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Cornea:
doi: 10.1097/ICO.0b013e3182a64850
Techniques

Combined Tissue Excision and Corneal Tuck for the Surgical Treatment of Extremely Advanced Pellucid Marginal Corneal Degeneration

Busin, Massimo MD*; Santorum, Paolo MD*,†; Barbara, Ramez MBChB*,‡

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Abstract

Pellucid marginal corneal degeneration (PMCD) is managed surgically in the advanced stages of the disease, but extreme thinning extending over a very wide area in most of the corneal circumference represents a true surgical challenge that makes conventional approaches unsuitable. Here, we present the results of a new procedure (partial excision of the corneal ectasia and tuck of the residual thinned corneal lips left behind) performed in 3 eyes of 2 patients with extremely advanced PMCD, judged unsuitable for undergoing conventional surgical approaches. Preoperatively, uncorrected visual acuity was limited to the perception of hand motion in 1 eye, which presented with hydrops, and to finger counting at 1 m in the other 2 eyes. With a follow-up of 3 to 4 years, a complete, stable resolution of the ectasia was seen in all cases. As early as 1 year postoperatively, the best spectacle-corrected visual acuity was 20/30 to 20/50 with no subsequent substantial changes. Partial excision of the ectasia and tucking was found to work successfully at achieving both a new corneal shape compatible with visual rehabilitation and restoring peripheral corneal thickness in advanced cases of PMCD that were unsuitable for conventional surgery.

Copyright © 2013 by Lippincott Williams & Wilkins

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