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P.F. Tzelikis, F.T. O. Komatsu, P.R. Laibson, E.J. Cohen, C.J. Rapuano, K.M. Hammersmith; Management of Pellucid MarginalCornea Degeneration . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1528.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine how patients with pellucid marginal corneal degeneration (PMCD) are managed in a tertiary cornea practice. Methods: Retrospective chart review of all patients with clinical PMCD, confirmed by corneal topography, from a corneal referral practice was performed. Information collected included demographics, best–corrected visual acuity, videokeratography, contact lens (CL) use, and surgical procedures. A study of patients' fit with Dyna intralimbal lenses was also performed. Results: Eighty–six eyes of 46 patients with PMCD were identified. Thirty–one were men and 15 were women. The patient mean age was 48 years (SD = 12) with an mean follow–up of 4.6 years (SD = 86.9). The disease was bilateral in 40 and unilateral in 6 patients. Seventy–six eyes (88.4%) were managed non–surgically with spectacles (36%) or contact lenses (52.4%). The mean visual acuity at referral was 0.50 (20/40) with best correction. At last visit the mean visual acuity of patients was 0.58 (20/34). Contact lens management was initially useful for 51 eyes (59%); six eyes failed CL by the end of the study period. A visual acuity of 0.5 (20/40) or better was noted in 34 eyes (75.5%) after CL fit. Successful fitting with Dyna intralimbal lens was achieved in 7 of 12 eyes. The eyes fitted with Dyna lens had an average visual acuity at presentation of 0.46 (20/43) (SD = 0.2) with habitual best correction, and 0.75 (20/25) (SD = 0.1) after the correction with the lens. Ten eyes underwent penetrating keratoplasty during follow–up. The average post–op follow–up was 9 years (SD = 82).After PK, the average visual acuity was 0.51 (20/40), significantly higher than before surgery (p< 0.05). At the end of the study all 10 grafts were clear. At the last follow–up, PMCD was managed non–surgically with spectacles or CL in 76 eyes (88.4%) and only 10 eyes (11.6%) underwent PK. The mean final visual acuity was 0.67 (20/30) in the non–surgical group and 0.50 (20/40) in the surgical group. Conclusions: The non–surgical management of PMCD continues to play a predominant role in the treatment of this disorder. The Dyna intralimbal lens can provide satisfactory visual correction in some cases of high astigmatism. Surgical correction with PK for PMCD also provides excellent visual correction in some cases of intolerance CL or poor visual acuity. Poor best–corrected visual acuity at presentation and long follow–up (96 months or more) were significantly associated with leading to surgery.
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