Simultaneous conventional photorefractive keratectomy and corneal collagen cross-linking for pellucid marginal corneal degeneration.
OBJECTIVE
To present the results after simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking for pellucid marginal corneal degeneration.


METHODS
In this prospective, interventional case series, 6 patients (8 eyes) with pellucid marginal corneal degeneration were enrolled. All patients underwent simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking; corneal epithelium was removed by transepithelial phototherapeutic keratectomy during treatment (Cretan protocol plus conventional photorefractive keratectomy). Visual and refractive outcomes were evaluated along with endothelial cell density preoperatively and at 1, 3, 6, and 12 months postoperatively.


RESULTS
No intraoperative or postoperative complications were observed in any of the patients. LogMAR mean uncorrected distance visual acuity improved significantly from 1.05 ± 0.33 preoperatively to 0.41 ± 0.27 (P = .018) at 12 months postoperatively. Mean corrected distance visual acuity did not change significantly (P > .05) postoperatively. Mean spherical equivalent improved significantly from -3.52 ± 2.29 diopters preoperatively to -1.57 ± 1.76 diopters (P = .028) at last follow-up. Mean corneal astigmatism was significantly reduced from -6.83 ± 2.33 diopters preoperatively to -4.71 ± 1.89 diopters (P = .018) at the last follow-up. No endothelial cell density alterations were observed throughout the follow-up period (P > .05).


CONCLUSIONS
Simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking seems to be an effective, safe, and promising treatment for the management of pellucid marginal corneal degeneration.
George D
GD
Kymionis
Michael A
MA
Grentzelos
Argyro D
AD
Plaka
Konstantinos I
KI
Tsoulnaras
Vardhaman P
VP
Kankariya
Mohammad M
MM
Shehadeh
Ioannis G
IG
Pallikaris
D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003317:Corneal Dystrophies, Hereditary / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003319:Corneal Stroma / Q000378:metabolism*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin