Retrospective analysis of lamellar keratoplasty for Terrien marginal degeneration: a clinical-molecular study

To integrate clinical outcomes with histopathology and transcriptomics in Terrien marginal degeneration (TMD), compare the clinical prognosis of partial versus total lamellar keratoplasty (LKP), define disease pathways, and link molecular features to prognosis. We reviewed 75 eyes of 66 patients who underwent LKP for TMD between 2013 and 2024. Eyes were sorted into partial LKP ( n = 40) and total LKP ( n = 35) groups. The main outcomes included corneal epithelial healing time, corrected distance visual acuity (CDVA), and postoperative astigmatism. Excised tissues were analyzed via histochemistry, immunohistochemistry, and RNA sequencing and compared to healthy tissues. Corneal epithelial healing was significantly faster in the partial LKP group (5 ± 2 days) than in the total LKP group (9 ± 4 days) ( P < 0.001). The 1-year corrected distance visual acuity (CDVA) and postoperative astigmatism were significantly better in the partial LKP group. Histopathology revealed stromal hypocellularity, collagen disorganization, and immune cell infiltration. Transcriptomics revealed significant upregulation of apelin signaling and downregulation of key inflammatory pathways (e.g., TNF and IL-17) in TMD lesions. Compared with total LKP, partial LKP for TMD yields superior epithelial healing and visual recovery. The underlying mechanism may involve an “immune-exhausted” microenvironment coupled with apelin-mediated dysregulated repair. The increased preservation of host stroma with partial LKP provides a favorable biological niche for integration, supporting its use as the preferred surgical strategy. Additionally, appropriate surgical timing ensures safety and efficacy.