Current Options in the Management of Pellucid Marginal Degeneration

Moshirfar, Majid; Edmonds, Jason N; Behunin, Nicholas; Christiansen, Steven M.

doi:10.3928/1081597x-20140429-02

Cited by 38 publications

(20 citation statements)

References 90 publications

(129 reference statements)

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“…42 Eyes with peripheral steepening with pellucid marginal corneal degeneration, however, may also benefit from cross-linking. 88, 106 There is likely more than preoperative keratometry or age that determines extreme outcomes. 48 …”

Section: Accepted Manuscriptmentioning

confidence: 99%

Corneal cross-linking

Randleman

Khandelwal

Hafezi

2015

Survey of Ophthalmology

164

113

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Since its inception in the late 1990s, corneal cross-linking has grown from an interesting concept to a primary treatment for corneal ectatic disease worldwide. Using a combination of ultraviolet-A light and a chromophore (vitamin B2, riboflavin), the cornea can be stiffened, usually with a single application, and progressive thinning diseases such as keratoconus arrested. Despite being in clinical use for many years, some of the underlying processes, such as the role of oxygen and the optimal treatment times, are still being worked out. More than a treatment technique, corneal cross-links represent a physiological principle of connective tissue, which may explain the enormous versatility of the method. We highlight the history of corneal cross-linking, the scientific underpinnings of current techniques, evolving clinical treatment parameters, and the use of cross-linking in combination with refractive surgery and for the treatment of infectious keratitis.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Corneal cross-linking

Randleman

Khandelwal

Hafezi

2015

Survey of Ophthalmology

164

113

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“…[9][10][11] Toric IOLs can be implanted in either the anterior or the posterior chamber, either with or without natural lens extraction (toric phakic IOLs (PIOLs)), and allow for the correction of refractive error and astigmatism independent of cornea alterations. 3 Camoriano et al 12 recently reported improved visual acuity and astigmatism with toric PIOL implantation for PMD in 10 eyes with severe glare and halos requiring removal in only 1 eye.…”

Section: Discussionmentioning

confidence: 98%

“…1,2 Management of affected patients depends on the level of visual disability and can be organized in structural, partial-thickness, fullthickness, and corneal-independent interventions. 3 Structural interventions include techniques designed to strengthen the structure of the corneal stroma, such as corneal collagen crosslinking (CXL), 4 or techniques designed to modify the curvature and the mechanical properties of the corneal stroma, such as intrastromal corneal ring segments (ICRS). 5 Partial-thickness techniques comprise interventions involving the removal of only the anterior layer of the abnormally thinned cornea, with partial cornea replacement or the removal of the total cornea preserving the host endothelium.…”

Section: Introductionmentioning

confidence: 99%

Mini-incision cataract surgery and toric lens implantation for the reduction of high myopic astigmatism in patients with pellucid marginal degeneration

Balestrazzi

Baiocchi

Cartocci

et al. 2015

Eye

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Purpose To evaluate the clinical outcomes, safety, and efficacy of cataract surgery with the implantation of a toric intraocular lens (IOL) in eyes with stable pellucid marginal degeneration (PMD). Methods Eleven eyes (eight patients) diagnosed as stable PMD and cataract underwent mini-incision 2.2 mm cataract surgery followed by the implantation of hydrophobic toric aspheric IOL (AcrySof IQ Toric IOL, Alcon, Fort Worth, TX, USA). Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. Paired samples t-tests were used to analyze preoperative and postoperative visual acuity, astigmatism, and spherical equivalent (SE) parameters. Follow-up was 6 months. Results The mean CDVA was 0.62 ± 0.26 logMAR preoperatively and 0.07 ± 0.07 logMAR postoperatively. The mean preoperative sphere and cylinder was − 3.14 ± 3.58D and − 4.84 ± 2.02D, respectively. The mean postoperative manifest refractive sphere and cylinder was − 0.30 ± 0.51D and − 0.81 ± 1.51D, respectively. There was a significant reduction in refractive astigmatism after toric IOL implantation (Po0.002). The toric IOL axis rotation was o5°in all cases at the final follow-up. Conclusions Implantation of hydrophobic toric IOL was a safe and effective surgical procedure to correct mild to moderate stable PMD.

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“…It was reported to stop the progression of ectasia, and studies reported persistent effects up to 7 years after treatment [2, 3]. Corneal CXL was also used to manage iatrogenic ectasias [3], pellucid marginal degeneration [19], infectious keratitis [4] or even bullous keratopathy [20]. It is believed to delay or even avoid invasive surgical procedures such as corneal transplantation.…”

Section: Discussionmentioning

confidence: 99%

Optimizing Genipin Concentration for Corneal Collagen Cross-Linking: An ex vivo Study

et al. 2018

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Purpose: Studying genipin variable concentrations, treatment durations, and delivery methods as a substance to increase corneal stiffness by inducing corneal collagen cross-linking (CXL). Materials and Methods: 100 bovine corneas treated with different genipin concentrations (0.1, 0.5, and 1%) and treatment durations (15 min, 40 min, 2 h, and 3 days) through different delivery methods compared to 10 controls treated with riboflavin/UV. Histology examination, enzymatic digestion with collagenase and thermal differential scanning calorimetry were performed on the different samples. Results: Bovine corneas soaked in 0.5% genipin morphologically showed 4.7% CXL in comparison to 5.6% in controls (p < 0.05). Corneas treated with topical 0.5% genipin, by a 140-µL drop applied hourly for 2 h, showed 7% corneal CXL. Corneas treated with topical genipin 0.5% for 30 min, 1 and 2 h showed 54 ± 6, 40 ± 7, and 39 ± 9% enzymatic degradation, respectively, in comparison to controls (74%). Corneas treated with 0.5% genipin for 1, 2, and 8 h showed higher thermal denaturation resistance (Td values of 64.9 ± 0.3, 64.7 ± 0.0 and 67.3 ± 0.9), respectively, in comparison to the control group (64.6 ± 0.5) (p < 0.05). Conclusions: Genipin 0.5%, in a 140-µL drop applied hourly for 2 h, showed better potential to enhance corneal stiffness and stability through inducing CXL.

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Current Options in the Management of Pellucid Marginal Degeneration

Cited by 38 publications

References 90 publications

Corneal cross-linking

Corneal cross-linking

Mini-incision cataract surgery and toric lens implantation for the reduction of high myopic astigmatism in patients with pellucid marginal degeneration

Optimizing Genipin Concentration for Corneal Collagen Cross-Linking: An ex vivo Study

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