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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

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:

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.

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Accepted November 01, 2016

© 2018 Contact Lens Association of Ophthalmologists, Inc.