Study evaluates surgical strategies for advanced pellucid marginal degeneration
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FRANKFURT, Germany — A study evaluated the outcomes of three surgical procedures for advanced pellucid marginal degeneration, namely sliding keratoplasty, sliding keratoplasty with relaxing incisions and sector lamellar keratoplasty.
“In our 10-year experience, 89 patients were diagnosed with pellucid marginal degeneration, but only nine eyes were included in this study because they [underwent] these three types of surgery,” Matteo Mario Carlà, MD, said at the ESCRS winter meeting.
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In sliding keratoplasty (SK), a crescent lamellar partial-thickness cut is performed in the inferior cornea, and sutures are positioned to induce with-the-rule astigmatism. In sliding keratoplasty with relaxing incisions (SKRI), the same procedure is associated with two relaxing incisions in the superior temporal and superior nasal quadrants of the cornea. In sliding lamellar keratoplasty (SLK), a crescent moon-shaped lamella of corneal tissue is positioned across the inferior quadrants, Carlà said.
“We followed the patients on average for more than 4 years. One year after surgery, 56% of patients had a [corrected distance visual acuity, CDVA] of at least 20/40, and seven eyes (78%) had a CDVA of 20/40 at the end of the study,” he said.
Refractive astigmatism was significantly reduced, and in the first month after surgery, eight patients had with-the-rule astigmatism, which was the aim of the procedure. However, partial recurrence of against-the-rule astigmatism occurred in five patients and then stabilized throughout the study period.
In a subgroup analysis, the outcomes of the three surgical procedures were compared. Patients who underwent SK and SKRI had better visual outcomes compared with patients who underwent SLK. However, baseline visual acuity was better in these groups because SLK was performed in only the most advanced cases, with the thinnest point of the cornea under 300 µm. In the SK and SKRI groups, astigmatism regression occurred more frequently. Suture loosening occurred in two cases in the SK group and one case in the SKRI group and required suture repositioning. SLK provided greater reduction of topographic astigmatism and worse refractive and functional outcomes but better stability over time.
“Surgical treatment for [pellucid marginal degeneration] is now reserved only to patients low CDVA at baseline, but patients may benefit from this type of surgery, with nearly 80% of them achieving CDVA of more than 20/40,” Carlà said.
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Carlà MM, et al. Topographical and functional analysis of different surgical strategies for advanced pellucid marginal degeneration: A long term follow-up. Presented at: ESCRS winter meeting; Feb. 15-18, 2024; Frankfurt, Germany.
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