1 Although PMCD is a bilateral disorder, atypical unilateral cases have been reported.
Pellucid marginal degeneration ectasia trial#
RGP contact lens trial was advised after surgery. 7 had almost total cataract in both the eyes, the cause of which was not clear. He had a visual acuity of 20/100 with 7D of astigmatism at his last visit, 2 months following surgery. 5 had a peripheral annular graft in the right eye. He had a final visual acuity of 20/50 at 14 months follow-up with a residual astigmatism of 6D. 1 underwent lamellar keratoplasty in the right eye. The final visual acuity in those treated with contact lenses ranged from 20/400 to 20/30. In two more eyes, RGP contact lens trial was advised. Six eyes were subjected to rigid gas-permeable contact lens fitting for visual rehabilitation. 3 had a keratoglobus-like pattern and the left eye of patient no. The scarring is probably because of resolved hydrops in 10 cases. 8 had a distorted pattern due to scarring. The corneal power was markedly lower in the vertical meridian with a superior loop cylinder peripheral to the area of thinning. The topographic features in 10 out of 16 eyes were consistent with the findings of superior PMCD ( Table 2). In eight eyes, the extent of thinning was from 10 o'clock to 2 o'clock positions. The degree of thinning varied from 30 to 90%. The visual acuity at presentation ranged from hand motions to 20/25. One case had associated secondary keratoglobus. All the cases had isolated superior PMCD. 8 was a diagnosed case of vernal keratoconjunctivitis and she was not on topical steroids. The age of the patients ranged from 18 to 48 years. 3 had topographic evidence of early PMCD in the right eye.
Pellucid marginal degeneration ectasia series#
All the patients in this series were bilateral except one. Of these patients, six were males and two were females. The salient clinical features of the 15 eyes of eight patients are summarized in Table 1. Topographic evaluation revealed against-the-rule astigmatism with the corridor of lowest power at about 70° in the right eye and 115° in the left eye ( Figures 3 and 4). The rest of the anterior segment was unremarkable except for a few anterior cortical lenticular opacities in the right eye. The inferior cornea was normal in both the eyes. The right eye had about 30% thinning and the left eye had 50% thinning. The area inferior to thinning was ectatic ( Figure 2). There was a crescent shaped thinning about 2 mm from the limbus extending from 10 to 12 o' clock positions in both the eyes ( Figure 1). Biomicroscopic examination showed clear corneas in both the eyes with no evidence of any inflammation or vascularization. The best-corrected visual acuity in the right eye was 20/30 with +7Dsph/−16Dcyl × 75 and in the left eye was 20/40 with +6Dsph/−13Dcyl × 110. Her medical history was positive for hyperthyroidism. Visual rehabilitation is usually possible with contact lenses, with surgical management required in selected cases.Ī 45-year-old woman presented to us on 6 July 2001 for the management of high astigmatic error in both the eyes. The topographic findings, of reduced power in the vertical meridian and superior loop cylinder, are typical of superior pellucid marginal degeneration. It should be considered in the differential diagnosis of superior ectatic disorders. Two eyes were subjected to surgical intervention (peripheral annular graft=1 and lamellar graft=1).Ĭonclusions PMCD can occur superiorly. The visual acuity improved with rigid gas-permeable contact lens in six eyes and the final visual acuity ranged from 20/400 to 20/30.
Orbscan was carried out in two eyes of one patient and revealed an area of increased elevation in relation to the best-fit sphere superiorly corresponding to the area of ectasia in both the eyes. Topographic features including vertical corridor of reduced power, against-the-rule astigmatism and superior loop cylinder were seen in 10 eyes. Ectasia was seen below the site of thinning in all the cases of superior PMCD. The extent of thinning was commonly seen between the 10 and 2 o'clock positions. One patient was a diagnosed case of vernal keratoconjunctivitis. The patients ranged in age from 18 to 48 years. Results In all, six patients were males and two were females. Improvement in visual acuity with spectacles or contact lens correction, surgical procedure if any, and final visual acuity were analysed. Detailed history, visual acuity at presentation, degree of astigmatism, slit-lamp examination findings, topographic features, and Orbscan findings were noted where available. Methods Retrospective chart review of 15 eyes of eight patients of superior PMCD. Purpose To report the clinical features and topographic findings of superior pellucid marginal corneal degeneration (PMCD).
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