Long-term outcomes of lamellar crescentic wedge resection on corneal astigmatism and optical aberrations in patients with advanced pellucid marginal degeneration.

Abstract

Background/aim: The present study investigates the long-term changes in corneal astigmatism and aberrations following lamellar wedge resection in cases with advanced pellucid marginal degeneration (PMD).

Materials and methods: Patients with advanced PMD whose visual acuity did not improve with glasses or contact lenses underwent lamellar crescentic wedge resection. Pre- and postoperative assessments at 3, 6, 12, and 24 months using Pentacam HR were conducted to identify changes in corrected visual acuity, corneal astigmatism, and higher-order aberrations (HOAs) following the procedure, and compared with a control group.

Results: Statistically significant postoperative improvements in corrected visual acuity were observed at 6 and 12 months compared to preoperative values. At postoperative 3, 6, 12, and 24 months, significant improvements from preoperative values were noted in logMAR, astigmatism, and Kmax parameters (p < 0.05). A comparison of the patients with PMD and a control group revealed significant postoperative reductions in anterior and posterior coma, trefoil, spherical, and tetrafoil aberrations at 4 mm and 6 mm (p < 0.05). Most parameters remained statistically different from the healthy controls, indicating improvement without complete normalization. Although no significant difference was noted in the 6 mm anterior root mean square (RMS) value, a statistically significant reduction was observed in the 6 mm posterior RMS value at postoperative 3 and 6 months (p < 0.05).

Conclusion: Lamellar crescentic wedge resection may be considered an appropriate and relatively safe surgical option for selected patients with advanced PMD, avoiding the risks associated with open-eye surgery, graft rejection, and secondary glaucoma. Long-term improvements in visual acuity, corneal astigmatism, and selected HOAs were noted following the procedure. Given the limited sample size and exploratory study design, these findings should be interpreted with caution and considered hypothesis-generating rather than definitive.