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Pellucid marginal degeneration cause1/10/2024 Combined treatments and improved screening could eliminate the need for surgical management in most cases of PMD. Corneal collagen cross-linking is especially exciting because it halts disease progression. Rarely, it may cause acute vision loss with severe pain due to perforation of the cornea. It typically presents with painless vision loss affecting both eyes. The exact etiology of TMD is unknown, but there is male predilection 3:1. 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. Pellucid marginal degeneration (PMD) is a degenerative corneal condition, often confused with keratoconus. Ultimately, stromal degeneration occurs, causing formation of a peripheral gutter. 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. 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. 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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