The current report highlights the notion that mid- and long-term evaluations of customized crosslinking techniques may reveal progressive flattening and corneal irregularity. In subsequent years, progressive inferior flattening was observed with decreased CDVA, corneal thinning and worsening of the haze. An uneventful first year postoperative follow-up showed stabilization of the ectasia. We report a case followed though 6 years of progressive irregular corneal flattening and thinning in both eyes (OU) after eccentric CXL for PMD.Ī 46-year-old man with bilateral PMD and corrected distance visual acuity (CDVA) of 20/20 (-2.00x80) in the right eye (OD) and 20/30 (+3.50-5.25x105) in the left eye (OS) underwent conventional 9 mm eccentric CXL in OU and intrastromal corneal ring implantation in the OS. Pellucid marginal degeneration (PMD) is a rare disease that is often mistaken for keratoconus but can similarly be treated with corneal collagen crosslinking (CXL). However, best corneal collagen crosslinking results were obtained in groups of patients with keratoconus and secondary corneal ectasia. In all groups, there was an increase in the best corrected visual acuity, a decrease in the index of asymmetry of the corneal surface and its refractive power in the center of ectasia. To assess the efficacy, preoperative examination results and interim data were used. Then changes in the state of the cornea and visual functions were monitored for 6 years. Corneal collagen crosslinking was performed by the same specialist, during the first or the second year of follow-up. The group of patients with keratoconus included 30 patients (30 eyes), that with pellucid marginal degeneration 30 patients (30 eyes), and that with secondary ectasia 30 patients (30 eyes). The nosological structure of the study included patients with keratoconus, pellucid marginal degeneration, and secondary ectasia. The results of corneal collagen crosslinking in patients with various forms of corneal ectasia 6 years after surgery were analyzed. The aim of the investigation was to evaluate the efficacy of corneal collagen crosslinking based on the analysis of long-term results of this treatment method for various forms of corneal ectasias. The literature shows no data on comparative analysis of remote results concerning the efficacy of this method in treatment of various forms of corneal ectasias. The number of diagnosed cases of pellucid marginal degeneration increased as well. In published studies, no remote results are met concerning the efficacy of corneal collagen crosslinking in other forms of corneal ectasias, which are now on the rise, including secondary ectasias that became more frequent with refractive surgery. In the literature, there are occasional data related to remote results concerning only the most common form of ectasias keratoconus. Sudanese J OphthalmolĬorneal collagen crosslinking is one of the most effective methods of prophylactics and treatment of progressive corneal ectasias. Updates on management of pellucid marginal degeneration: Topographic patterns, differential diagnosis, and surgical options. Different surgical techniques are available for PMD management however, none of them were found to be effective, so further studies will be needed in the future. Spectacles, soft and rigid gas permeable contact lens are the main visual correcting method in early stage of the disease. Corneal topography is the main diagnostic tool of PMD with characteristic diagnostic patterns "crab-claw" or "butterfly." PMD could be mistaken as KCN, keratoglobus, and other peripheral thinning conditions such as Terrien marginal degeneration and Mooren's ulcer. It is difficult to differentiate between keratoconus (KCN) and PMD by slit lamp, especially in the detection of early and subclinical stages of the diseases. Pellucid marginal degeneration (PMD) is a rare ectatic corneal disease involving the inferior part of the cornea.
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