Femtosecond Assisted Wedge Resection For Pellucid Marginal Degeneration

To describe a case to demonstrate the effect and use of femtosecond laser assisted crescentic corneal lamellar wedge resection in managing an advanced case of pellucid marginal degeneration (PMD).  

Department of Ophthalmology, Frimley Health NHS Foundation Trust 

A 58 year old male patient was confirmed to have pellucid marginal degeneration on topography and had documented worsening of vision. He had undergone crosslinking previously and subjective refraction measured +2.50/-10.0 x 90. Clinical examination showed inferior corneal thinning with scarring and neovascularisation secondary to contact lens wear. Following a discussion of all management options, he opted to undergo a femtosecond assisted corneal wedge resection at our institution. We utilised the Bausch & Lomb Victus platform to plan arcuate keratotomies which were crescentically placed at the area of ectasia and maximal bowing. The length and position of the wedge was guided by topography and clinical assessment.  The crescentic wedge of corneal tissue was then excised using lamellar scissors in theatre and five 10-0 nylon sutures were optimally placed with appropriate tension whilst using intraoperative keratoscopy. At 1 month follow up, the patient reported an improvement in best corrected visual acuity, measuring 6/9. Post op refraction measured +3.75/-1.50 x 85  

Femtosecond laser assisted corneal wedge resection is an effective surgical intervention for treating corneal ectasia in PMD. This technique offers precision and provides improvement in visual acuity and astigmatism in advanced cases of PMD.