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Pellucid marginal degeneration treated by lamellar and penetrating keratoplasty.

Pellucid marginal degeneration (PMD) is characterized by noninflammatory, inferior peripheral corneal thinning, progressing to a narrow band (1 to 2 mm) of corneal ectasia 1 to 2 mm above the inferior corneal limbus. 1 The degree of thinning is usually severe, resulting in up to 80% stromal loss, but the overlying corneal epithelium remains intact. The final condition consists of corneal topographic abnormalities characterized by a flattened vertical meridian. 1 The inferior corneal ectasia may be so steep as to offset the central vertical flattening, resulting in a paradoxical "with-the-rule" astigmatism. 1 A number of surgical procedures for visual rehabilitation of patients with PMD have been described. These include thermocauterization, total lamellar keratoplasty, crescentic lamellar keratoplasty, eccentric penetrating keratoplasty, 1 crescentic resection, 2 and even crescentic penetrating keratoplasty. 3 Report of a Case. —A 37-year-old woman with a diagnosis of bilateral keratoconus, more advanced in her left eye, has been