Pellucid Marginal Corneal Degeneration and Keratoconus: Differential Diagnosis and Management of Patients
https://doi.org/10.18008/1816-5095-2019-4-433-441
Abstract
The authors present the problem of differential diagnosis of primary corneal keratectasias: pellucid marginal degeneration (PMD) and keratoconus. Some cases of differential diagnosis can be very challenging and choice of rational treatment for these patients is actual. Despite multiple publications concerning keratoconus and extensive knowledge of this disease, articles about PMD are rare. Results of surgical treatment for PMD are usually worse than for keratoconus. The authors show the value of confocal microscopy, keratotopography, and high-resolution optical tomography of the anterior segment of the eye based on a two-channel Scheimpflug camera and give clinical examples of differential diagnosis that present certain complexity. Recommendations on treatment of patients with PMD are given, including such severe complication of progressive far-advanced corneal ectatic diseases as acute corneal hydrops. The important role of modern scleral gas-permeable contact lenses in visual correction of PMD and keratoconus is summarized. The authors believe that in cases of PMD without critical thinning of the cornea, if patients are satisfied with contact correction, the surgical treatment should be avoided or postponed.
About the Authors
A. Yu. Slonimskiy
LLC “The Moscow Eye Clinic”
Russian Federation
Russian Federation
MD, Professor
Semenovsky lane, 11, Moscow, 107023, Russian Federation
Yu. B. Slonimskiy
Medical Academy of postgraduate education
Russian Federation
Russian Federation
MD, Professor
Barrikadnaya, 2/1, build. 1, Moscow, 125993, Russian Federation
H. V. Sitnik
Medical Academy of Postgraduate Education, chair of ophthalmology
Belarus
Belarus
PhD, assistant professor
Brovki str., 3, build. 3‑3, Minsk, 220013, Republic of Belarus
A. V. Myagkov
Academy of Medical Optics and Optometry
Russian Federation
Russian Federation
MD, Professor, director
Mikhalkovskaya str., 63 B, build. 4, Moscow, 125438, Russian Federation
S. V. Milash
Helmholtz National medical center of eye diseases
Russian Federation
Russian Federation
researcher, department of refraction pathology, binocular vision and ophthalmoergonomics
Sadovaya‑Chernogriazskaya str., 14/19, Moscow, 105062, Russian Federation
References
1. Takhchidi Kh.P., Malyugin B.E., Moroz Z.I., Izmaylova S.B., Maychuk N.V. A method for determining differentiated indications for the selection of a treatment method for initial and developed keratoconus. RU 2400190, 28.05.2009 (In Russ.)
2. Doga A.V., Mushkova I.A., Kishkin Yu.I., Izmaylova S.B., Branchevskaya E.S., Maychuk N.V., Karimova A.N. Confocal microscopy in the evaluation of corneal morphology after ametropia correction using the transepithelial PRK method in patients with stabilized keratoconus. Modern technologies in ophthalmology = Sovremennyye tekhnologii v oftalmologii. 2014;3:126–129 (In Russ.)
3. Bikbov M.M., Surkova V.K., Khalimov A.R., Usubov E.L. Results of corneal crosslinking for pellucid marginal corneal degeneration. Annals of Ophthalmology = Vestnik oftal’mologii 2017;3:58–64. (In Russ.) DOI: 10.17116/oftalma2017133358‑64
4. Myagkov A.V., Abugova T.D. Diagnosis of rare corneal diseases in the conditions of the optical salon: keratotorus. Frames and lenses = Opravy i linzy. 2012;2(68):36–38 (In Russ.)
5. Myagkov A.V. Guide to medical optics. Part 2. Contact vision correction. Moscow: Aprel, 2018 (In Russ.)
6. Schlaeppi V. La dystrophie marginale inferieure pellucide de la cornee. Bibl Ophthalmol. 1957;12(47):672–677.
7. Moshirfar M., Edmonds J.N., Behunin N.L., Chistiansen S.M. Current options in the management of pellucid marginal degeneration. J Refract Surg. 2014;30(7):474–485. DOI: 10.3928/1081597X‑20140429‑02
8. Gomes J.A., Tan D., Rapuano C.J., Belin M.W., Ambrósio R. Jr, Guell J.L., Malecaze F., Nishida K., Sangwan V.S.; Group of Panelists for the Global Delphi Panel of Keratoconus and Ectatic Diseases. Global consensus on keratoconus and ectatic diseases. Cornea. 2015;34(4):359–369. https://doi.org/10.1097/ICO.0000000000000408
9. Sridhar M., Mahesh S., Bansal A.K., Nutheti R., Rao G. Pellucid marginal corneal degeneration. Ophthalmology. 2004;111(6):1102–1107. DOI: 10.1016/j.oph‑tha.2003.09.035
10. Shimazaki, J., Maeda, N., Hieda, O., Ohashi, Y., Murakami, A., Nishida, K., Japan Pellucid Marginal Corneal Degeneration Study Group. National survey of pellucid marginal corneal degeneration in Japan. Japanese journal of ophthalmology.2016; 60(5):341–348. DOI: 10.1007/s10384‑016‑0462‑0
11. Lee B.W., Jurkunas U.V., Harissi‑Dagner M., Pootulil A.M., Tobaihy F.M., Azar D.T. Ectatic disorders associated with a claw‑shaped pattern on corneal topography. Am J Ophthalmol 2007;144(1):154–156. DOI: 10.1016/j.ajo.2007.02.032
12. Farraq A.N., Hussein A.A., Ummar S. Treatment of Pellucid Marginal Degeneration. International Journal of Keratoconus and Ectatic Corneal Diseases. 2017;6(2):87–89. DOI: 10.5005/jp‑journals‑10025‑1148
13. Corneal Collagen Cross Linking. Mazen M. Sinjab, Arthur B. Cummings Editors. Springer, 2017. 296 p.
14. Kymionis G.D., Grentzelos M.A., Liakopoulos D.A., et al. Long‑term follow‑up of corneal collagen cross‑linking for keratoconus — the Cretan study. Cornea. 2014;33(10):1071–1079. DOI: 10.1097/ICO.0000000000000248
Review
For citations:
Slonimskiy A.Yu., Slonimskiy Yu.B., Sitnik H.V., Myagkov A.V., Milash S.V. Pellucid Marginal Corneal Degeneration and Keratoconus: Differential Diagnosis and Management of Patients. Ophthalmology in Russia. 2019;16(4):433-442. (In Russ.) https://doi.org/10.18008/1816-5095-2019-4-433-441
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