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Crescentic Tuck in Lamellar Keratoplasty—A Novel Technique in a Case of Advanced Pellucid Marginal Corneal Degeneration

Arora, Ritu, M.D., D.N.B.; Manudhane, Aditi, M.S., D.N.B., F.I.C.O.; Jain, Parul, M.S., F.I.C.O., F.A.I.C.O.; Goyal, Jawahar Lal, M.D., D.N.B.

doi: 10.1097/ICL.0000000000000352
Case Report
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Purpose: To describe a new surgical technique “crescentic tuck in lamellar keratoplasty” for the management of advanced pellucid marginal corneal degeneration (PMCD).

Methods: A 45-year-old man with advanced PMCD and maximal thinning in the inferior juxtalimbal periphery underwent a crescentic lamellar keratoplasty in the right eye. Best-corrected visual acuity was 6/60 with no further improvement because of severe irregular astigmatism. Thinnest pachymetry in the peripheral cornea was 280 μm. Peripheral crescent-shaped lamellar corneal dissection of 3.5-mm width was performed, and an intrastromal pocket was fashioned from 4 to 8 O'clock, extending beyond limbus. A crescent-shaped donor corneal button of 3.5-mm width was denuded of its endothelium and beveled in inferior periphery to create a flange. The flange was tucked into the peripheral scleral pocket. The donor graft was secured to the host bed using 10-0 nylon interrupted sutures.

Results: Donor cornea integrated with the host bed over time and best spectacle-corrected visual acuity at 1 year improved to 6/9 with –1.25/–3.5 D × 90°. The simK (simulated keratometry) changed from 41.6/56.3 diopters (D) to 45.1/50.6 D. The astigmatism reduced from 14.6 D to 5.5 D.

Conclusion: Crescentic tuck in lamellar keratoplasty provides good apposition of the donor lenticule and tectonic support to the peripheral thin cornea while preserving the peripheral limbal stem cells. Additionally, there is a significant reduction in the astigmatism, resulting in visual improvement.

Department of Ophthalmology, Guru Nanak Eye Centre (R.A., J.L.G.), Affiliated to Maulana Azad Medical College, New Delhi, India; Tirupati Eye Centre (A.M.), Noida, Uttar Pradesh, India; and I CARE Hospital and Post Graduate Research Institute (P.J.), Noida, Uttar Pradesh, India.

Address correspondence to Aditi Manudhane, M.S., D.N.B., F.I.C.O., G-30, First floor, Opposite metro pillar no 102, Preet Vihar, New Delhi 110092; e-mail: aditi.manudhane13@rediffmail.com

The authors have no funding or conflicts of interest to disclose.

Earlier presented as Video in AAO Annual Conference, October 18–21, 2014, McCormick Place, Chicago. http://links.lww.com/ICL/A54

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.eyeandcontactlensjournal.com).

Accepted November 01, 2016

© 2018 Contact Lens Association of Ophthalmologists, Inc.