Crescentic Lamellar Keratoplasty for Pellucid Marginal Degeneration

doi:10.1016/S0002-9394(14)77798-0

American Journal of Ophthalmology

Volume 96, Issue 2, August 1983, Pages 253-254

https://doi.org/10.1016/S0002-9394(14)77798-0 Get rights and content

Pellucid marginal degeneration is an uncommon, idiopathic, noninflammatory peripheral thinning disorder affecting the inferior cornea.¹ The resulting irregular corneal astigmatism frequently precludes spectacle or contact lens correction. Various surgical procedures have been used to modify the corneal astigmatism and improve visual acuity in severe cases.² We successfully treated pellucid marginal degeneration with an inferior, crescentic, lamellar keratoplasty.

References (2)

J.H. Krachmer
Pellucid marginal degeneration
Arch. Ophthalmol.
(1978)
V.W. Hallermann
Über atypischen Keratokonus und andere Konstitutionell-progressive Hornhauterktasien
Klin. Monatsbl. Augenheilkd.
(1970)

Cited by (47)

Lamellar Corneal Transplantation
2012, Survey of Ophthalmology
Citation Excerpt :
Lamellar excision of a crescent wedge of corneal tissue from the inferior cornea followed by tight suturing has been reported to reduce ectasia61,157—the incidence of recurrence is high, however. Schanzlin et al described the use of a crescent LK to reinforce the area of thinning.201 The advantage of this procedure is that the anterior chamber is not entered.
Penetrating keratoplasty (PK) has been the gold standard for the surgical treatment of most corneal pathologies; lamellar keratoplasty that only replaces the diseased corneal layers has recently evolved as an alternative, however. Innovations in surgical technique and instrumentation provide visual outcomes comparable to PK. We review the indications and outcomes of various techniques of anterior lamellar surgery developed to treat stromal disorders. Similarly, we discuss posterior lamellar keratoplasty techniques such as Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty. Posterior lamellar keratoplasty provides faster visual rehabilitation than PK in cases of Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. In addition, for medically unresponsive infectious keratitis, therapeutic anterior lamellar keratoplasty yields similar graft survival to PK without an increased risk of disease recurrence.
Management of Corneal Perforation
2011, Survey of Ophthalmology
Corneal perforation may be associated with prolapse of ocular tissue and requires prompt diagnosis and treatment. Although infectious keratitis is an important cause, corneal xerosis and collagen vascular diseases should be considered in the differential diagnosis, especially in cases that do not respond to conventional medical therapy. Although medical therapy is a useful adjunct, a surgical approach is required for most corneal perforations. Depending on the size and location of the corneal perforation, treatment options include gluing, amniotic membrane transplantation, and corneal transplantation.
Pellucid corneal marginal degeneration: A review
2011, Contact Lens and Anterior Eye
Citation Excerpt :
The authors found that post-operative visual acuity remained stable at 6/6-2 even one year after surgery. Earlier techniques used in treating PMD include lamellar crescentic keratoplasty [109,110]. Biswas et al. [28] have also reported conducting lamellar thermo-keratoplasty (LTK), an adaptation of the surgical technique described by Schanzlin et al. [109], for one eye with PMD.
Pellucid marginal corneal degeneration (PMD) is a rare ectatic disorder which typically affects the inferior peripheral cornea in a crescentic fashion. The condition is most commonly found in males and usually appears between the 2nd and 5th decades of life affecting all ethnicities. The prevalence and aetiology of this disorder remain unknown. Ocular signs and symptoms of patients with PMD differ depending on the severity of the condition. Unless corneal topography is evaluated, early forms of PMD may often be undetected however, in the later stages PMD can often be misdiagnosed as keratoconus. Visual signs and symptoms include longstanding reduced visual acuity or increasing