Terrien’s marginal degeneration (TMD)

Terrien’s Marginal Degeneration is a rare, bilateral, progressive corneal condition characterized by thinning of the peripheral cornea, most commonly starting in the superior region. This thinning advances in a crescent-shaped pattern around the corneal edge. While TMD generally progresses slowly and painlessly, over time it can cause significant visual distortion through irregular astigmatism and, in rare cases, corneal perforation.

Can TMD be treated?

There is no causal therapy of Terrien’s disease of the cornea. A member of the ELZA Institute was able to publish a much-noticed report, which shows that the cross-linking procedure may stop and even partially reverse the thinning of the cornea in Terrien’s disease: the published case received a CXL in both eyes. The corneas of both eyes were then stable for years and the peripheral cornea was even slightly thicker (and thus more stable).

Challenges in Treating TMD

Because TMD affects the outer edges of the cornea, treatment options have traditionally been limited. Observation is common in early stages, while advanced disease has often required surgery. However, surgical outcomes are frequently poor due to the disease’s eccentric location and structural instability.

Innovative Treatment with Customized Corneal Cross-Linking at ELZA

Until recently, there was no proven therapy to halt or reverse TMD progression. Researchers at the ELZA Institute, led by Prof. Farhad Hafezi, have pioneered an innovative application of corneal collagen cross-linking (CXL) tailored specifically to the peripheral location of TMD.

In a landmark published case, Prof. Hafezi applied a modified Dresden protocol with UV irradiation deliberately decentered to target the affected corneal periphery rather than the central cornea. This precision treatment achieved:

Significant measurable corneal thickening at the thinnest point (e.g., from 414  µm to 450  µm in one eye).
Improved and stabilized visual acuity over five years.
Comfortable use of rigid gas-permeable contact lenses post-treatment.

“This was the first time a case of Terrien’s could be stopped – and even partially reversed.”

— Prof. Farhad Hafezi

Why Customized Cross-Linking?

The peripheral thinning and unique pattern of TMD require a tailored cross-linking approach different from central keratoconus treatment. ELZA’s customized protocols focus the UV treatment precisely on affected areas, preserving healthy tissue and optimizing therapeutic outcomes.

This research-driven approach reflects ELZA’s broader mission to translate cutting-edge science into patient care and positions ELZA as one of the few centers worldwide offering this specialized treatment for rare corneal conditions like TMD.

Categories: Farhad Hafezi | Popular press

New therapy for Terrien’s Marginal Degeneration

“We only treated two eyes, but it was the first time a Terrien could be stopped and partially reversed,” Farhad Hafezi, MD, PhD, OSN Europe Edition Board Member, said in a telephone interview with Ocular Surgery News

READ

Categories: Farhad Hafezi | Scientific article

Cross-Linking for Terrien’s Marginal Degeneration (TMD)

Scientific article describing the first use of cross-linking to treat TMD

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Terrien’s marginal degeneration (TMD)

Can TMD be treated?

Challenges in Treating TMD

Innovative Treatment with Customized Corneal Cross-Linking at ELZA

“This was the first time a case of Terrien’s could be stopped – and even partially reversed.”

Why Customized Cross-Linking?

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