Topographical and functional analysis of different surgical strategies for advanced pellucid marginal degeneration: A long term follow-up

Abstract

Purpose

To compare clinical and topographical outcomes of three different surgical strategies for advanced pellucid marginal degeneration (PMD).

Methods

Retrospective, interventional case series of 8 advanced PMDs undergoing three different surgical interventions: Sliding Keratoplasty (SK), Sliding Keratoplasty with Relaxing Incision (SKRI), Sector Lamellar Keratoplasty (SLK). Pre-operatively and at 1, 3, 6, 12-month and final follow-up (50.8 ± 20.6 months) post-operatively, we collected: uncorrected and corrected distance visual acuity (UDVA and CDVA), spherical equivalent (SE), refractive astigmatism (RA), corneal Ks, topographical astigmatism (TA) and calculated against-the-rule (ATR) component.

Results

CDVA significantly improved from 6 months after surgery (p = 0.04), while final CDVA was at least 20/40 in 75% of eyes. As desired, surgery led to an overcorrection toward with-the-rule astigmatism at 1-month, which then decreased at 12-month and at final follow-up (p < 0.05). The ATR-component was significantly decreased at 1-month (1.9 ± 1.1 vs. 17.6 ± 6.3 D pre-operatively, p = 0.0015) and remained quite stable over time (4.2 ± 4.2 D at final follow-up). In subgroup analysis, SK and SKRI offered better CDVA and lower RA, while SLK showed more TA stability. The ATR component, comparing baseline and final follow-ups, decreased from 16.8 ± 8.3 D to 5.9 ± 3.6 after SK; from 18.9 ± 3.6 D to 3.3 ± 3.3 D after SKRI; from 17.0 ± 10.3 D to 1.9 ± 1.5 D after SLK.

Conclusion

The surgical treatment of advanced PMD showed long-term favourable outcomes. SK and SKRI offered better visual outcomes, but were more inclined to astigmatism regression over time. Conversely, SLK had more stable results but offered worse refractive outcomes.

Keywords

Corneal transplantation < CORNEA/EXTERNAL DISEASE CORNEA/EXTERNAL DISEASE corneal degenerations < CORNEA/EXTERNAL DISEASE examination techniques: corneal topography/Keratometry < CORNEA/EXTERNAL DISEASE penetrating keratoplasty < CORNEA/EXTERNAL DISEASE

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