against-the-rule irregular astigmatism leading to a slow reduction in visual acuity. In rare cases, patients may present with a sudden loss of vision and excruciating ocular pain due to corneal hydrops or spontaneous perforation. The vast majority of PMD patients are managed using spectacles and contact lenses. Several surgical procedures have been used in an attempt to improve visual acuity when spectacles and contact lenses do not provide adequate vision correction. Since patients with PMD make poor candidates for laser vision correction, an awareness of the topographical and slit-lamp features of PMD will be useful to clinicians screening for signs of corneal abnormality before corneal refractive surgery. This review describes the clinical features of PMD, its differential diagnosis and various management strategies presently available.
Classification and terminology of refractive surgery
2008, Corneal Surgery: Theory Technique and Tissue: Fourth Edition
Peripheral corneal disease with thinning
2008, Corneal Surgery: Theory Technique and Tissue: Fourth Edition
Intrastromal ring segment insertion using a femtosecond laser to correct pellucid marginal corneal degeneration
2006, Journal of Cataract and Refractive Surgery
Citation Excerpt :
As the topographic changes progress, spectacle correction of vision becomes impossible.16 Several surgical procedures to correct the irregular astigmatism have been tried including crescentic wedge resection, crescenting lamellar keratoplasty, PKP, epikeratophakia, thermokeratoplasty, and a modified procedure in which an inferior crescentic lamellar keratoplasty is combined with a central PKP.5–10,17 However, these procedures require extensive surgery and yield unpredictable visual results.
To assess the outcomes of intrastromal ring segment (Intacs, Addition Technology) implantation using a femtosecond laser in patients with pellucid marginal corneal degeneration.
Kudret Eye Hospital, Ankara, Turkey.
In this retrospective noncomparative case series, 9 eyes of 6 patients with pellucid marginal corneal degeneration had implantation of Intacs segments by a femtosecond laser technique. Preoperative and postoperative evaluations included slitlamp examination, uncorrected (UCVA) and best corrected (BCVA) visual acuities, and keratometry by a Pentacam Scheimpflug camera (Oculus Opticgerate GmbH). All parameters were reviewed within 6 months.
Intacs were successfully implanted in all eyes. The UCVA significantly improved from preoperatively to 6 months after Intacs implantation (mean 0.18 ± 0.24 [SD] and 0.53 ± 0.23, respectively). The mean difference between the preoperative and postoperative UCVA was 3.5 ± 1.6 lines (P = .008). The BCVA also significantly improved from preoperatively to 6 months after implantation (mean 0.63 ± 0.26 and 0.85 ± 0.18 at 6 months, respectively). The Snellen BCVA was 1.0 in 5 eyes postoperatively. The mean difference between preoperative and postoperative BCVA was 2.3 ± 51 lines (P = .011). The mean preoperative spherical refraction decreased from −3.86 ± 2.91 diopters (D) to −2.77 ± 1.43D (P = .091) and the mean cylindrical refraction, from −2.41 ± 2.27 D to −0.94 ± 1.07 D (P = .046). The mean central corneal curvature decreased from 48.20 ± 4.19 D preoperatively to 46.90 ± 5.00 D (P = .008) at 6 months and the mean posterior elevation, from 53.88 ± 21.72 μm to 32.55 ± 11.23 μm (P = .008).
Intacs insertion using a femtosecond laser was safe and efficient in the correction of pellucid marginal corneal degeneration.

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: This study was supported in part by a postdoctoral fellowship grant from Fight for Sight, Inc. (Dr. Robin), and by Core Center grant 03040 from the National Institutes of Health.

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Letters to the JournalCrescentic Lamellar Keratoplasty for Pellucid Marginal Degeneration

Pellucid marginal degeneration

Arch. Ophthalmol.

Über atypischen Keratokonus und andere Konstitutionell-progressive Hornhauterktasien

Klin. Monatsbl. Augenheilkd.

Letters to the Journal
Crescentic Lamellar Keratoplasty for Pellucid Marginal Degeneration