Prevalencia de pacientes con queratocono en la Clínica Barraquer en Bogotá, Colombia / Prevalence of keratoconus patients at the Barraquer Clinic in Bogotá, Colombia

Introducción: Queratocono es un término clínico amplio, que describe un estado de la córnea derivado de su adelgazamiento focal y protrusión secundaria central, paracentral y/o periférica. Los reportes epidemiológicos globales revelan un amplio rango en cifras de prevalencia e incidencia que se podría explicar por las diferencias geográficas, factores de riesgo, tipo de población, métodos y criterios diagnósticos utilizados. En Colombia no hay estudios epidemiológicos que evalúen esta enfermedad de manera integral por lo que su frecuencia aún no ha podido ser determinada. Objetivo: identificar la prevalencia de Queratocono y Degeneración Marginal Pelucida (DMP) en el centro oftalmológico privado Clínica Barraquer, durante el periodo de tiempo comprendido entre enero de 2014 y enero de 2019. Diseño del estudio: estudio transversal de fuentes secundarias. Método: revisión de los registros médicos electrónicos de todos los pacientes que consultaron por primera vez; posteriormente, se filtraron por el diagnóstico de Ectasia Corneal y/o Queratocono. Cada una de las historias clínicas fue analizada por un oftalmólogo teniendo en cuenta los diagnósticos preestablecidos. Resultados: del grupo de 91.426 pacientes, 2.647 tenían Queratocono o DMP. Se estableció una prevalencia de Queratocono y DMP del 2.84%. La edad promedio al momento del diagnóstico fue de 29.7±12 años. El 42.8% eran mujeres y el 57.2% hombres. Conclusión: la ectasias corneales de tipo Queratocono y DMP, son enfermedades con una prevalencia significativa en la población colombiana evaluada en la clínica Barraquer; consideramos se requiere de programas de tamizaje visual para su detección y tratamiento oportunos.

Background: Keratoconus is a wide clinical term used to describe a corneal disease characterized by thinning and secondary central, paracentral or peripheral protrusion of the cornea. The global epidemiological reports reveal a wide range of prevalence and incidence, that may be explained by geographical differences, risk factors, kind of population, and methods and diagnostic criteria employed. There are no epidemiological studies to evaluate globally this disease in Colombia, therefore, its frequency has not been determined yet. Objective: to identify the prevalence of Keratoconus and Pellucid Marginal Degeneration (PMD) from January 2014 to January 2019 at the private ophthalmological center Clínica Barraquer. Study Design: cross-sectional study using secondary data. Method: a review of the electronic medical records of all patients who consulted for the first time was performed, and then, filtered by the initial diagnosis of Corneal Ectasia or Keratoconus. Each one of the medical records was analyzed by an ophthalmologist taking into account a series of pre-established diagnostic criteria. Results: of 91.426 patients, 2.647 had Keratoconus or PMD within the time interval of the study. A prevalence of 2.84% was determined in first time patients. The average age at the time of diagnosis was 29.7±12 years. 42.8% were female patients and 57.2% male patients. Conclusion: Keratoconus and PMD are diseases with significant prevalence in the Colombian population evaluated at the Barraquer clinic, thus, visual screening programs are required for accurate detection and treatment.

C-type Anterior Lamellar Keratoplasty Using Cryopreserved Leftover Cornea for Terrien's Marginal Degeneration

PURPOSE: To report a case of Terrien's marginal degeneration treated with C-type anterior lamellar keratoplasty using cryopreserved leftover cornea. CASE SUMMARY: A 63-year-old female visited our clinic because of left ocular discomfort and visual deterioration over several years. The patient had +2.25 Dsph = -5.00 Dcyl × 111° of astigmatism, and best corrected visual acuity was 20/20. Microscopic slit lamp examinations revealed an approximately 10.0 mm width semilunar shaped stromal opacity with surrounding stromal lipid deposit, as well as superficial neovascularization with thinning at superior perilimbal cornea. Anterior segment optical coherence tomography confirmed extreme thinning at the opacified cornea. The patient was diagnosed with Terrien's marginal degeneration. To prevent corneal perforation, C-type anterior lamellar keratoplasty using cryopreserved leftover cornea was performed. After 18 months after operation, donor graft was successfully attached via the anterior segment optical coherence tomography and microscopic slit lamp examination and graft rejection was not observed. CONCLUSIONS: C-type anterior lamellar keratoplasty using a cryopreserved cornea can be an effective therapeutic strategy for Terrien's marginal degeneration.

