title: Combined tissue excision and corneal tuck for the surgical treatment of extremely advanced pellucid marginal corneal degeneration.
abstract: Pellucid marginal corneal degeneration (PMCD) is managed surgically in the advanced stages of the disease, but extreme thinning extending over a very wide area in most of the corneal circumference represents a true surgical challenge that makes conventional approaches unsuitable. Here, we present the results of a new procedure (partial excision of the corneal ectasia and tuck of the residual thinned corneal lips left behind) performed in 3 eyes of 2 patients with extremely advanced PMCD, judged unsuitable for undergoing conventional surgical approaches. Preoperatively, uncorrected visual acuity was limited to the perception of hand motion in 1 eye, which presented with hydrops, and to finger counting at 1 m in the other 2 eyes. With a follow-up of 3 to 4 years, a complete, stable resolution of the ectasia was seen in all cases. As early as 1 year postoperatively, the best spectacle-corrected visual acuity was 20/30 to 20/50 with no subsequent substantial changes. Partial excision of the ectasia and tucking was found to work successfully at achieving both a new corneal shape compatible with visual rehabilitation and restoring peripheral corneal thickness in advanced cases of PMCD that were unsuitable for conventional surgery.
authors.affiliation: *Department of Ophthalmology, "Villa Igea" Private Hospital, Forlì, Italy; †Department of Ophthalmology, "S. Maurizio" Regional Hospital, Bolzano, Italy; and ‡Department of Ophthalmology, "Bnai Zion" Medical Center, Haifa, Israel.
authors.forename: Massimo
authors.initials: M
authors.lastname: Busin
authors.forename: Paolo
authors.initials: P
authors.lastname: Santorum
authors.forename: Ramez
authors.initials: R
authors.lastname: Barbara
mesh_terms: D000368:Aged; D003315:Cornea / Q000473:pathology / Q000601:surgery*; D003316:Corneal Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome; D014792:Visual Acuity