Purchase this article with an account.
N.J. Peterson, S.B. Yee, H.M. Sorour, F.T. Li, M.S. Macsai, X.C. Zhao, R.W. Yee; Recurrence of Thiel-Behnke Dystrophy After Excimer Laser Phototherapeutic Keratectomy and Penetrating Keratoplasty . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3856.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the recurrence of Thiel-Behnke dystrophy after excimer laser phototherapeutic keratectomy (PTK) or penetrating keratoplasty (PKP). Thiel-Behnke dystrophy is an anterior basement membrane dystrophy recently linked to the 10q23-24 gene. A Pub-Med search revealed no previous reports concerning recurrence of Thiel-Behnke dystrophy (linked to the 10q23-24 gene) post-PTK or PKP. Methods: This is a retrospective case series reviewing the records of 5 patients with Thiel-Behnke dystrophy. Four patients (8 eyes) underwent PTK and 1 patient (2 eyes) underwent PKP. Best-corrected visual acuity (BCVA) was assessed, and biomicroscopic examinations for evidence of recurrent dystrophy were performed. The location (central and/or peripheral), lesion distribution (confluent or non-confluent) and lesion pattern (reticular, honeycomb, focal, or geographic) of any recurrence was noted. Each instance of recurrence was documented by slit-lamp photography. Results: Post-operative follow-up ranged from 8 months to 25 years (mean, 9.7 years). All 10 eyes (5 patients) showed biomicroscopic evidence of central recurrence in various forms (reticular, or nonspecific polygonal opacities). Sixty percent of the eyes showed an intermediate zone of the classic honeycomb lesions giving way peripherally to a zone of focal and geographic lesions. Despite the high incidence of recurrence, the functional central visual acuity was maintained. The best-corrected visual acuities of the eyes were as follows: 20/25 (20%), 20/30 (20%), 20/40 (10%). 20/50 (30%), 20/70 (10%), 20/80 (10%). All of the PTK eyes maintained functional best-corrected visual acuity (ranging from 20/25 to 20/70) despite recurrence 10 years post-operatively. Conclusion: Recurrence of Thiel-Behnke dystrophy is extremely high after either phototherapeutic keratectomy or penetrating keratoplasty. Despite the high incidence of recurrence, the central corneal epithelium is the last to be affected. The peripheral to central progression of the lesions point to an epithelial origin for the pathogenesis of recurrent Thiel-Behnke dystrophy. Phototherapeutic keratectomy in the treatment of Thiel-Behnke dystrophy offers an effective treatment modality, providing patients 10 years of improved vision. PTK is currently the treatment of choice for anterior membrane dystrophies and avoids other invasive and aggressive surgical intervention.
This PDF is available to Subscribers Only