Cornea Cases

Title:

A combined approach to the treatment of pellucid marginal degeneration: case report

Case Report Details

First Author: D.Nevrov RUSSIA

Co Author(s):    Y. Kalinnikov   S. Kalinnikova                 

Abstract Details

Purpose:

To present a patient who was diagnosed with pellucid marginal degeneration and underwent a combined surgical procedure that included intrastromal lamellar keratoplasty with the use of a SMILE–derived refractive lenticule, radial keratotomy in the steep meridian, and a simultaneous intracorneal ring segment implantation, followed by a local cross-linking after three months postoperatively.

Setting:

Ambulatory Eye Microsurgery Clinic, Moscow, Russian Federation

Report of case or case series:

A patient who was diagnosed with pellucid marginal degeneration using slit-lamp examination, corneal topography, pachymetry and anterior segment OCT presented with a preoperative UCVA of 20/200 and BCVA of 20/60. He was addressed to our clinic where he underwent a surgical procedure that combined simultaneous intrastromal lamellar keratoplasty in the zone of corneal thinning with the use of a SMILE–derived refractive lenticule, radial keratotomy in the steep meridian and an implantation of two intracorneal ring segments parallel to the steep axis. After three months we performed a local cross-linking in the inferior quadrant of the cornea. One month after the first step of surgical treatment UCVA and BCVA increased to 20/32 and 20/25 respectively. Corneal topography demonstrated an astigmatism reduction from 8.50D to 2.75D. Minimal corneal thickness increased from 523 μm to 627 μm in the zone of the thinning. Visual acuity, corneal topography readings and corneal thickness didn't change significantly after local collagen cross-linking and remained stable during the follow-up period of 12 months.

Conclusions/Take Home Message:

The ICRS implantation along with radial keratotomy allowed for both a significant cylinder reduction and an improvement of visual acuity. The lamellar keratoplasty allowed for a reinforcement of the thinned cornea while preserving the patient’s endothelial layer and keeping the optical center of the cornea intact. The subsequent local collagen cross-linking ensured corneal stability.