Primary surgical repair of severe peripheral marginal ectasia in Terrien's marginal degeneration

We have developed a safe, successful, and simple procedure for repairing the severe peripheral marginal ectasia in Terrien's marginal degeneration. The area of ectasia is incised along its thinnest paralimbal dimension down to Descemet's membrane. Ectatic stroma along both sides of the incision is then undermined until normal-thickness stroma is reached. After excision of excess ectatic stroma, if necessary, the normal-thickness stroma is then sutured together, primarily with 9-0 Prolene. The sutures are left in place permanently, and the remaining refractive error is corrected with spectacles or contact lenses. This technique substantially improved visual acuity in three of four patients and decreased corneal astigmatism in all four. Although one eye required resuturing, there were no complications in any case.