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Chen M, Lin P, Li D, Tian L. Phototherapeutic keratectomy for corneal epithelial-stromal dystrophies in pediatric patients. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06513-x. [PMID: 38761205 DOI: 10.1007/s00417-024-06513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 01/31/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024] Open
Abstract
Corneal dystrophies may develop gradually from early onset in childhood and persist for years to decades. Visual impairment or repeated ocular irritations caused by corneal dystrophies severely affect the quality of life. Although various surgical treatment options are indicated for adult patients, the treatment plan for pediatric patients remains unclear. Herein we describe clinical observations of phototherapeutic keratectomy for corneal epithelial-stromal dystrophies in three pediatric patients (five eyes). Corneal opacities were successfully removed, and visual acuity was greatly improved in all operated eyes. The procedure of phototherapeutic keratectomy seems to be feasible in the treatment of corneal epithelial-stromal dystrophies in c hildren, with advantages of minimal invasion and good visual outcomes.
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Affiliation(s)
- Min Chen
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Qingdao, China.
| | - Ping Lin
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Qingdao, China
| | - Dewei Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Qingdao, China
| | - Le Tian
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University, Qingdao, China
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Li D, Tian LE, Wang X, Zhang F, Liu T, Dong Y, Lin P, Li D, Sun D, Chen M. Recurrence Characteristics on Optical Coherence Tomography and Treatments of Reis-Bücklers Corneal Dystrophy After Phototherapeutic Keratectomy or Penetrating Keratoplasty. Am J Ophthalmol 2024; 266:37-45. [PMID: 38735449 DOI: 10.1016/j.ajo.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To evaluate the recurrence characteristics on optical coherence tomography and clinical outcomes after phototherapeutic keratectomy (PTK) or penetrating keratoplasty (PKP) in patients with Reis-Bücklers corneal dystrophy (RBCD). DESIGN Retrospective interventional case series. METHODS Seventeen patients with RBCD (31 eyes, including 6 surgery-naïve eyes and 25 surgical eyes) received 44 surgical interventions from 1996 through 2022. PTK or PKP was performed as the initial surgical procedure. Significant recurrence was determined when best spectacle-corrected visual acuity decreased at least 2 lines with increased opacity in the superficial cornea. Repeated PTK or PTK on the corneal graft (CG-PTK) was considered if patients could not endure poor vision due to significant recurrence. Recurrence depth and annual increase in thickness of the central cornea and subepithelial deposits were assessed by anterior segment optical coherence tomography. RESULTS The mean follow-up time was 12.8 ± 8.5 years (range, 2.0-25.5 years). The mean logMAR best spectacle-corrected visual acuity improved from 1.24 ± 0.48 preoperatively to 0.27 ± 0.09 postoperatively in the initial PTK group (13 eyes, P < .001), from 1.84 ± 0.69 to 0.40 ± 0.13 in the PKP group (12 eyes, P < .001), from 1.04 ± 0.46 to 0.30 ± 0.07 in the repeated PTK group (12 times in 7 eyes, P < .001), and from 1.29 ± 0.43 to 0.39 ± 0.11 in the CG-PTK group (7 times in 5 eyes, P = .001). The median significant recurrence time was 27 months (95% confidence interval 23.9-30.1), 96 months (84.1-107.9), 31 months (28.8-33.1), and 24 months (19.8-28.2), respectively (P < .001). The depth of superficial deposits located between the epithelium and the anterior stroma was approximately 115 µm (85-159 µm). The annual thickening of subepithelial deposits was 14 ± 2 µm after initial PTK, 7 ± 3 µm after PKP, 14 ± 3 µm after repeated PTK, and 30 ± 11 µm after CG-PTK, compared to 4 ± 2 µm in surgery-naïve eyes (P = .002, .515, .002, <.001). The thickness of the central cornea increased by 15 ± 2 µm, 7 ± 2 µm, 15 ± 3 µm, and 31 ± 10 µm per year in the 4 surgery groups, respectively, compared to 5 ± 2 µm in surgery-naïve eyes (P = .001, .469, .001, <.001). CONCLUSIONS Better visual acuity can be achieved after PTK than PKP for treatment of RBCD. The annual thickening of subepithelial deposits may approximate an increase in central corneal thickness. The superficial distribution of subepithelial deposits makes it feasible to perform repeated PTK, even on the corneal allograft, for recurrent RBCD.
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Affiliation(s)
- Dewei Li
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - L E Tian
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Xiaochuan Wang
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Feifei Zhang
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China
| | - Ting Liu
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Yanling Dong
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Ping Lin
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Dongfang Li
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Dapeng Sun
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China
| | - Min Chen
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China.
