title: Sclerocorneal Intrastromal Lamellar Keratoplasty for Pellucid Marginal Degeneration.
abstract: OBJECTIVE
  Surgical management of advanced pellucid marginal degeneration is challenging. To correct both corneal thinning and induced corneal astigmatism, we propose a modified intrastromal lamellar sclero-keratoplasty.
  
  
  METHODS
  Corneal thinning was mapped using perioperative optical coherence tomography (OCT). Then through a scleral tunnel, an intrastromal pocket was created by stromal lamellar dissection under OCT guidance. A 300 μm-thick stromal lamellar graft was inserted in that pocket before closing the sclera to increase vertical median keratometry.
  
  
  RESULTS
  Intrastromal lamellar sclero-keratoplasty enabled corneal thinning correction and increased corneal astigmatism correction (-11.6 diopters) without complications.
  
  
  CONCLUSIONS
  Intrastromal lamellar keratoplasty with scleral tunnel is efficient in PMD. Corneal thinning is corrected with the intrastromal lamellar keratoplasty, and scleral tunnel closure allows increased corneal astigmatism correction. Perioperative OCT guidance allows better detection of the diseased cornea and is helpful for the lamellar dissection.
authors.affiliation: *Anterior Segment-Cornea Department, Fondation A. de Rothschild, Paris, France; †Hôpital Bichat Claude Bernard, Paris, France; and ‡Université Paris Diderot, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Guindolet
authors.forename: Alexandra
authors.initials: A
authors.lastname: Petrovic
authors.forename: Serge
authors.initials: S
authors.lastname: Doan
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cochereau
authors.forename: Eric E
authors.initials: EE
authors.lastname: Gabison
mesh_terms: D003317:Corneal Dystrophies, Hereditary / Q000601:surgery*; D003319:Corneal Stroma / Q000601:surgery*; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods*; D006801:Humans; D012590:Sclera / Q000601:surgery*; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence