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case_images: Slit-lamp photography of the right eye (a), left eye (b) at the time of the initial medical consultation. A progressive thinning and furrow formation with superficial vascularization are observed in the peripheral cornea 360  (small black arrows), particularly superiorly and nasally. Nasally a pseudopterygium is also visible (white arrow). In addition, lipid deposition occurs at the leading edge of the affected region (black dashed arrow). Both eyes exhibit also mild to moderate hiperemia
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case_images: In addition, there was peripheral corneal thinning from the 11-o'clock to 8-o'clock positions, accompanied by fine superficial vessels, linear lipid deposition near the thinning area, and an absence of epithelial defect [Figure 1a]. The LE exhibited similar findings, with peripheral thinning spanning 360 , fine superficial vessels, and a nasal pseudopterygium invading 3 mm of the cornea [Figure 1b].
case_images: Slit lamp photography of the right eye (RE) (a), left eye (LE) (b) after superficial keratectomy and conjunctival autograft of the LE, performed elsewhere. There is a noticeable progression of the pseudopterygium in the RE, and a nasal thinned leucoma in the LE
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case_images: This procedure also involved removing the peripheral nasal superior pannus and placing a conjunctival autograft nasally, harvested from the superotemporal quadrant of the same eye [Figure 2b]. In contrast, the RE, which had not undergone intervention, exhibited a marked increase in the pseudopterygium [Figure 2a] and corneal thinning close to the head of the pseudopteryigum [Figure 3].
case_images: Anterior segment optical coherence tomography of the right eye showing the leading edge of thinning beneath the pseudopterygium
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case_images: In contrast, the RE, which had not undergone intervention, exhibited a marked increase in the pseudopterygium [Figure 2a] and corneal thinning close to the head of the pseudopteryigum [Figure 3].
case_images: Slit-lamp photography of the right eye (RE) (a), left eye (b) after superficial keratectomy and conjunctival autograft of the RE. Notice the lipid deposition in the leading edge of the thinning bilaterally, which is a hallmark of Terrien marginal degeneration
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case_images: The best spectacle-corrected visual acuity was 20/20 in the RE (-1-2,5 at 160 ) [Figure 4a] and 20/25 in the LE (-2-4 at 65 ) [Figure 4b].
case_images: Corneal topography showing corneal curvature maps before and after the surgery in both the right eye and left eye
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case_images: However, irregular astigmatism had only mildly reduced due to the thinning and scarred tissue [Figure 5].