PMC10349272_01
External photograph of the right eye at presentation, shows cicatricial entropion involving the upper eyelid (yellow arrows, A). Slit-lamp image shows diffuse conjunctival hyperemia, pseudopterygium involving two clock hours of the nasal limbus and five clock hours of the temporal limbus with peripheral corneal vascularization involving all quadrants and central descemetocele measuring 3x4 mm (B). Corresponding anterior-segment optical coherence tomography (AS-OCT) image shows dense corneal scarring and severe thinning, with a residual thickness of 94 microns in the area of the descemetocele (C). Three months postoperative image, after entropion correction showing well integrated lid margin mucous membrane graft along the upper eyelid margin (yellow doted lines, D). 18 months postoperative slit-lamp image, after combined autologous simple limbal epithelial transplantation, penetrating keratoplasty triple procedure, showing a well epithelized corneal surface with a clear corneal graft (E). Corresponding AS-OCT image of the same visit, showing compact cornea and corneal epithelium noted over the entire cornea (F).
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On clinical examination, the RE showed cicatricial entropion involving the upper eyelid ( Figure 1A, yellow arrows), diffuse conjunctival hyperemia, pseudopterygium involving two clock hours of the nasal limbus and five clock hours of the temporal limbus with peripheral corneal vascularization involving all quadrants ( Figure 1B). Underlying leucomatous corneal scarring was seen with a central descemetocele measuring around 3x4 mm ( Figure 1B). The anterior segment optical coherence tomography (AS-OCT) of the RE showed corneal thickness of 94 microns in the area of the descemetocele, with surrounding corneal thinning and dense leucomatous corneal scarring ( Figure 1C). Prior to performing any surface reconstruction, entropion correction of the upper eyelid with mucous membrane grafting was performed in the RE ( Figure 1D, yellow dotted lines). Postoperatively, the graft is clear and well epithelized, with a stable ocular surface ( Figure 1E). The AS-OCT of the RE revealed a compact cornea with a central corneal thickness of 434 microns and uniform corneal epithelium ( Figure 1F).