title: Progressive nonulcerative paracentral keratolysis associated with elevated corneal metalloproteinases.
abstract: OBJECTIVE
  We report a patient with progressive idiopathic, nonulcerative, noninflammatory, avascular, bilateral, paracentral and peripheral corneal thinning monitored for 13 years.
  
  
  METHODS
  Because of progressive corneal thinning, the patient underwent several surgical procedures, including an arcuate lamellar keratectomy with suturing, bilateral 15-mm diameter onlay lamellar corneoscleral epikeratoplasties, and removal of interface epithelial tissue. Over time, the keratolysis also thinned 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 patient's normal-appearing and abnormal corneal samples but not from adjacent conjuctiva and sclera or normal controls. This is the first reported case with these clinical and laboratory findings.
  
  
  CONCLUSIONS
  A previously undescribed progressive idiopathic paracentral keratolysis is associated with increased quantities of matrix metalloproteinases. Clinical management requires tectonic corneal surgery.
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA.
authors.forename: K B
authors.initials: KB
authors.lastname: Hagen
authors.forename: G O
authors.initials: GO
authors.lastname: Waring
authors.forename: B
authors.initials: B
authors.lastname: Johnson-Wint
mesh_terms: D001706:Biopsy; D017364:Collagenases / Q000378:metabolism*; D003315:Cornea / Q000201:enzymology* / Q000473:pathology / Q000601:surgery; D003316:Corneal Diseases / Q000175:diagnosis* / Q000201:enzymology / Q000601:surgery; D016039:Corneal Transplantation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged
chemical_list: D017364:Collagenases