This video describes a novel surgical technique, the horseshoe tuck, a semiannular tuck-in lamellar sclerokeratoplasty in a challenging case of advanced Terrien marginal degeneration. A young woman with bilateral 360-degree peripheral corneal superficial vascularization, marked thinning, and lipid deposition developed a second perforation in her left eye. Cyanoacrylate tissue-adhesive application failed to restore globe integrity. The authors modified the peripheral and tuck-in lamellar keratoplasties. A year later, the patient had a stable ocular surface and no recurrence of Terrien marginal degeneration. This procedure restored globe integrity, stabilized astigmatism, and potentially arrested the disease process.