Long-term Results of Corneal Cross-linking for Terrien's Marginal Degeneration

PURPOSE: To report the long-term clinical outcomes of a patient with Terrien's marginal degeneration who underwent successful peripheral corneal cross-linking (CXL) to arrest progression. METHODS: Clinical assessment included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography, anterior segment optical coherence tomography, ultrasonic pachymetry, corneal hysteresis, and corneal resistance factor. Eccentric epithelium-off CXL was performed in both eyes after limbal conjunctival resection. Following the Dresden protocol, fluence irradiation was set at 5.4 J/cm 2 , using 3 mW/cm 2 for a total exposure time of 30 minutes. RESULTS: Nine years of postoperative follow-up showed significant bilateral improvement in visual acuity, refraction, and corneal topography with no signs of progression of Terrien's marginal degeneration. In the right eye, UDVA improved from 0.05 to 0.3 decimal and CDVA from 0.8 to 1.2 decimal, cylinder was reduced from −14.00 to −3.00 diopters (D), simulated keratometry improved from 10.50 to 3.70 D, and the thinnest point on pachymetry remained almost unchanged (from 483 to 469 μ m). In the left eye, UDVA improved from 0.1 to 0.2 decimal and CDVA remained unchanged at 1.2 decimal, cylinder was reduced from −6.00 to −2.75 D, simulated keratometry improved from 5.60 to 3.30 D, and the thinnest point on pachymetry remained stable at 486 μ m. CONCLUSIONS: Eccentric peripheral CXL can be a safe, noninvasive alternative therapeutic approach for the management of Terrien's marginal degeneration with peripheral thinning. [ J Refract Surg. 2018;34(6):424–429.]