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Jagadesh C. Reddy, Christopher J. Rapuano, Kristin M. Hammersmith, Parveen K. Nagra; Clinical Outcomes Of Surgical Intervention For Stromal Corneal Dystrophies. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6052.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual,refractive and recurrence results after surgical intervention for primary and recurrent corneal stromal dystrophies.
Retrospective study of 38 eyes of 25 patients after excimer laser phototherapeutic keratectomy (PTK) and 18 eyes of 15 patients after penetrating keratoplasty (PK).
Mean age at the time of surgery was 55 and 62 years in PTK and PK groups respectively. PTK was performed in 23 eyes with granular dystrophy(GD),11 eyes with lattice dystrophy(LD),3 eyes with macular corneal dystrophy(MCD) and 1 eye with Schnyder corneal dystrophy(SCD).Twenty-three PTK procedures were performed for recurrent dystrophies(15 after PK and 8 after PTK).PK was performed in 10 eyes with LD,4 eyes with MCD,3 eyes with SCD and 1 eye with GD.Ten eyes had PK for recurrent dystrophy (9 after PK and 1 after PTK).Pre-operative and post-operative mean Log MAR best spectacle corrected visual acuity was 0.5(20/63),0.25(20/32) in PTK group and 1.01(20/200),0.43(20/50) in PK group respectively. Mean cylinder and spherical equivalent at final follow-up was 1.82D,1.07D in PTK group and 3.05D,0.42D in PK group. In PTK group 68% gained 2 or more lines. Mean follow-up was 43 and 73 months for PTK and PK groups respectively. Mild recurrence (only slit lamp evidence or <2 episode of recurrent erosion/month) was seen in 13(34%) eyes (8-GD,3-LD,2-MCD),significant recurrence (loss of 2 or more lines of VA or ≥2 episodes of recurrent erosions/month) was seen in 8(21%)eyes (3-GD,4-LD,1-MCD) at a mean of 34.6 and 53.71 months respectively after PTK. Mild recurrence was seen in 8 eyes (53%) (7-LD,1-SCD), significant recurrence was seen in 3 eyes (17%) (2-LD,1-GD) at mean of 65 and 55.3 months respectively after PK. Mild recurrence was seen early in PTK group (p=0.001) but there was no difference in time period in case of severe recurrence between the two groups(p=0.866). Mild central haze was seen in 9 eyes (24%) after PTK. In the PK group 2 eyes had an episode of endothelial graft rejection, one eye had a graft infiltrate which subsequently required a repeat PK for scar. At final follow-up 15 grafts (83%) were clear.
Recurrence of corneal dystrophy is seen after both PTK and PK, but PTK can restore or preserve visual acuity for significant period of time. Due to itsrepeatability, PTK can be considered for both primary and recurrent anteriorstromal dystrophies.
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