False Keratoconus and Pellucid diagnoses in monocular ectasia secondary to trauma, ?forceps@birth скачать в хорошем качестве

False Keratoconus and Pellucid diagnoses in monocular ectasia secondary to trauma, ?forceps@birth

This is a 46-year-old myopic lady with long history of diagnosed keratoconus since 1990 ( over 30 years!) She has had good visual function since with gas permeable contact lenses, but has recently seen deterioration in vision She was advised that her diagnosis has changed from KCN to pellucid marginal degeneration in her left eye and was recommended to undergo corneal cross-linking. Upon careful evaluation as a second opinion, we established that her right eye does not have KCN nor does her left eye . Based on careful bio microscopy I am also moving away from the PMD diagnosis as there is a clear split a Descemet’s membrane arcuate in the inferior cornea probably causing the ectasia. This cornea probably underwent significant injury in the past most likely a childbirth forceps injury! The current ectasia and residual thickness precludes in my opinion the option of undergoing corneal cross-linking as the inferior ecstatic area has gone under 200 µm! Our surgical recommendation was that of an allograft arcuate patch graft ( we have reported in this technique in the past) pcombined with cross-linking in order to reverse some of the extreme arcuate inferior thinning and ectasia and rehabilitate the significant morbidity caused by the what in my opinion is not idiopathic in origin