PROGRESSIVE NONULCERATIVE PARACENTRAL KERATOLYSIS ASSOCIATED WITH ELEVATED CORNEAL METALLOPROTEINASES

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.