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L. Di Silvestre, A. Mularoni, V. Casamenti, S. Benedetti; Cornea in Pellucid Marginal Degeneration: In vivo Confocal Microscopy Analysis Before and After the Treatment With Intra Corneal Ring (ICR) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2719.
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Purpose: To describe the clinical manifestations and confocal microscopic findings in patients with Pellucid Marginal Degeneration (PMD) and to examine the stromal healing response after the treatment with Intra Corneal Ring (ICR). Methods: Eight contact lens intolerant patients with PMD, received ICR segments in the superior cornea (0.25 mm thickness) and in the inferior cornea (0.45 mm thickness). Diagnosis was supported by tomography and in vivo confocal microscopy (Confoscan 2.0) Preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), refractive astigmatism, sphero–equivalent were assessed. Changes in corneal shape were evaluated by corneal tomographic maps. Confocal Microscopy was performed 6 to 18 months after ICR implant. Results: Before the surgery, we found normal morphologic features in the central cornea, whereas in peripheral sections, irregular and elongated epithelial cells with altered arrangement of keratocytes were observed. After ICR implant, the stroma in the superior and inferior cornea showed signs of activation (highly reflective nuclei with visible processes) in some of the patients. Around the ICRS, moderate fibrosis was detected.Conclusions: ICR implant in patients with early and moderate pellucid marginal degeneration intolerant to contact lenses seems to provide a new conservative treatment. This procedure resulted efficacy and safety in all patients and provided fast visual rehabilitation. Confocal in vivo microscopy could be a useful noninvasive tool to study the course of PMD before and after surgical treatment.
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