Treating Extreme Myopia And High Astigmatism Due To Pellucid Marginal Degeneration (Pmd) With Custom-Made Intraocular Lenses – A Case Report

Extreme myopia and high astigmatism resulting from Pellucid Marginal Degeneration (PMD) pose significant challenges to conventional vision correction methods. Traditional treatments like glasses or standard contact lenses may not provide satisfactory visual acuity due to the irregular corneal shape. Custom-made Intraocular lens (IOL) technology has evolved to address these complexities, offering tailored solutions for improved visual outcomes. This case report highlights the utilization of custom-made toric IOL in the management of extreme myopia and astigmatism due to PMD, showcasing their effectiveness in achieving refractive precision, patient satisfaction and incredible everyday living.

Emmetropia Eye Clinic, Heraklion, Crete, Greece

A 57-year-old female presented with complaints of very blurred vision due to high myopia and cataract. On the examination, she was found to have severe myopia and astigmatism as her refraction was for the O.D. Sph.-13.75 Cyl.-4.50 @ 51^o and O.S. Sph.-19.50 Cyl. -4,00 @ 119^o. Upon comprehensive examination with biomicroscopy, fundoscopy, corneal topography, endotheliometry, scheimpflug tomography, Optic Coherence Tomography and biometry, The patient was found to have cataract, myopia and PMD. She was found suitable for custom-made toric IOL implantation and correction of her extreme myopic and astigmatic refractive errors. Phacoemulsification with IOL implantation was performed under topical anaesthesia. Precise alignment of the toric IOL was achieved to correct astigmatism with slit lamp marking of the 0^o-180^o axis and intraoperative marking of the IOL axis. We performed firstly a successful cataract surgery in the Left Eye (non-dominant) targeting slightly myopic post-operative refraction result and a week later we performed a successful cataract surgery in the Right Eye (Dominant) targeting close to plano. Postoperatively, the patient exhibited significant improvement in visual acuity. At the one-month follow-up, uncorrected distance visual acuity improved from counting fingers at 1 meter to 9/10 for the RE and 7/10 for the LE. Additionally, the patient was found to have minimal residual astigmatism and decreased reliance on corrective lenses for daily activities.

This case demonstrates the successful correction of complex refractive errors using custom toric IOLs. By providing precise astigmatic correction and enhanced visual outcomes, custom toric IOLs offer a promising solution for patients seeking optimal vision quality and reduced dependence on glasses or contact lenses. By documenting such cases and sharing outcomes, ophthalmologists contribute valuable insights into the efficacy and safety of custom-made IOLs for managing PMD-related refractive errors. Continued research and innovation in ocular imaging, surgical techniques, and lens design will further refine this approach, ultimately benefiting patients with challenging corneal conditions like PMD.