Purpose: Surgical management of advanced pellucid marginal degeneration is challenging. To correct both corneal thinning and induced corneal astigmatism, we propose a modified intrastromal lamellar sclero-keratoplasty.
Methods: Corneal thinning was mapped using perioperative optical coherence tomography (OCT). Then through a scleral tunnel, an intrastromal pocket was created by stromal lamellar dissection under OCT guidance. A 300 μm-thick stromal lamellar graft was inserted in that pocket before closing the sclera to increase vertical median keratometry.
Results: Intrastromal lamellar sclero-keratoplasty enabled corneal thinning correction and increased corneal astigmatism correction (-11.6 diopters) without complications.
Conclusions: Intrastromal lamellar keratoplasty with scleral tunnel is efficient in PMD. Corneal thinning is corrected with the intrastromal lamellar keratoplasty, and scleral tunnel closure allows increased corneal astigmatism correction. Perioperative OCT guidance allows better detection of the diseased cornea and is helpful for the lamellar dissection.