![]() Although overall this two-step tectonic graft approach may take 3 months longer than a standard PKP, it is likely to decrease the overall time for the recovery of useful vision. In this day and age of advanced refractive surgery, a well-tested practice such as a tectonic corneal transplant is very useful in the treatment of corneal pellucid marginal degeneration. In severe cases of keratoglobus, enterprising corneal surgeons have used 16-mm-diameter tectonic lamellar and full-thickness corneal donors in order to save a patient's eye. Matching the donor limbus to the recipient and using a peritomy allows for an excellent cosmetic result. Dissecting the sclera of the donor and patient is not particularly difficult or dangerous. The use of templates to create sector and arcuate (crescentic) grafts is difficult, and few surgeons will take the time and effort to master this technique, which is infrequently used.Ī surgeon can use a femtosecond laser to create the donor and recipient bed, which is a great advance in order to facilitate the surgery, but he must often deal with the scleral aspect of the recipient in a manual fashion. The chances of a successful graft with a manageable amount of astigmatism are greatly enhanced.Īlthough surgeons may choose from many patterns for tectonic grafts, I believe that the method described earlier is much easier to perform because one can use the same trephine action on the patients and on the donor with an easy match. About 3 months later, a surgeon can perform a well-centered PKP. This tectonic lamellar graft will not be effective visually but will serve to strengthen the cornea peripherally. This eccentric graft may even cross the limbus, and a surgeon can perform a peritomy in this area. In my opinion, the most helpful offering is to perform a large lamellar graft, decentered if necessary, that includes the areas of pathology inferiorly (Figure 1). ![]() The likelihood of very high astigmatism postoperatively and long-term ectasia is increased. This surgery is a reasonable consideration except that the chance of very high astigmatism or wound dehiscence is likely due to the 7.5- to 10.0-mm optical zone area of the recipient cornea where the graft would be sutured because the recipient host cornea is very thin. Next, the surgeon may consider performing a penetrating keratoplasty (PKP). A lamellar graft will not correct the irregular astigmatism because the foundation is too weak. If and when that fails, the surgeon is likely to entertain the need for a corneal transplant. This article discusses treatment options.įirst, a corneal specialist may attempt to place a hard contact lens. How would a corneal specialist treat corneal pellucid marginal degeneration if it were progressive? This is a difficult clinical challenge and is similar to treating severe keratoconus. In the past, corneal pellucid marginal degeneration was only diagnosed at a very advanced state.Īssume that corneal pellucid marginal degeneration is diagnosed and LASIK is canceled, or PRK is performed successfully. Currently, many corneal specialists view keratoconus and corneal pellucid marginal degeneration as the same basic pathophysiology of the cornea but with a different primary focus (ie, inferocentral for keratoconus generally inferior for corneal pellucid marginal degeneration). Corneal specialists can now diagnose corneal pellucid marginal degeneration based on corneal topography devoid of any significant slit-lamp findings. The increased use of pre-LASIK automated corneal topography as a screening method for keratoconus has alerted ophthalmologists to the high prevalence of corneal pellucid marginal degeneration. The Pros and Cons of the Fugo Plasma Bladeĭoes the Capsulorhexis Affect Refractive Outcomes? Strategies for Managing the Difficult Capsulorhexis Why Did We Abandon the Can-Opener Capsulotomy?Ĭreating the Capsulorhexis Through Microincisions ![]() The History of the Capsulorhexis Technique Treating Corneal Pellucid Marginal DegenerationĬorrecting Capsular Contraction After Crystalens Implantation
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