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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

doi: 10.1097/ICO.0b013e3182a64850

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.

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*Department of Ophthalmology, “Villa Igea” Private Hospital, Forlì, Italy;

Department of Ophthalmology, “S. Maurizio” Regional Hospital, Bolzano, Italy; and

Department of Ophthalmology, “Bnai Zion” Medical Center, Haifa, Israel.

Reprints: Massimo Busin, Department of Ophthalmology, “Villa Igea” Hospital, Viale Antonio Gramsci 42, 47122 Forlì, Italy (e-mail:

M. Busin receives travel expense reimbursement and royalties from Moria (Antony, France). R. Barbara and P. Santorum have no financial interest to disclose.

Presented in part at the 16th European Society of Cataract and Refractive Surgeons winter meeting, Prague, February 3 to 5, 2012.

M. Busin had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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 (

Received March 22, 2013

Accepted July 12, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.