de Almeida Ferreira Gabriel, Coral Ghanem Vinicius, Coral Ghanem Ramon
Sadalla Amin Ghanem Eye Hospital, Joinville, SC, Brazil.
Am J Ophthalmol Case Rep. 2020 Feb 22;18:100621. doi: 10.1016/j.ajoc.2020.100621. eCollection 2020 Jun.
Pellucid marginal degeneration (PMD) is a rare disease that is often mistaken for keratoconus but can similarly be treated with corneal collagen crosslinking (CXL). We report a case followed though 6 years of progressive irregular corneal flattening and thinning in both eyes (OU) after eccentric CXL for PMD.
A 46-year-old man with bilateral PMD and corrected distance visual acuity (CDVA) of 20/20 (-2.00x80) in the right eye (OD) and 20/30 (+3.50-5.25x105) in the left eye (OS) underwent conventional 9 mm eccentric CXL in OU and intrastromal corneal ring implantation in the OS. An uneventful first year postoperative follow-up showed stabilization of the ectasia. In subsequent years, progressive inferior flattening was observed with decreased CDVA, corneal thinning and worsening of the haze. At the last follow-up, his CDVA was 20/40 (+5.00-2.00x55) OD and 20/60 (+6.00-1.50x80) OS.
The current report highlights the notion that mid- and long-term evaluations of customized crosslinking techniques may reveal progressive flattening and corneal irregularity.
透明边缘变性（PMD）是一种罕见疾病，常被误诊为圆锥角膜，但同样可用角膜胶原交联术（CXL）进行治疗。我们报告了1例PMD患者，在接受偏心CXL治疗后，双眼出现了6年的进行性角膜不规则扁平及变薄。
一名46岁男性，双眼患有PMD，右眼（OD）矫正远视力（CDVA）为20/20（-2.00×80），左眼（OS）为20/30（+3.50 - 5.25×105）。双眼接受了传统的9毫米偏心CXL，左眼植入了基质内角膜环。术后第一年随访顺利，扩张得到稳定。在随后几年中，观察到角膜逐渐向下扁平，CDVA下降，角膜变薄，雾状混浊加重。在最后一次随访时，其右眼CDVA为20/40（+5.00 - 2.00×55），左眼为20/60（+6.00 - 1.50×80）。
本报告强调了这样一个观点，即对定制交联技术的中长期评估可能会揭示角膜的进行性扁平及不规则。
