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A novel treatment for extremely advanced pellucid marginal corneal degeneration: a case series
Session Title: Cornea Surgical II
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 08:06
Venue: Forum (Ground Floor)
First Author: : R.Barbara ITALY
Co Author(s): : S. De Angelis E. Albč L. Mattioli M. Busin Murta
To present a case series of three eyes with extremely advanced pellucid marginal corneal degeneration (PMCD), judged to be unsuited for conventional surgical approaches and therefore treated by means of a novel surgical procedure, including partial excision of the corneal ectasia and tuck of the residual thinned corneal margins.
Eye Department of private hospital "Villa Igea" in Forli, Italy.
Three eyes of two patients diagnosed with extremely advanced PMCD (ectatic area extending for about 4 mm from the corneoscleral limbus towards the center of the cornea and over about 270° of the circumference), one of which presenting with hydrops, underwent a surgical intervention including: a. Removal of the corneal peripheral epithelium from the entire area of thinning and opening of the conjunctiva at the limbus. b. Excision of a full-thickness strip of thinned corneal tissue, about 1mm in width, along the whole 270° of the ectasia; c. Overlapping of the residual wound margins ("corneal tuck"), which were then sutured together with interrupted 10-0 nylon stitches and a 10-0 nylon running suture.
Selective suture removal was completed within 9 months from surgery in all 3 cases. Uncorrected, best spectacle-corrected visual acuity (BSCVA), refraction, and corneal topography were assessed preoperatively as well as 3, 6, 9, 12, 24,36, and 48 months after surgery in all cases.
No complications were recorded during or after surgery in any case. In the eye presenting with hydrops, the cornea was clear and of normal central thickness as early as the first postoperative day. One year postoperatively, BSCVA had improved from the preoperative perception of hand movement (n = 1) or finger counting (n = 2) to 20/50 or better in all eyes. Refractive astigmatism was within 5 diopters in all cases. In two eyes uneventful phacoemulsification with intraocular lens implantation was also performed within the first postoperative year. These results remained substantially unchanged over the entire follow-up period (3 years n= 2; 4 years n = 1).
Partial excision of the ectasia and tucking, was found to work successfully both at achieving a new corneal shape compatible with visual rehabilitation and at restoring peripheral corneal thickness in advanced cases of PMCD, unsuitable for conventional surgery. The "corneal tuck" created this way was sufficiently thick to allow easy and safe suturing through the tucked tissue, and the resulting scar was strong enough to avoid recurrence of ectasia. Corneal hydrops had resolved on the first postoperative day most likely as a result of the peripheral tuck sealing the Descemet break from which it had originated
Our technique not only makes excisional surgery possible, while minimally affecting the structural integrity of the eye, but also rehabilitates vision to the 20/50 level or better.