Corneal perforation during scleral indentation in a patient with pellucid marginal degeneration.

An observational case report of corneal perforation following scleral indentation in a patient with previously undiagnosed pellucid marginal degeneration is presented. Clinical examination, investigations, and subsequent management of this unwarranted and rare complication are described and discussed. The case highlights the need for thorough anterior segment examination before indirect ophthalmoscopy particularly in the presence of ectatic corneal pathology in which case scleral indentation should be avoided.

Analysis of clinical features of 56 cases with Terrien's marginal degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To analyze the clinical features of Terrien marginal degeneration ( TMD) .?METHODS:Fifty-six patients(90 eyes) admitted in our hospital from January 2013 to January 2015 were selected as observation group.At the same period, 56 healthy (88 eyes) for corneal examination were as control group to analyze the clinical features of TMD. With immunohistochemistry and enzyme linked immunoassay method ( ELISA), the levels of HLA-DR, HLA-DQ and tumor necrosis factor-α( TNF-α) in blood samples of TMD patients were tested.?RESULTS:The transparent degree of the eye, lipid deposition in TMD patients with early, advanced, swelling and hole-wearing period were significantly different (χ2=10.85,χ2=65.32, P<0.05).Astigmatism in TMD patients with early and advanced, swelling and hole -wearing period were significantly different (P<0.05).The levels of HLA-DR, HLA-DQ and TNF-αin blood samples between the two groups were significantly different ( t=45.326, t=23.564, t=19.86, P<0.05).?CONCLUSION: Terrien's marginal degenerative is an inflammatory disease characterized by increased levels of TNF-α, HLA-DQ, and HLA-DR in peripheral blood, decreased corneal transparency, astigmatism and lipid deposition.This research provides experiment evidence for the mechanism of TMD.

Collagen cross-linking in the treatment of pellucid marginal degeneration.

Pellucid marginal degeneration (PMD) is an uncommon cause of inferior peripheral corneal thinning disorder, characterized by irregular astigmatism. We analyzed a case of bilateral PMD patient and treated one eye with corneal collagen cross-linking (CXL) therapy. Corneal topography was characteristic for PMD. Visual acuity, slitlamp examinations, tonometry, and corneal thickness were observed. Simulated keratometric and topographic index values were detected with corneal topography. Uncorrected, LogMAR visual acuity has improved from +0.8 to +0.55 during the 6 months and +0.3 during the 8 months followup after CXL. Pachymetry values and intraocular pressure showed no changes. Keratometric values and topografic indexes disclosed no progression of the disease. CXL may postpone or eliminate the need of corneal transplantation in cases with PMD.

Iatrogenic corneal perforation in Terrien Marginal Degeneration

This case report is about a rare disease with unusual presentation. Failure to recognise atypical presentation may lead to error in managing the patient and cause disastrous complications. Here we highlight a case of Terrien Marginal Degeneration in both eyes with atypical presentation; namely pseudopterygium. A 22 year old man was referred to our centre for iatrogenic right eye corneal perforation after having an atypical pterygium removed at another hospital. On arrival, his vision was 1/60 in both eyes with bilateral cornea Terrien Marginal Degeneration. His right eye anterior chamber was deep with a conjunctival flap covering the perforation site which was located from the 2.30 – 3.30 clock position nasally with no aqueous leak. However after a day his right eye anterior chamber became flat and there was fast aqueous leak from the perforation site. An emergency C shaped peripheral corneal lamellar keratoplasty was performed to seal the perforation. Post operatively his right eye improved to 6/24.

A Case of a Traumatic Eyeball Rupture in Terrien's Marginal Degeneration and It's Surgical Repair

PURPOSE: To report a primary surgical repair of a severe corneal laceration, a lens prolapse and a traumatic aniridia by blunt trauma in Terrien's marginal degeneration. METHODS: A 46-year-old female visited our hospital for corneal laceration due to a blunt trauma of the right eye. A primary corneal suture was done and 8 days later, amniotic membrane transplantation was performed. RESULTS: The perforated eyeball regained its integrity with a stabilized cornea. Also, the anterior chamber was reformed and visual acuity improved. CONCLUSIONS: In the first case of Terrien's marginal degeneration in the right eye, which had a 360-degree iridodialysis(aniridia) with aphakia due to blunt traumatic separation of the iris root from the ciliary body. We achived a good operative result with primary corneal suture and amniotic membrane transplantation.

