Crescentic Tuck in Lamellar Keratoplasty—A Novel Technique in a Case of Advanced Pellucid Marginal Corneal Degeneration

Abstract

To describe a new surgical technique "crescentic tuck in lamellar keratoplasty" for the management of advanced pellucid marginal corneal degeneration (PMCD). A 45-year-old man with advanced PMCD and maximal thinning in the inferior juxtalimbal periphery underwent a crescentic lamellar keratoplasty in the right eye. Best-corrected visual acuity was 6/60 with no further improvement because of severe irregular astigmatism. Thinnest pachymetry in the peripheral cornea was 280 μm. Peripheral crescent-shaped lamellar corneal dissection of 3.5-mm width was performed, and an intrastromal pocket was fashioned from 4 to 8 O'clock, extending beyond limbus. A crescent-shaped donor corneal button of 3.5-mm width was denuded of its endothelium and beveled in inferior periphery to create a flange. The flange was tucked into the peripheral scleral pocket. The donor graft was secured to the host bed using 10-0 nylon interrupted sutures. Donor cornea integrated with the host bed over time and best spectacle-corrected visual acuity at 1 year improved to 6/9 with -1.25/-3.5 D × 90°. The simK (simulated keratometry) changed from 41.6/56.3 diopters (D) to 45.1/50.6 D. The astigmatism reduced from 14.6 D to 5.5 D. Crescentic tuck in lamellar keratoplasty provides good apposition of the donor lenticule and tectonic support to the peripheral thin cornea while preserving the peripheral limbal stem cells. Additionally, there is a significant reduction in the astigmatism, resulting in visual improvement.