Surgical treatment of advanced pellucid marginal degeneration

Purpose: To determine the efficacy of simultaneous peripheral crescentic la mellar keratoplasty (LK) and central penetrating keratoplasty (PK) for adva nced pellucid marginal degeneration (PMD). Design: Retrospective, noncomparative, interventional case series. Participants: Five patients with advanced PMD. Method: Simultaneous peripheral crescentic LK and central PK followed by se lective suture removal and astigmatic keratotomy in the postoperative perio d. Main Outcome Measures: These included interval of time required for visual rehabilitation, best spectacle-corrected visual acuity achieved, and amount of corneal astigmatism, as measured by videokeratography. Measuring the ch ange in corneal astigmatism by videokeratography over the subsequent follow -up period after spectacle correction had been prescribed assessed stabilit y of the achieved refraction. Results: Visual acuity results were 20/40 in three eyes, 20/80 in one eye, and 20/400 in one eye. The latter two had decreased acuity from posterior s ubcapsular cataract formation, which may have been caused by topical steroi d use. The time required for visual rehabilitation ranged from 5.13 to 10.9 3 (mean, 9.92) months, and the amount of corneal astigmatism at the end of this period ranged from 0.3 diopters (D) to 5.3 D, A tendency for an increa se in "with the rule astigmatism" after the rehabilitation period was noted . Two patients had elevations of intraocular pressure that responded to red uction in topical steroid dose. Conclusions: The short-term results with this technique are excellent in th at it provides early and stable visual rehabilitation in patients with adva nced PMD. Low to moderate levels of postkeratoplasty astigmatism were achie ved in all the eyes treated. The usual tendency of an increase in "against the rule astigmatism" that occurs when PK alone is done for PMD was elimina ted. Ophthalmology 2000;107:1836-1840 (C) 2000 by the American Academy of O phthalmology.