Current options in the management of pellucid marginal degeneration.

摘要: PURPOSE: To review and evaluate current future directions in the diagnosis surgical management of pellucid marginal degeneration (PMD), including pen- etrating keratoplasty, full-thickness crescentic wedge resection (FTCWR), deep anterior lamellar keratoplasty (DALK), (CLWR), tuck-in kerato- plasty (TILK), toric phakic intraocular lens (PIOL) implan- tation, intrastromal corneal ring segment implantation (ICRS), collagen cross-linking (CXL), com- bined therapies. This is first article looking at literature specific to PMD. METHODS: Review published studies. RESULTS: Reported data for each treatment presented. Penetrating last resort PMD effective, but with considerable complica- tions. DALK provides visual outcomes similar penetrat- ing without risk immune-mediated graft rejection, its complexity relative novelty limit acceptance. FTCWR has good outcomes, significant astigmatic drift. CLWR lacks long-term results. Crescentic TILK are technically difficult long- term Toric PIOL ecta- sia progression a concern. ICRS can delay penetrating improve contact toler- ance, does not treat underlying process. CXL dem- onstrates effectiveness complications, although limited results needed. Com- bining treatments such as ICRS, CXL, refractive surgery promising, additional studies needed investigate their efficacy safety. CONCLUSIONS: Although little understood about etiology, pathophysiology, epidemiology, genet- ics PMD, new improving out- comes reducing complications. Corneal especially exciting because it halts dis- ease progression. Combined improved screening could eliminate need manage- ment most cases