Kb. Hagen et al., PROGRESSIVE NONULCERATIVE PARACENTRAL KERATOLYSIS ASSOCIATED WITH ELEVATED CORNEAL METALLOPROTEINASES, Cornea, 16(4), 1997, pp. 486-492
Purpose, We report a patient with progressive idiopathic, non-ulcerati
ve, noninflammatory, avascular, bilateral, paracentral and peripheral
corneal thinning monitored for 13 years. Methods. Because of progressi
ve corneal thinning, the patient underwent several surgical procedures
, including an arcuate lamellar keratectomy with suturing, bilateral 1
5-mm diameter onlay lamellar corneoscleral epikeratoplasties, and remo
val of interface epithelial tissue. Over time, the keratolysis also th
inned the donor stroma, requiring a lamellar tectonic graft. A biopsy
was performed of the patient's cornea and conjunctiva, and the tissue
was analyzed for proteolytic enzymes. Results, Increased quantities of
matrix metalloproteinases (57 and 63 kDa) were extracted from the pat
ient's normal-appearing and abnormal corneal samples but not from adja
cent conjunctiva and sclera or normal controls. This is the first repo
rted case with these clinical and laboratory findings. Conclusion. A p
reviously undescribed progressive idiopathic paracentral keratolysis i
s associated with increased quantities of matrix metalloproteinases. C
linical management requires tectonic corneal surgery.