Case Reports

Toric intraocular lens implantation in a patient with pellucid marginal degeneration

Case Report Details

First Author: G.Garotti BRAZIL

Co Author(s):    G. Garotti   L. Alberto Rosa Barbalho   B. Luiz Manni   A. Cardoso Toldo   E. Hideki Uchida   N. Bigolin Machado     

Abstract Details

Purpose:

Pellucid marginal degeneration (PMD) is a idiopathic, bilateral and asymmetric corneal ectasia, with a higher incidence between 20 and 50 years, without predilection for gender. (1,2) The clinical picture, it is characterized by low visual acuity (BAV) slowly progressive due to the induction of irregular astigmatism, (3,4) aspect that when added visual loss related to formation cataract, represents a surgical challenge, there must be a planning. The work, aims to objective to report the planning and approach in performing facectomy with lens implant toric intraocular (IOL) for correction of astigmatism in a patient with cataracts and PMD.

Setting:

Perform a facectomy and implantation of toric intra ocular lens in a pacient with cataract and a previous pellucid marginal degeneration in both eyes.

Report of Case:

W.A.F patient, 66 years old, male, brown, married, born and living in São Paulo, with complaint of progressive AVB in both eyes (AO), more important in left eye (LE) than than in the right eye (DO), for over 20 years, but which has increased in the last year. In yours personal ophthalmological history has diagnosis of pellucid marginal degeneration carried out through current eye exams. Ophthalmological examination has visual acuity (AV) with better correction in RE 20 / 30p (+1.25 - 5.75 x 700) and in LE 20 / 60p (-0.50 -3.00 x 1250). In RE biomicroscopy was normal in an anterior segment associated with opacity of lens due to a cataract, having nuclear classification 2+ according to LOCS III (Lens Opacities Classification System), and, in LE, with a similar biomicroscopic aspect, but with nuclear classification 2+ associated with cortical anterior 2+. Intraocular pressure performed by applanation tonometry (Goldmann) worth 11 mmHg in both eyes. Corneal specular microscopy RE 2718 / LE 2709. Pachymetry RE 460 / LE 421. The indirect binocular ophthalmoscopy did not present changes. Corneal topography performed preoperatively with pentacam presenting the following results: RE - curved corneal meridian 50.83D (6.64mm) 1540 and flatter 45.67D (7.39mm) 640. LE - curved corneal meridian 49.85D (6.77mm) 380 and flatter 45.67D (7.39mm) 1280. Astigmatism resulting from 5.16 in RE and 4.18 in LE.

Conclusion/Take Home Message:

The conduct adopted was to perform a facectomy in both eyes with toric intra ocular lens(IOL) implantation, first approaching the LE and then RE. The IOL model chosen was Tecnis ZCT800 15,0 for BE based on calculations performed by the VERIONTM that pointed out as perspective the following residuals: RE: -0.02 -0.40D x 640; LE: +0.08 -0.00D x 1230. Final VA with correction was 20/20 (+0.50) in RE and LE 20/20 (+0.25), with addition of +2.75 in BE (J1).

Financial Disclosure:

None