BACKGROUND: To evaluate the clinical efficacy of ring-shaped corneoscleral lamellar keratoplasty under guidance of high-definition optical coherence tomography (HD-OCT) and Scheimpflug imaging for severe Terrien's marginal corneal degeneration. METHODS: Twenty-five patients (25 eyes) with Terrien's marginal corneal degeneration and ≥ 6 diopters of astigmatism were treated at the Shandong Eye Institute from January 2008 through December 2010. In these patients, the diseased area was > 1 quarter of the cornea, and the thickness at the thinnest corneal area was < 150 μm with residual corneal stroma. Ring-shaped corneoscleral lamellar keratoplasty was performed, and the depth and width of dissection was set according to the HD-OCT and Pentacam examinations. Data of complications, surgical effects, visual acuity, and astigmatism were collected. RESULTS: No intraoperative corneal perforation occurred. No patients had liquid accumulation between the graft and the recipient. At 1 year after surgery, the average best-corrected visual acuity improved to 6/9 from preoperative 6/36, and the average astigmatism reduced to 4.37 (2.04) diopters from preoperative 13.39 (7.52) diopters. There was no recurrence of the disease or corneal graft rejection in the follow-up period. CONCLUSIONS: Ring-shaped corneoscleral lamellar keratoplasty guided by HD-OCT and Pentacam imaging appears to be effective in the treatment of severe Terrien's marginal corneal degeneration. Surgical perforation can be significantly reduced.
BACKGROUND: To evaluate the clinical efficacy of ring-shaped corneoscleral lamellar keratoplasty under guidance of high-definition optical coherence tomography (HD-OCT) and Scheimpflug imaging for severe Terrien's marginal corneal degeneration. METHODS: Twenty-five patients (25 eyes) with Terrien's marginal corneal degeneration and ≥ 6 diopters of astigmatism were treated at the Shandong Eye Institute from January 2008 through December 2010. In these patients, the diseased area was > 1 quarter of the cornea, and the thickness at the thinnest corneal area was < 150 μm with residual corneal stroma. Ring-shaped corneoscleral lamellar keratoplasty was performed, and the depth and width of dissection was set according to the HD-OCT and Pentacam examinations. Data of complications, surgical effects, visual acuity, and astigmatism were collected. RESULTS: No intraoperative corneal perforation occurred. No patients had liquid accumulation between the graft and the recipient. At 1 year after surgery, the average best-corrected visual acuity improved to 6/9 from preoperative 6/36, and the average astigmatism reduced to 4.37 (2.04) diopters from preoperative 13.39 (7.52) diopters. There was no recurrence of the disease or corneal graft rejection in the follow-up period. CONCLUSIONS: Ring-shaped corneoscleral lamellar keratoplasty guided by HD-OCT and Pentacam imaging appears to be effective in the treatment of severe Terrien's marginal corneal degeneration. Surgical perforation can be significantly reduced.