Coincident Pellucid Marginal Degeneration and Fuchsiridocyclitis: a case report

TL;DR

A rare case of two eye conditions, Pellucid Marginal Degeneration and Fuchs' uveitis, is reported, highlighting the challenges in diagnosis and treatment.

Contribution

This case report documents the rare coexistence of PMD and FHI, emphasizing the need for individualized surgical planning.

Findings

PMD and FHI coexistence is exceptionally rare and poses diagnostic and surgical challenges.

Multimodal imaging and tailored surgical strategies are essential for optimal outcomes.

Postoperative vigilance is crucial due to risks of glaucoma and persistent inflammation.

Abstract

We report a rare coexistence of Pellucid Marginal Degeneration (PMD) and Fuchs' heterochromic iridocyclitis (FHI) in a 40-year-old female. The overlap of corneal ectasia and chronic uveitis created significant diagnostic and surgical challenges, highlighting the importance of individualized planning in complex anterior segment diseases.

The patient presented with painless, progressive visual decline in the right eye. Clinical examination revealed inferior corneal thinning, mature cataract, pigmented keratic precipitates, and peripheral anterior synechiae (PAS). Corneal tomography confirmed PMD with a characteristic “crab-claw” pattern. The patient underwent phacoemulsification with posterior chamber intraocular lens implantation. Postoperatively, visual acuity improved, although optic disc cupping and persistent PAS underscored the need for long-term glaucoma surveillance.

The coexistence of PMD and FHI is exceptionally rare. PMD complicates surgical planning by affecting keratometric reliability and corneal biomechanics, while FHI contributes to cataract formation, intraocular inflammation, and risk of secondary glaucoma. Multimodal imaging, tailored surgical strategy, and vigilant postoperative follow-up are key to optimizing outcomes.

Simultaneous PMD and FHI represent a unique clinical entity requiring comprehensive assessment and individualized management. Tailored surgical planning and vigilant surveillance are essential to preserve vision and mitigate long-term risks.

•Coexistence of pellucid marginal degeneration (PMD) and Fuchs' uveitis presenting for cataract surgery•Pre-operative tomography and angle assessment guided intraocular lens (IOL) strategy in an ectatic cornea.•Intra-operative observation of the Amsler sign with implications for glaucoma surveillance•Post-operative visual and refractive outcomes presented with time-stamped follow-up

Coexistence of pellucid marginal degeneration (PMD) and Fuchs' uveitis presenting for cataract surgery

Pre-operative tomography and angle assessment guided intraocular lens (IOL) strategy in an ectatic cornea.

Intra-operative observation of the Amsler sign with implications for glaucoma surveillance

Post-operative visual and refractive outcomes presented with time-stamped follow-up

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