Combined treatments and improved screening could eliminate the need for surgical management in most cases of PMD. Pellucid marginal degeneration (PMD) is a rare disorder of the peripheral cornea affecting usually the most inferior quadrant. Corneal collagen cross-linking is especially exciting because it halts disease progression. Combining treatments such as ICRS, CXL, toric PIOL implantation, and refractive surgery is promising, but additional studies are needed to investigate their efficacy and safety.Īlthough little is understood about the etiology, pathophysiology, epidemiology, and genetics of PMD, new treatments are improving visual outcomes and reducing complications. Distinguishing Terrien marginal degeneration from other peripheral corneal diseases such as Mooren ulcer and pellucid marginal degeneration is important. CXL demonstrates effectiveness without complications, although data are limited and long-term results are needed. ICRS implantation can delay penetrating keratoplasty and improve contact lens tolerance, but does not treat the underlying process. Toric PIOL implantation is effective, but ectasia progression is a concern. Crescentic lamellar keratoplasty and TILK are effective, but technically difficult and without long-term results. CLWR is effective, but lacks long-term results. FTCWR has good visual outcomes, but with significant astigmatic drift. The thinning is most marked at the limbus, extending circumferentially for. Keratoglobus causes generalized thinning of the cornea. Similarities between PMD and keratoconus have been attributed to the absence of firm criteria for each disease entity. DALK provides visual outcomes similar to penetrating keratoplasty without the risk of immune-mediated graft rejection, but its complexity and relative novelty limit its acceptance. Keratoconus is the major mimicker of pellucid marginal degeneration. Penetrating keratoplasty is the treatment of last resort in PMD and is effective, but with considerable complications. ![]() Reported data for each treatment is presented. This is the first review article looking at the literature specific to PMD. To review and evaluate current and future directions in the diagnosis and surgical management of pellucid marginal degeneration (PMD), including penetrating keratoplasty, full-thickness crescentic wedge resection (FTCWR), deep anterior lamellar keratoplasty (DALK), crescentic lamellar wedge resection (CLWR), crescentic lamellar keratoplasty, tuck-in lamellar keratoplasty (TILK), toric phakic intraocular lens (PIOL) implantation, intrastromal corneal ring segment implantation (ICRS), corneal collagen cross-linking (CXL), and combined therapies.
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