Clinical Findings and Management of Pellucid Marginal Degeneration Using Scleral Lenses Over INTACS and Corneal Collagen Cross-linking with Riboflavin
Bibliographic record
Abstract
This case study provides an analysis of an individual affected by pellucid marginal degeneration (PMD). This particular case demonstrates the effectiveness of new scleral lenses over a severe form of PMD that underwent corneal crosslinking (CXL) with riboflavin over intra-stromal corneal ring segments (INTACS). PMD is a rare, progressive, degenerative corneal disease typically characterized as peripheral, bilateral, and inferior ectasia producing a crescent shape. It has been found more commonly in males and appears between the second and fifth decade of life showing no signs of ethnic predilection. Although there is no evidence of the prevalence and etiology of PMD, it may be postulated that PMD is poorly differentiated because this disease is often confused or used interchangeably with keratoconus (KC). KC is a developmental anomaly in which a part of the cornea becomes thinner and bulges forward in a cone-shaped fashion as a result of non-inflammatory stromal thinning. KC is predominantly bilateral (90%) and according to recent studies demonstrates a prevalence of 2.3%. The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) study found the genetic predisposition of KC to be at 13.5%, whereas other studies found it to be between 6–10%. This means most of those found having KC have no known association with the disease. More importantly, the cause of KC is still unknown. Regardless, the Federal Drug Administration (FDA) approval of KC treatment using CXL in April 2016 has shown excellent promise of improving the visual potential for patients with this progressive disease. This case demonstrates the usefulness of utilizing scleral gas permeable (GP) contacts over INTACS post CXL to provide optimal, stable vision, comfort and therapy. In addition, this paper shows an innovative way to utilize corneal topography to ensure proper fitting scleral lenses.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".