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A severe case of Salzmann’s nodular degeneration following trachoma: a two-step surgical approach

Poster Details

First Author: R.Esteves Marques PORTUGAL

Co Author(s):    F. Teixeira   J. Pinto   A. Quintas   P. Guerra   W. Rodrigues        

Abstract Details


Salzmann’s Nodular Degeneration (SND) is a rare corneal disease. Severe and/or refractory cases may require repeated surgical interventions. We present a severe case of SND following trachoma, highlighting results of a two-step surgical approach with superficial keratectomy with amniotic membrane transplantation, followed by big bubble deep anterior lamellar keratoplasty (BB-DALK).


Cornea and Ocular Surface Department, Ophthalmology Clinic, Hospital de Santa Maria, Lisboa, Portugal.


Case report of a 45-year old melanodermic male, who presented to our department for ocular discomfort and low visual acuity in both eyes (OU). The patient had an ocular history of strabismic amblyopia in the right eye (OD), and childhood trachoma with progressive visual deterioration OU. Best corrected visual acuity (BCVA) was “hand motion” OD and “counting fingers” in the left eye (OS). Slit lamp microscopy: bilateral corneal peripheral neovascularization and findings of limbal stem cell insufficiency; there were also multiple greish epithelial nodules, peripheral and central, associated with subepithelial haze.


After establishing the diagnosis of SND OU with etiology attributed to childhood trachoma, the patient started on intense topical preservative-free lubrication. The patient was then submitted to a programmed superficial keratectomy with amniotic membrane transplantation, with postoperative tapering steroid regimen. Two months postoperative, BCVA OS improved to 20/100, with considerable patient satisfaction, but the subepithelial haze was maintained. For these successful but shortcoming results, the patient was then submitted to BB-DALK with a peripheral Descemet microperforation. After three rebubbling procedures and one year postoperative, BCVA OS improved to 60/100, with maintained corneal transparency and no recurrence of disease.


A two-step surgical approach to Salzmann’s Nodular Degeneration was revealed as an effective option towards symptoms resolution and visual acuity improvement. Despite the relative success of superficial keratectomy, BB-DALK was associated with a more significant visual improvement.

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