here, indicates advanced disease. AS-OCT provides non invasive and high resolution images of the corneal microstructure and is useful for the observation of detailed morphologic changes of diseased cornea. It aids in diagnosis and monitoring. Recently, differentiating features between TMD and inflammatory peripheral corneal ectatic disorders on AS-OCT have been described.