Further Outpatient Care
Patients with pellucid marginal degeneration should receive follow-up care as needed.
Complications
Corneal hydrops similar to that seen in keratoconus, with disruption of the endothelial basement membrane and hydration of the adjacent corneal stroma, rarely occurs in pellucid marginal degeneration (PMD). [20]
Spontaneous corneal perforations in cases of pellucid marginal degeneration are rare. A few case reports have been published in the literature. [20, 21, 22]
Prognosis
No large-scale longitudinal studies of pellucid marginal degeneration have been reported. Quantifying the proportion of patients who eventually require surgery is difficult. Contact lens fitting and surgical correction are more difficult with pellucid marginal degeneration than with keratoconus.
In a follow-up of their ongoing longitudinal study of keratoconus, Rabinowitz and Rasheed have observed 31 patients with pellucid marginal degeneration up to 8 years. [23] Five patients have required corneal transplantation in 1 eye, and one patient has required transplantation in both eyes. The data must be interpreted with caution because these observations may have been affected by selection bias.
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Slit lamp image of the inferior cornea in a patient with advanced pellucid marginal degeneration. Image illustrates inferior corneal thinning, a hallmark of this disease.
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Corneal topography of early (right eye) and moderate (left eye) pellucid marginal degeneration.
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Optical coherence tomography (OCT) of cornea with moderate pellucid marginal degeneration.
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Image shows simultaneous central penetrating keratoplasty and inferior peripheral lamellar keratoplasty performed to treat pellucid marginal degeneration.
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Representative photographs of corneal topography. Courtesy of the Japanese Journal of Ophthalmology, published by the Japanese Ophthalmological Society.
