Topographical and functional analysis of different surgical strategies for advanced pellucid marginal degeneration: A long term follow-up

Author:

Mosca Luigi123ORCID,Carlà Matteo Mario12ORCID,Guccione Laura123,Vico Umberto De12,Scartozzi Luca12ORCID,Fasciani Romina123,Rizzo Stanislao12

Affiliation:

1. Catholic University of Sacred Heart - Agostino Gemelli University Polyclinic Foundation – IRCCS, Rome, Italy

2. Department of Ophthalmology, Agostino Gemelli University Polyclinic Foundation - IRCCS, Rome, Italy

3. Cornea and Refractive Surgery Unit, Agostino Gemelli University Polyclinic Foundation - IRCCS, Rome, Italy

Abstract

Purpose To compare clinical and topographical outcomes of three different surgical strategies for advanced pellucid marginal degeneration (PMD). Methods Retrospective, interventional case series of 8 advanced PMDs undergoing three different surgical interventions: Sliding Keratoplasty (SK), Sliding Keratoplasty with Relaxing Incision (SKRI), Sector Lamellar Keratoplasty (SLK). Pre-operatively and at 1, 3, 6, 12-month and final follow-up (50.8 ± 20.6 months) post-operatively, we collected: uncorrected and corrected distance visual acuity (UDVA and CDVA), spherical equivalent (SE), refractive astigmatism (RA), corneal Ks, topographical astigmatism (TA) and calculated against-the-rule (ATR) component. Results CDVA significantly improved from 6 months after surgery ( p  = 0.04), while final CDVA was at least 20/40 in 75% of eyes. As desired, surgery led to an overcorrection toward with-the-rule astigmatism at 1-month, which then decreased at 12-month and at final follow-up ( p  < 0.05). The ATR-component was significantly decreased at 1-month (1.9 ± 1.1 vs. 17.6 ± 6.3 D pre-operatively, p  = 0.0015) and remained quite stable over time (4.2 ± 4.2 D at final follow-up). In subgroup analysis, SK and SKRI offered better CDVA and lower RA, while SLK showed more TA stability. The ATR component, comparing baseline and final follow-ups, decreased from 16.8 ± 8.3 D to 5.9 ± 3.6 after SK; from 18.9 ± 3.6 D to 3.3 ± 3.3 D after SKRI; from 17.0 ± 10.3 D to 1.9 ± 1.5 D after SLK. Conclusion The surgical treatment of advanced PMD showed long-term favourable outcomes. SK and SKRI offered better visual outcomes, but were more inclined to astigmatism regression over time. Conversely, SLK had more stable results but offered worse refractive outcomes.

Publisher

SAGE Publications

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