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Posterior Polymorphous Corneal Dystrophy Treatment & Management

  • Author: Mark Ventocilla, OD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Apr 08, 2015

Medical Care

Management of PPMD varies widely based on the differences in severity of corneal decompensation. Many patients who are asymptomatic and show minimal signs of PPMD can be treated conservatively and do not require therapy.

Ruptured corneal bullae should be treated similar to a corneal abrasion.

Hyperosmotic saline drops and ointments may be used in cases of corneal failure with corneal edema.

Secondary glaucoma may require medical or surgical management.

A bandage soft contact lens may be used as a temporary measure to treat bullous keratopathy.


Surgical Care

The risk factors for more advanced disease, requiring surgery, include increased intraocular pressure and iridocorneal adhesions.

Corneal transplantation is usually reserved for patients with substantially decreased visual acuity or when the disease is advanced and painful due to ruptured epithelial bullae. Penetrating keratoplasty (full thickness corneal transplantation) has been the transplant procedure of choice in the past. The newer techniques of posterior endothelial keratoplasty, such as Descemet membrane stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK), have been shown to be successful.[6, 7]

Rare cases of corneal graft failure due to recurrence of PPMD in the donor graft have been reported, but the most common problem following a corneal transplant is related to uncontrolled glaucoma.[8]

To treat pain in eyes without good visual potential, other procedures, such as anterior stromal micropuncture, excimer laser phototherapeutic keratectomy, amniotic membrane transplantation, and conjunctival flap surgery, can also be considered.

When glaucoma medications no longer adequately control the intraocular pressure, glaucoma laser or incisional surgery may be required to prevent glaucomatous optic nerve damage. Surgery with limited success is often seen in patients with peripheral anterior synechiae without gonioscopy and elevated intraocular pressure. Poor intraocular pressure control, even with surgical intervention, is observed.



Depending on the severity of the condition, consultation with corneal and glaucoma subspecialists may be warranted.

Contributor Information and Disclosures

Mark Ventocilla, OD, FAAO Adjunct Clinical Professor, Michigan College of Optometry; Editor, American Optometric Association Ocular Surface Society Newsletter; Chief Executive Officer, Elder Eye Care Group, PLC; Chief Executive Officer, Mark Ventocilla, OD, Inc; President, California Eye Wear, Oakwood Optical

Mark Ventocilla, OD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.


Dustin J Coupal, MD, FRCSC Eye Specialist and Surgeon, Private Practice

Dustin J Coupal, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, Canadian Medical Association, Canadian Medical Protective Association, and Canadian Ophthalmological Society

Disclosure: Nothing to disclose.

W Keith Hamilton, MD Clinical Assistant Professor, Department of Ophthalmology, Saskatoon City Hospital Eye Centre

Disclosure: Nothing to disclose.

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Slit lamp image demonstrates posterior corneal vesicles and opacities in linear bands and other polymorphous configurations typical of posterior polymorphous corneal dystrophy.
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