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

Luigi Mosca; Matteo Mario Carlà; Laura Guccione; Umberto De Vico; Luca Scartozzi; Romina Fasciani; Stanislao Rizzo

doi:10.1177/11206721241297324

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

Eur J Ophthalmol. 2024 Nov 13:11206721241297324. doi: 10.1177/11206721241297324. Online ahead of print.

Authors

Luigi Mosca^{1

2

3}, Matteo Mario Carlà^{1

2}, Laura Guccione^{1

2

3}, Umberto De Vico^{1

2}, Luca Scartozzi^{1

2}, Romina Fasciani^{1

2

3}, Stanislao Rizzo^{1

2}

Affiliations

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.

PMID: 39533956
DOI: 10.1177/11206721241297324

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.

Keywords: CORNEA/EXTERNAL DISEASE; Corneal transplantation < CORNEA/EXTERNAL DISEASE; corneal degenerations < CORNEA/EXTERNAL DISEASE; examination techniques: corneal topography/Keratometry < CORNEA/EXTERNAL DISEASE; penetrating keratoplasty < CORNEA/EXTERNAL DISEASE.