A sequential approach to the management of an advanced case of pellucid marginal degeneration.

Purpose: We report a sequential approach in the management of a case with advanced pellucid marginal degeneration (PMD). The management was tailored based on the patient's corneal topography and degree of corneal astigmatism. Full thickness corneal transplants in cases of PMD carry a prolonged rehabilitation period and the risk of graft failure.This case consisted of lamellar wedge resection followed by wavefront guided transepithelial photorefractive keratectomy (wTPRK) combined with accelerated corneal crosslinking (aCXL) in preparation for a cataract extraction with intraocular lens.

Observation: A 68-year-old gentleman with advanced PMD underwent phacoemulsification with toric intraocular lens (T-IOL) for the right eye and a lamellar wedge resection, followed by wTPRK combined with aCXL for the contralateral eye. The left eye underwent a sequential approach to regularize the cornea, minimize the higher order aberrations (HoA) and degree of corneal astigmatism. Effective visual rehabilitation was achieved with significant visual improvement.

Conclusion And Importance: Although advanced PMD may have limited options for visual rehabilitation, a sequential stepwise approach may be considered in such cases, permitting a better quality with less invasive options.