#Icd 10 pellucid marginal degeneration Patch#

Crescent-shaped lamellar or full-thickness corneoscleral patch grafts may be used.

Surgical correction is indicated when perforation is imminent due to progressive thinning or when astigmatism significantly limits visual acuity. Most common medical therapy is contact lenses to address the corneal astigmatism. Underlying corneal thinning should be monitored carefully.

Initial conservative management for the severe astigmatism includes the use of spectacles or rigid gas-permeable contact lenses. Generally no treatment is required, unless perforation or impending perforation occurs. Marginal furrow degeneration is bilateral and avascular with only minimal, if any, thinning. Inflammatory Staphylococcal lesions usually have a lucid interval between the limbus and the infiltrate and only rarely cause thinning. Terrien’s is generally easy to differentiate from Mooren’s because there is no pain or inflammation, the epithelium is intact and there is no overlying edge. This variant may be the same as Fuchs' superficial marginal keratitis.Ĭorneal topography reveals flattening of the peripheral thinned cornea, with steepening of the corneal surface approximately 90° away from the midpoint Rarely, it may present as a pseudo-pterygium with a broad, flat, leading edge that arises in an oblique axis. Collagen vascular diseases should be excluded. It can present with recurrent painful episodes of inflammation. Terrien’s marginal degeneration may be differentiated from other peripheral corneal thinning disorders by the lack of inflammation, presence of superficial vascularization, advancing linear deposition of lipid, lack of epithelial defect and slow progressive course. Typically presents as painless progressive blurred vision. Patients have a high against-the-rule or oblique astigmatism from the progressive flattening of the vertical meridian. Physical examination reveals a leading edge of lipid, steep central edge, sloping peripheral edge, intact epithelium and superficial vascularization. The diagnosis of Terrien’s Marginal Degeneration is primarily clinical, based on history and slit lamp examination of the eye. Histocytes with a high degree of lysosomal activity are responsible for the destruction of collagen fibrils. Electron microscopy demonstrates collagen precursors, stromal ground substance, and possibly lipid phagocytized by histiocytic cells with high lysosomal activity. Subepithelia fibrillar collagen degeneration has been seen with light microscopy. Thinning and occasional breaks may be seen in Descemet’s membrane. Bowman’s membrane is typically absent or degenerated. The epithelium may be normal, thickened or thinned. It has also been reported in patients with posterior polymorphous dystrophy, anterior basement membrane dystrophy and erythema elevatum diutinum. The second more inflammatory type occurs in young to middle-aged men (75%) and occurs in the second or third decade of life. The first occurring in the older population and is asymptomatic and slowly progressive. It is more common in men than women (3:1). Terrien’s marginal degeneration is typically seen in patients 20-40 years of age, although it may present in childhood. Spontaneous ruptures in Descemet’s membrane can result in interlamellar fluid or even a corneal cyst. Spontaneous perforation is rare, although perforation can occur easily with minor trauma.

Vessels transverse the furrow and pass beyond it. A yellow line of lipid deposits appears at the leading edge of the pannus (central edge of the furrow). The central wall is steep, and the peripheral wall slopes gradually. The thinning spreads circumferentially, rarely involves the inferior limbus, and leaves the epithelium intact. Opacification is followed by the development of a peripheral, superficial, fine vascular pannus, which progresses over the years to include subepithelial opacity at the advancing edge, without the overlying edge characteristic of Mooren’s ulcer. Degeneration typically begins superiorly with mild, punctuate subepithelial and/or anterior stromal opacities and leaves a clear area between the opacities and the limbus. Degeneration may lead to a high degree of against-the-rule or oblique astigmatism.Ĭorneal thinning can be localized or involve extensive proportions of the peripheral cornea. It causes a slowly progressive non-inflammatory, unilateral or asymmetrically bilateral peripheral corneal thinning and is associated with corneal neovascularization, opacification and lipid deposition. Terrien’s marginal degeneration is an uncommon but distinct variety of marginal thinning of the cornea. Peripheral degenerations of cornea, ICD-9 371.48.

Icd 10 pellucid marginal degeneration