Scleral lenses can be used succesfully in patients with PMD who are intolerant to other types of contact lenses. Patients who abandoned the scleral lens wear tended to have a better spectacle corrected visual acuity and less gain of lines. Three patients (6 eyes, 25%) abandoned scleral lens wear. More than half (16 eyes, 67%) reported wearing their scleral lenses for 8h or more on a daily basis. With scleral lenses, mean BCVA was 0.75☐.15 (range, 0.5-0.9), (p=0.003) with a mean gain of 3.3 lines of BCVA. The mean Snellen best-corrected visual acuity (BCVA) before scleral lenses with spectacle correction was 0.42☐.15 (range, 0.2-0.6). All eyes were fit with mini Misa(®) scleral lenses with a diameter of 16.5 or 17mm. The average length of follow-up was 14.1☓.7 months (range, 8.5-18 months). The mean patient age was 35.0☑3.8 years (range, 23-47 years). Patients were followed regularly for continuous daily wearing time (CDWT), contact lens handling issues, visual acuity, and any subjective or objective contact lens related complications. In this prospective interventional case series, 24 eyes of 12 PMD patients were fitted with scleral Misa(®) lenses. To report the clinical outcomes of scleral Misa(®) lenses (Microlens Contactlens Technolgy, Arnhem, Netherlands) for visual rehabilitation in patients with pellucid marginal degeneration (PMD). Surgery for PMCD-lamellar keratoplasty and crescentic lamellar keratoplasty, if indicated-usually results in significant residual astigmatism. The majority of patients were treated with spectacles or contact lens. In our study, patients presented with severe astigmatism, and hydrops was a common complication. Superior PMCD was seen in approximately 15% of the eyes. Keratoconus was seen in approximately 10% of the eyes, and keratoglobus in approximately 13%. Pellucid marginal corneal degeneration was seen predominantly in males in this series, and was not strongly associated with VKC. The final astigmatism in the operated eyes at the last follow-up ranged from 4 to 11 D. Visual acuity improved in 4 eyes after surgery with a follow-up of 2 to 37 months. Lamellar keratoplasty was performed in 3 eyes, and a crescentic lamellar graft was done in 2 eyes. Forty-one eyes (35.3%) received spectacles, and 31 eyes (26.7%) were fitted with rigid gas-permeable contact lenses. Visual acuity improved in 52 eyes (55.3%) with correction, in 40 eyes (42.6%) it remained the same as that of the initial presentation, and in 2 eyes (2.1%) it worsened relative to the initial presentation. In 12 eyes (10.3%), PMCD was associated with keratoconus, and in 15 eyes (12.9%), keratoglobus was associated. The thinning was commonly seen between the 5-o'clock and 7-o'clock positions. Typical inferior PMCD was seen in 99 eyes (85.3%), and superior PMCD was seen in 17 (14.7%). The degree of astigmatism was 20 D in 6 (6.1%). One patient (1.7%) had associated vernal keratoconjunctivitis (VKC), 1 (1.7%) had Marfan's syndrome, and 1 (1.7%) had ocular hypertension. The age of the patients ranged from 8 to 66 years, with a mean of 34.0+/-14.8. In one eye, no clinical features of PMCD were seen, but the diagnosis was made based on topographic features of typical PMCD. ![]() ![]() The mode of visual rehabilitation surgical procedure, if any and the final VA achieved were analyzed.Ĭlinical features, associations, complications, and outcome of treatment. The visual acuity (VA) at presentation the location, extent, and degree of thinning presence of concurrent keratoconus and keratoglobus and complications, if any, were noted. A detailed history including the age of presentation, onset of symptoms, systemic diseases, atopy, and relevant family history was reviewed. The diagnosis of PMCD was based on the presence of corneal thinning with ectasia of the normal cornea above or below the area of thinning with no evidence of scarring, vascularization, or lipid deposition and typical topographic features whenever topography was performed. Retrospective chart review of 116 eyes of 58 patients with PMCD seen between 19 at the Cornea Service at L.V. Retrospective noncomparative case series. To report the clinical features and outcome of patients with pellucid marginal corneal degeneration (PMCD).
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