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We developed SILK surgery (Sclero-Corneal Intrastromal Lamellar Keratoplasty) this technique allows to address both astigmatism and corneal thinning in Pellucid Marginal Degeneration (a peripheral keratoconus). PMD is a bilateral, peripheral corneal ectatic disorder characterized by a band of corneal thinning, typically located in the inferior part of the cornea. This thinning usually measures 1-2 mm in width and is found 1-2 mm central to the inferior limbus, predominantly extending from the 4 to 8 o'clock positions. There are atypical cases where the thinning extends beyond these positions or is confined to a superior location. Notably, PMD can occasionally be unilateral.Comparison with KeratoconusPMD is often compared to keratoconus, another corneal ectatic disorder. However, while keratoconus typically shows maximum corneal protrusion within the thinning area, PMD features maximum protrusion just superior to the thinning area. This results in a distinctive corneal contour likened to a "beer belly". Clinical Presentation and Diagnosis Patients usually present between the second and fifth decades of life with blurred vision due to irregular astigmatism. PMD affects all races and genders equally. Diagnostically, corneal power maps often show a "crab-claw" configuration, indicative of PMD. However, distinguishing PMD from conditions like inferior keratoconus is crucial, often necessitating detailed corneal tomography in addition to standard topography. Management and Treatment Managing PMD is challenging:Contact Lenses: Large-diameter rigid gas permeable (RGP), hybrid, or scleral lenses may be used to manage astigmatism and improve vision.Surgical Interventions: Surgical options like large-diameter or eccentric lamellar keratoplasty (DALK) are sometimes necessary but of poor prognosis. Newer approaches using ring segments are being explored. Complications While the corneas in PMD remain clear and avascular, complications can include hydrops leading to scarring and vascularization. Spectacles often fail to correct the high degree of irregular astigmatism, necessitating the use of contact lenses or surgical intervention.