A Treatment using Amniotic Membrane Transplantation in Rupture of Terrien's Marginal Degeneration

PURPOSE: To evaluate the effectiveness of amniotic membrane transplantation (AMT) on the repair of peripheral corneal perforation occurring during cataract surgery of a case of Terrien's marginal degeneration. METHODS: A 77-year-old male patient was referred to our hospital from a private clinic because of corneal perforation during cataract surgery of the right eye. Emergency AMT was performed. RESULTS: The eyeball regained its integrity with stabilized corneal surface, reformed anterior chamber and clearance of the inflammation. CONCLUSIONS: AMT may be an effective alternative for treating corneal perforation or impending perforation.

Long-term Follow-up of Terrien's Marginal Degeneration

PURPOSE: The purpose of this study is to investigate the long-term follow up of the patients with Terrien's marginal degeneration and to help the treatment of disease. METHODS: Eighteen (22 eyes) patients were selected who visited the Department of Opthalmology at Kangnam St. Mary's Hospital from 1994 to 2001 and were diagnosed with Terrien's marginal degeneration. The mean follow-up periods was 4.1 years. The distribution of lesion location and depth by slit lamp biomicroscopy, refraction by autorefractor and keratometry, and corneal topography were done. And we retrospectively analyzed age, sex, change of astigmatism, erythrocyte sedimentation rate by blood sampling, and serum level of C-reactive protein and rheumatoid factor. RESULTS: The range of age is from 11 to 74 years and the mean age of Terrien's marginal degeneration is 46 years. The superior nasal portion of cornea is most common site of Terrien's marginal degeneration. In 8 cases, axis of astigmatism is concordant with lesion site. And there were no statistically significant progression of cylindrical diopter changes except those undergoing intraocular surgery. Serum indicators of immunologic and inflammatory disease had no difference from normal value. CONCLUSIONS: Terrien's marginal degeneration occurs at any age without specific underlying causes such as immunologic or inflammatory disease. It is relatively safe and not vision threatening except severe forms of corneal thinning which affect astigmatism. Cases with corneal perforation require partial or full thickness corneal graft and have good prognosis

Clinical study of reversed lamellar keratoplasty / 眼科新进展

Objective　To evaluate the therapeutic efficiency of reversed lamellar keratoplasty for bullous keratopathy, Terrien's marginal degeneration and ocular chemical burns.Methods　Twenty eyes of patients with bullous keratopathy, twelve eyes with Terrien's marginal degeneration, ten eyes with chemical burns were recruited in this study.Diseased tissues were removed by means of dissection.Reversed lamellae corneal tissues which had been prepared by cryopreservation were thawed and rinsed. Then the prepared posterior corneal lamellae was turned over, endothelium facing upwards. The diameter of the graft should be 0.5～1.0mm larger than that of the recipient bed. The reversed donor posterior lamellae was sutured into the host keratectomy bed with 10-0 nylon sutures continuously or interruptedly.Results　Allograft reaction episode occurred only one (chemical burn) of the total 42 eyes enrolled.The grafts of the rest 41 eyes maintained clear or semitransparent for 1～5 years. Graft edema could be observed within 2～4 weeks postoperatively. Postoperative interface separation was not found. For all 20 patients with bullous keratopathy, the symptoms of pain disappeared. The visual acuity improved 2～3 lines of Snellen among eleven of twelve patients with Terrien's marginal degeneration. The visual acuity improved 2～3 lines of Snellen with four patients with chemical burns.Conclusion　The technique of reversed lamellar keratoplasty can be applied successfully for tectonic reconstruction of corneal surface such as bullous keratopathy, Terrien' s marginal degeneration and also chemical burns.The effects of therapy was satisfactory.

Sterile Corneal Peripheral Perforation after Cataract Surgery in Terrien's Marginal Degeneration

Previous reports have documented the occurrence of sterile peripheral corneal ulcer and perforation after cataract surgery in patients with systemic autoimmune vasculitic disease or Sjogren's syndrome. But the corneal complication after cataract surgery in patients with Terrien's marginal degeneration, characterized by bilateral slowly progressive thinning of peripheral cornea with opacity and superficial vascularization, have not been reported. We report a case of sterile peripheral corneal perforation following recent cataract surgery in a 77 year old woman with Terrien's marginal degeneration, treated with partial penetrating keratoplasty.

