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I. N. Lai, S. A. Rayner, V. S. Yellore, A. J. Aldave; Exacerbation of Granular Corneal Dystrophy, Type II Following LASIK Performed in the United States. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4649.
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Rapid deposition of dystrophic corneal deposits in the lamellar interface following LASIK surgery has been reported almost exclusively in individuals of Korean ancestry with granular corneal dystrophy, type II (Avellino corneal dystrophy). We wish to make refractive surgeons in North America more aware of this phenomenon by reporting the accelerated deposition of TGFBI protein (TGFBIp) following LASIK surgery performed in the United States in two individuals of non-Korean ancestry.
Small case series, including description of clinical course and serial documentation of corneal deposits with slit lamp photography and anterior segment OCT. DNA was collected from each patient, and exons 4 and 12 of TGFBI were screened to identify the presumed pathogenic mutation.
A 51-year-old Chinese man with no clinically evident corneal opacities and without a family history of a corneal dystrophy underwent an uncomplicated bilateral LASIK procedure. Two years after surgery, dense polymorphic opacities had developed in the lamellar interface, resulting in reduced visual acuity and glare. A 48-year-old Japanese woman with an extensive family history of presumed granular corneal dystrophy underwent uncomplicated bilateral LASIK and an enhancement procedure one year later in each eye. Three years after the enhancement procedure, the patient noted decreased vision and significant glare secondary to confluent granular interface opacities. Laser phototherapeutic keratectomy to the stromal bed performed eight years after the enhancement procedure did not result in an improvement in the patient’s symptoms. Screening of TGFBI in both patients revealed p.Arg124His, diagnostic of granular corneal dystrophy, type II.
LASIK surgery should not be performed in patients with a known TGFBI dystrophy, although exacerbation of TGFBIp deposition following LASIK has been reported to date only in individuals with granular corneal dystrophy type II. Molecular genetic analysis should be performed in all clinically unaffected family members of individuals with a TGFBI dystrophy prior to elective keratorefractive surgery, as dystrophic deposits may not appear until after LASIK surgery is performed.
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