Long–Term Results of Phototherapeutic Keratectomy and Extended Wear of Therapeutic Soft Contact Lenses for the Treatment of Gelatinous Drop–Like Corneal Dystrophy

Abstract

Abstract: : Purpose: Gelatinous drop–like corneal dystrophy (GDLD) may be managed with keratoplasty but the recurrence rate is significant. One report suggests that extended wear postoperatively of therapeutic soft contact lenses (SCL) might prevent recurrence after keratoplasty (Miyamoto et al, Jpn Clin Ophthalmol, 1996). The purpose of this study was to evaluate the efficacy of phototherapeutic keratectomy (PTK) followed by the extended–wear of SCL for the treatment of GDLD in the long term. Methods: Five eyes of 5 patients (average age 36 yrs; range 29 to 47 yrs) with GDLD diagnosed both clinically and by DNA analysis were included in this study. At the time of surgery epithelial layers including protruding subepithelial masses were scraped away from a 9mm–diameter area of the central cornea. The inner 7mm–diameter area then received PTK with a cutting depth less than 100µm. Immediately after surgery a SCL was put in place, and SCL wear was continued with renewal once a month for an average follow–up time of 3.0 yrs (range 2.8 to 3.8 yrs). The efficacy of this treatment was evaluated by visual acuity (VA) improvement and recurrence rate. Results: PTK was successful in the restoration of corneal transparency. The best–corrected VA improved 7 or more lines in three eyes, and 2 lines in one eye. This improvement was maintained during the follow–up. In one eye, VA was unchanged, but episodes of photophobia and irritation were markedly diminished. No recurrence was observed. Conclusions: PTK with postoperative extended–wear of SCLs is an effective and safe procedure for the long–term management of GDLD.

Keywords: degenerations/dystrophies • clinical (human) or epidemiologic studies: outcomes/complications • laser