Superficial Keratectomy and Conjunctival Autograft for Fuchs' Superficial Marginal Keratitis

Purpose. To describe a patient with bilateral, recurrent marginal corneal infiltrates consistent with Fuchs' superficial marginal keratitis who developed bilateral nasal pseudopterygia encroaching on the visual axis, reducing visual acuity in both eyes. Methods. Bilateral superficial keratectomy combined with conjunctival autografting was performed in each eye. Results. Best corrected visual acuity improved from 20/60 in the left eye and 20/40 in the right eye to 20/25 in both eyes. Our patient has had no disease relapses in her right eye, as of 29 months after the surgery, but experienced a mild flare-up of marginal keratitis in her left eye 8 months after the surgery. Despite this flare-up, disease symptoms in the left eye have markedly diminished. Conclusion. Superficial keratectomy combined with conjunctival autograft is a therapeutic alternative in the management of severe, recurrent Fuchs' superficial marginal keratitis. In the present case, it has resulted in an improvement in visual acuity as well as a decrease in the frequency of disease flare-ups. The clinical course of this patient suggests that the conjunctiva may play a role in the etiology of Fuchs' superficial marginal keratitis.