Azman may also conduct diagnostic tests using Corneal Topography, which is a noninvasive medical imaging technique that maps the outer structure of the eye. Azman to shine a thin sheet of light onto the eye while using a biomicroscope to provide microscopic details of the structure of the eye.įor 100 percent assurance, Dr. This examination process is completely noninvasive. Azman often uses his slit lamp instrument to carefully diagnose patients. However, if left untreated, an individual with PMD is very likely to develop an irregular astigmatism over time.ĭr. PMD is relatively difficult to diagnose, aside from vision deterioration and a very gradual thinning of the cornea, there are very few symptoms. Irwin Azman, who has many years treating patients with both PMD and Keratoconus. That is why it is important to visit an experience doctor, like Dr. The two conditions are so closely linked that inexperienced doctors often confuse the two. Next to Keratoconus, PMD is the second most prevalent condition that causes clear, bilateral thinning in cornea. Topography-guided customized laser-assisted subepithelial keratectomy for the treatment of postkeratoplasty astigmatism.Pellucid Marginal Degeneration is similar to Keratoconus, an eye condition that causes vision to deteriorate as the cornea slowly changes shape.Long-term analysis of LASIK for the correction of refractive errors after penetrating keratoplasty.Deep lamellar keratoplasty by intracorneal dissection: a prospective clinical and confocal microscopic study.Microkeratome-assisted lamellar keratoplasty for the surgical treatment of keratoconus.Intracorneal ring segment implantation in corneas with post-laser in situ keratomileusis keratectasia.Refractive and Corneal Aberrometric Changes After Crescentic Lamellar Wedge Resection in Pellucid Marginal Degeneration."Tuck In" Lamellar Keratoplasty (TILK) for corneal ectasias involving corneal periphery.Wedge resection for high astigmatism after penetrating keratoplasty for keratoconus: refractive and histopathologic changes.Pellucid marginal corneal degeneration.Refractive and corneal aberrometric changes after intracorneal ring implantation in corneas with pellucid marginal degeneration.The technique has a low intraoperative complication rate and gives improved UCVA, BCVA, keratometric cylinder, and spectacle or contact lens tolerance. CONCLUSIONS: Corneal wedge resection with and without lamellar dissection is an effective surgical intervention for corneal ectasia in PMD and avoids allogeneic transplantation by way of a large penetrating or lamellar keratoplasty. The average reduction in keratometric cylinder for cases with >2 months of follow-up was 9.1 diopters (SD, 5.3 range, 3.1-16.3 diopters). One patient with only 6 months of follow-up had a UCVA of 6/7.5. Four patients were able to manage with improved visual acuity in spectacles, and 1 patient chose to wear contact lenses to achieve 6/7.5. Four of 5 eyes of patients with >2 months of follow-up had a BCVA of 6/12 or better. The eyes of patients with >1 month of follow-up had improved UCVA and BCVA.
The patients were followed for a mean of 10.7 months (SD, 9.2 range, 1-25 months). RESULTS: Seven eyes of 6 patients had wedge resections performed by 1 surgeon (S.M.D.). Mersilene 10-0 (Ethicon, Somerville, NJ) sutures were used and adjusted to achieve a 90-degree shift in the axis of astigmatism.
Complete host deep lamellar dissection (limbus to limbus) was performed in 3 cases and partial host lamellar dissection in 3 cases to enable closure by mobilizing the host anterior lamellar cornea. A crescentic wedge of ectatic corneal tissue was excised in each case, the extent of which was judged both clinically and by Orbscan. The irregular corneal shape with ectasia was detected clinically and confirmed by Orbscan tomography. All patients had progressive deterioration of BCVA, increased astigmatism, and intolerance to contact lens wear. A retrospective review was performed of all patients who underwent a corneal wedge resection for PMD at our institutions. METHODS: The setting was a specialist referral corneal surgery center, United Kingdom. N2 - PURPOSE: To describe the use of crescentic corneal lamellar wedge resection and autolamellar dissection for the correction of pellucid marginal degeneration (PMD), and to assess its effectiveness in improving uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), astigmatism, corneal topography, and contact lens or spectacle tolerability.
T1 - Wedge resection and lamellar dissection for pellucid marginal degeneration.