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Pseudopterygia in Fuchs Superficial Marginal Keratitis: Clinical Course and Surgical Outcomes
Jin-Yu Chang1, Tzu-Yu Huang1, Yih-Shiuan Kuo1,2
1Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; and.
Purpose:
Surgery for pseudopterygia in Fuchs superficial marginal keratitis (FSMK) bears the risk of corneal perforation, as described in a few case reports. The aim of this case series was to understand the clinical course and surgical outcomes of pseudopterygia in FSMK.
Methods:
A retrospective case series included patients meeting FSMK criteria with pseudopterygia in at least 1 eye. The severity grading of pseudopterygia and peripheral infiltration events at follow-up were analyzed. Pseudopterygia involving corneal central 3 mm diameter (grade III) received surgery. Peripheral corneal infiltrate events within 1 week after surgery were recorded.
Results:
Thirty-three eyes of 19 patients (8 men, 11 women; age 40-85 years; mean, 65 years) were included, with an average 48.1-month follow-up (range 0-188.8 months). At presentation, 7 eyes (21%) had grade III pseudopterygia. One patient showed corneal perforation 3 days after "pterygium" surgery elsewhere. The contralateral eye met the diagnosis of FSMK. During follow-up, 16 eyes (49%) exhibited peripheral corneal infiltrates, and 7 eyes (21%) showed progression of pseudopterygia to higher grades before or without any surgery. Ten eyes with grade III pseudopterygia underwent surgery. The best-corrected visual acuity in Logarithm of the Minimum Angle of Resolution improved from 0.34 ± 0.18 (range 0.05-0.52) to 0.13 ± 0.11 (range 0.05-0.4) ( P = 0.0023). Six eyes (60%) developed peripheral corneal infiltrates within 1 week after surgery, which responded well to topical corticosteroids.
Conclusions:
Pseudopterygia in FSMK may progress to threaten visual acuity. Surgical excision can be safe and can effectively improve vision on the condition that the patients are closely followed in the early postoperative period to notice the corneal infiltrates.
Insights
Surgery for pseudopterygia in Fuchs superficial marginal keratitis (FSMK) can improve vision but carries risks. Close postoperative monitoring is crucial to manage potential corneal infiltrates and ensure patient safety.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Ocular Surface Disease
Background:
- Fuchs superficial marginal keratitis (FSMK) is a rare inflammatory condition affecting the cornea.
- Pseudopterygia, wing-like growths on the cornea, can occur in FSMK and may threaten vision.
- Surgical intervention for pseudopterygia in FSMK carries a risk of corneal perforation, as noted in prior case reports.
Purpose of the Study:
- To investigate the clinical course and surgical outcomes of pseudopterygia in patients with FSMK.
- To assess the safety and efficacy of surgical excision for pseudopterygia in this patient population.
- To identify potential complications and management strategies associated with pseudopterygia in FSMK.
Main Methods:
- A retrospective case series was conducted, including patients diagnosed with FSMK and pseudopterygia.
- Pseudopterygia severity was graded, and peripheral corneal infiltration events were analyzed.
- Surgical intervention was performed for grade III pseudopterygia (involving the central 3 mm of the cornea), with postoperative monitoring for infiltrates.
Main Results:
- The study included 33 eyes from 19 patients with a mean follow-up of 48.1 months.
- Seven eyes (21%) presented with grade III pseudopterygia; one patient experienced corneal perforation post-surgery elsewhere.
- Postoperatively, 60% of surgically treated eyes developed peripheral corneal infiltrates, which responded well to corticosteroids, and visual acuity improved significantly (P = 0.0023).
Conclusions:
- Pseudopterygia in FSMK can progress and compromise visual acuity.
- Surgical excision of pseudopterygia in FSMK can be a safe and effective method for vision improvement.
- Close postoperative monitoring is essential to detect and manage early corneal infiltrates, ensuring favorable surgical outcomes.
