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Updated: Dec 27, 2025

Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Late progressive corneal flattening, haze and visual loss after eccentric crosslinking for Pellucid marginal
Gabriel de Almeida Ferreira1, Vinicius Coral Ghanem1, Ramon Coral Ghanem1
1Sadalla Amin Ghanem Eye Hospital, Joinville, SC, Brazil.
Purpose:
Pellucid marginal degeneration (PMD) is a rare disease that is often mistaken for keratoconus but can similarly be treated with corneal collagen crosslinking (CXL). We report a case followed though 6 years of progressive irregular corneal flattening and thinning in both eyes (OU) after eccentric CXL for PMD.
Observation:
A 46-year-old man with bilateral PMD and corrected distance visual acuity (CDVA) of 20/20 (-2.00x80) in the right eye (OD) and 20/30 (+3.50-5.25x105) in the left eye (OS) underwent conventional 9 mm eccentric CXL in OU and intrastromal corneal ring implantation in the OS. An uneventful first year postoperative follow-up showed stabilization of the ectasia. In subsequent years, progressive inferior flattening was observed with decreased CDVA, corneal thinning and worsening of the haze. At the last follow-up, his CDVA was 20/40 (+5.00-2.00x55) OD and 20/60 (+6.00-1.50x80) OS.
Conclusion And Importance:
The current report highlights the notion that mid- and long-term evaluations of customized crosslinking techniques may reveal progressive flattening and corneal irregularity.
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