Advanced Spheroidal Degeneration Managed With Superficial Keratectomy

to illustrate a case of advanced spheroidal degeneration treated with superficial keratectomy 

The case was managed at the Department of Ophthalmology, Habib Thameur Hospital, Tunis, Tunisia

single case report

90-year-old male patient presented with bilateral golden-colored translucent deposits. AS-OCT of the corneal lesions revealed hyperreflective deposits involving Bowman’s layer and the adjacent stroma in both eyes, along with superficial cystic structures of different sizes and shapes in OS. The patient underwent superficial keratectomy. Histopathology showed the presence of amorphous deposits under the corneal epithelium with no Congo red staining. The clinical, imaging, and histopathological findings were all consistent with the diagnosis of spheroidal degeneration. Postoperatively, the corneal surface of the left eye was smooth with a localized area of persistent corneal opacification.

Spheroidal degeneration is characterized by the accumulation of spheroid-like deposits at the superficial layers of the cornea. It is often linked to prolonged ultraviolet light exposure, as seen in patients with basal cell carcinoma. AS-OCT can be useful to identify the depth of the lesions especially when a surgical intervention is planned. Histopathology helps to rule out other differential diagnoses. In advanced stages, superficial keratectomy can be an effective treatment option before considering keratoplasty.