A Sequential Approach To The Management Of An Advanced Case Of Pellucid Marginal Degeneration

We report a sequential approach in the management of a case with advanced pellucid 
marginal degeneration (PMD). The management was tailored based on the patient’s corneal 
topography and degree of corneal astigmatism. Full thickness corneal transplants in cases of 
PMD carry a prolonged rehabilitation period and the risk of graft failure. 
This case consisted of lamellar wedge resection followed by wavefront guided transepithelial 
photorefractive keratectomy (wTPRK) combined with accelerated corneal crosslinking 
aCXL) in preparation for a cataract extraction with intraocular lens. 

A 68-year-old gentleman with advanced PMD underwent phacoemulsification with toric 
intraocular lens (T-IOL) for the right eye and a lamellar wedge resection, followed by 
wTPRK combined with aCXL for the contralateral eye. The left eye underwent a sequential 
approach to regularize the cornea, minimize the higher order aberrations ( HoA) and degree 
of corneal astigmatism. Effective visual rehabilitation was achieved with significant visual 
improvement. 

Case report

Although advanced PMD may have limited options for visual rehabilitation, a sequential

stepwise approach may be considered in such cases, permitting a better quality with less

invasive options.

Advanced PMD may have limited options for

visual rehabilitation. A sequential stepwise approach may be considered,

permitting a better quality of vision and life with less invasive options.