Two-step annular tectonic lamellar keratoplasty in severe Terrien's marginal degeneration

We present a case of severe Terrien's marginal degeneration treated with two-step annular lamellar keratoplasty. Both eyes of the patient had peripheral corneal thinning with ectasia around the entire corneal circumference. First, an annular-shaped ectatic lesion was defined and removed, and donor tissue of the same size and shape was sutured on the recipient bed with 10-0 nylon. Four months later, the same operation was performed in the fellow eye. This procedure allows corneal astigmatism to be controlled either by suture removal or resuturing, thereby substantially improving visual acuity. No complications occurred during 1 1/2 years of follow up.