A Case of Unilateral Pellucid Marginal Corneal Degeneration Diagnosed by Computerized Topography

Pellucid marginal degeneration is a noninflammatory peripheral corneal thining disorder, which progresses slowly, affects inferior cornea bilaterally, occurs usually between twenties and fifties. Protrusion of the cornea with normal corneral thickness occurs above a band of thinning which is located 1 to 2mm from the limbus and measures 1 to 2mm in width and the patient complaints of progressive visual disturbance due to high irregular astigmatism. Topographically, the lowest corneal power is located along a narrow corridor of the central and peracental cornea and corneal power is highest along the inferior peripheral cornea and in the mid-peripheral cornea along the inferior oblique corneal meridian in a band-like fashion and is decreased slowly superior to that meridian. We experienced a case of pellucid marginal degeneration who had a history of progressive visual loss due to high irregular astigmatism. A 67 year-old woman had the characteristic topographic pattern and clinical feature of pellucid marginal degeneration only in her righ eye and we report it as the first case of unilateral pellucid marginal degeneration in Korea.

A Case of Unilateral Pellucid Marginal Corneal Degeneration Diagnosed by Computerized Topography

Pellucid marginal degeneration is a noninflammatory peripheral corneal thining disorder, which progresses slowly, affects inferior cornea bilaterally, occurs usually between twenties and fifties. Protrusion of the cornea with normal corneral thickness occurs above a band of thinning which is located 1 to 2mm from the limbus and measures 1 to 2mm in width and the patient complaints of progressive visual disturbance due to high irregular astigmatism. Topographically, the lowest corneal power is located along a narrow corridor of the central and peracental cornea and corneal power is highest along the inferior peripheral cornea and in the mid-peripheral cornea along the inferior oblique corneal meridian in a band-like fashion and is decreased slowly superior to that meridian. We experienced a case of pellucid marginal degeneration who had a history of progressive visual loss due to high irregular astigmatism. A 67 year-old woman had the characteristic topographic pattern and clinical feature of pellucid marginal degeneration only in her righ eye and we report it as the first case of unilateral pellucid marginal degeneration in Korea.

Two Cases of Pellucid Marginal Corneal Degeneration

Pellucid marginal degeneration is an uncommon, idiopathic, non-inflammatory, peripheral thinning disorder affecting the inferior cornea bilaterally. Protrusion of the cornea occurs above a band of thinning which is located 1 to 2mm from the limbus and measures 1 to 2mm in width. The disease is diagnosed usually between 20 and 50 years of age and its etiology remains obscure. We experienced two cases of pellucid marginal degeneration who had a histories of progressIve visual disturbance due to high irregular astigmatism. A 32 year old female(case.1) had the characteristic feature of pellucid marginal corneal degeneration with marked endothelial cell loss(OD. 624 +/- 32 cells/mm2, OS. 596 +/- 52 cells/mm2) in polymorphism. A 30 year old male(Case. 2) showed pellucid marginal corneal degeneration associated with rheumatoid athritis, but corneal endothelial cells appeared within normal ranges(OD. 2764 +/- 26, OS. 2812 +/- 34) with slight polymorphism. The Vision in these two cases improved to 20/20 with hard contact lens(Case. 1) and glasses(Case.2)

A Case of Terrien's Margina| Degeneration of the Cornea accompanied with the Iritis

Terrien's marginal degeneration is a rare bilateral condition. Most investigators have thought that it was a degenerative origin, and emphasized the lack of significant inflammatory signs and symptoms. Several reports in Korea, except one case of perforation reported only mild conjunctival injection. But, recent reports suggested the possibility of inflammatory process and immune phenomenon. We experienced one case of Terrien's marginal degeneration accompanied with the iritis and treated with topical steroid, conjunctival flap and therapeutic contact lens.

A Case of Terrien's Margina| Degeneration of the Cornea accompanied with the Iritis

Terrien's marginal degeneration is a rare bilateral condition. Most investigators have thought that it was a degenerative origin, and emphasized the lack of significant inflammatory signs and symptoms. Several reports in Korea, except one case of perforation reported only mild conjunctival injection. But, recent reports suggested the possibility of inflammatory process and immune phenomenon. We experienced one case of Terrien's marginal degeneration accompanied with the iritis and treated with topical steroid, conjunctival flap and therapeutic contact lens.