Post Lasik Pellucid Marginal Degeneration- A Dreaded Complication And Its Management

To report a rare case of pellucid marginal degeneration (PMD), after 5 years of Cornea based refractive Laser in situ keratomileusis (LASIK) 

Case Report

A 38-year-old male presented to our clinic with the history of blurring of vision for distance for the last year. The diminution in vision was progressive and painless. The patient gives the history of undergoing LASIK for spectacle removal 5 years back. After surgery the patient attained 6/6 vision in both eyes. At present, the patient has an astigmatic error in both eyes. On slit lamp examination an area of peripheral thinning was observed in both eyes. Pentacam scan was performed on both eyes which depicted a classical crab claw appearance on the refractive map and increased back elevation in both of the eyes. A diagnosis of pellucid marginal degeneration post-LASIK was made. The patient was planned to undergo corneal collagen crosslinking(c3r) in both th eyes. Post c3r a bandage contact lens was placed in both eyes along with prescribing antibiotic and mild steroid eye drops. The contact lens was removed after complete epithelization. Visual rehabilitation was done using correct power spectacles in one eye and the other eye required semiscleral lenses.

LASIK/SMILE surgeries are effective and safe ways for permanent spectacle removal. but there is always a risk of post-surgery ectasia. 

It is always best to use all advanced imaging, including Pentacam and Corvis-ST to rule out any subclinical ectasia or risk of ectasia.

Early diagnosis and prompt treatment can go a long way in saving these eyes from dreaded complications of corneal ectasia.