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Chang MS, Jun I, Kim EK. Mini-Review: Clinical Features and Management of Granular Corneal Dystrophy Type 2. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:340-347. [PMID: 37336511 PMCID: PMC10427907 DOI: 10.3341/kjo.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023] Open
Abstract
Granular corneal dystrophy type 2 (GCD2) is an autosomal dominant corneal stromal dystrophy that is caused by p.Arg124His mutation of transforming growth factor β induced (TGFBI) gene. It is characterized by well demarcated granular shaped opacities in central anterior stroma and as the disease progresses, extrusion of the deposits results in ocular pain due to corneal epithelial erosion. Also, diffuse corneal haze which appears late, causes decrease in visual acuity. The prevalence of GCD2 is high in East Asia including Korea. Homozygous patients show a severe phenotype from an early age, and the heterozygote phenotype varies among patients, depending on several types of compound heterozygous TGFBI mutations. In the initial stage, conservative treatments such as artificial tears, antibiotic eye drops, and bandage contact lenses are used to treat corneal erosion. Different surgical methods are used depending on the depth and extent of the stromal deposits. Phototherapeutic keratectomy removes anterior opacities and is advantageous in terms of its applicability and repeatability. For deeper lesions, deep anterior lamellar keratoplasty can be used as the endothelial layer is not always affected. Recurrence following these treatments are reported within a wide range of rates in different studies due to varying definition of recurrence and follow-up period. In patients who have undergone corneal laser vision-correction surgeries such as photorefractive keratectomy, LASEK, or LASIK including SMILE surgery, corneal opacity exacerbates rapidly with severe deterioration of visual acuity. Further investigations on new treatments of GCD2 are necessary.
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Affiliation(s)
- Myung Soo Chang
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul,
Korea
| | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul,
Korea
- Saevit Eye Hospital, Goyang,
Korea
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Ashena Z, Niestrata M, Tavassoli S. Management of Stromal Corneal Dystrophies; Review of the Literature with a Focus on Phototherapeutic Keratectomy and Keratoplasty. Vision (Basel) 2023; 7:vision7010022. [PMID: 36977302 PMCID: PMC10059954 DOI: 10.3390/vision7010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Corneal dystrophies are a group of non-inflammatory inherited disorders of the cornea. This review considers treatment options for epithelial-stromal and stromal corneal dystrophies: namely Reis–Bücklers, Thiel–Behnke, lattice, Avellino, granular, macular and Schnyder corneal dystrophies. Where there is visual reduction, treatment options may include either phototherapeutic keratectomy (PTK) or corneal transplantation. Due to the anterior location of the deposits in Reis-Bücklers and Thiel–Behnke dystrophies, PTK is considered the treatment of choice. For lattice, Avellino, granular and macular corneal dystrophies, PTK provides temporary visual improvement; however, with recurrences, repeat PTK or a corneal transplant would be needed. For Schnyder dystrophy, should treatment be required, PTK may be the preferred option due to the potential for recurrence of the disease in corneal transplantation. This review discusses the literature and evidence base for the treatment of corneal dystrophies in terms of visual outcomes and recurrence rate.
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Affiliation(s)
- Zahra Ashena
- Ophthalmology Department, Queen’s Hospital, Barking, Havering and Redbridge University NHS Hospitals Trust, Romford RM7 0AG, UK
- Correspondence: ; Tel.: +01708-435000
| | - Magdalena Niestrata
- Moorfields Reading Centre and Clinical AI Hub, Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- NIHR Biomedical Research Centre, UCL Institute of Ophthalmology, London EC1V 2PD, UK
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Ji YW, Ahn H, Shin KJ, Kim TI, Seo KY, Stulting RD, Kim EK. De Novo L509P Mutation of the TGFBI Gene Associated with Slit-Lamp Findings of Lattice Corneal Dystrophy Type IIIA. J Clin Med 2022; 11:jcm11113055. [PMID: 35683443 PMCID: PMC9181583 DOI: 10.3390/jcm11113055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Mutations of the transforming growth factor-β-induced (TGFBI) gene produce various types of corneal dystrophy. Here, we report a novel de novo L509P mutation not located in a known hot spot of the transforming growth factor-β-induced (TGFBI) gene and its clinical phenotype, which resembles that of lattice corneal dystrophy type IIIA (LCD IIIA). Case presentation: A 36-year-old man (proband) visited our clinic due to decreased visual acuity with intermittent ocular irritation in conjunction with painful recurrent erosions in both eyes for 10 years. Molecular genetic analyses revealed a TGFBI L509P mutation (c.1526T>C) in the proband and one of his sons. Interestingly, neither TGFBI mutations nor corneal abnormalities were detected in either of the proband’s biological parents, indicating the occurrence of a de novo L509P mutation. Clinical examinations, including slit-lamp retro-illumination and Fourier-domain anterior segment optical coherence tomography (FD-OCT), revealed gray deposits in the anterior stroma and deeper refractile lines extending from limbus to limbus in both corneas of the proband, consistent with a diagnosis of LCD IIIA. Superficial diffuse haze and surface irregularity were observed in conjunction with corneal erosions and visual impairment, necessitating phototherapeutic keratectomy (PTK). A 60 μm PTK of the Bowman layer and anterior stroma of the proband’s left eye was performed following the removal of the epithelium in order to remove superficial corneal opacities. His BCVA improved from 20/400 to 20/50 at postoperative week 8 and was maintained for 45 months. Pinhole-corrected VA was 20/20 at the last visit, and corneal opacities had not recurred. Conclusions: An inheritable de novo mutation of L509P in the TGFBI gene can produce severe LCD IIIA, which can be successfully treated with OCT-guided PRK.
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Affiliation(s)
- Yong Woo Ji
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Korea;
| | - Hyunmin Ahn
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (H.A.); (T.-i.K.); (K.Y.S.)
| | - Kyoung-Jin Shin
- Department of Forensic Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Tae-im Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (H.A.); (T.-i.K.); (K.Y.S.)
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (H.A.); (T.-i.K.); (K.Y.S.)
| | | | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea
- Saevit Eye Hospital, Goyang 10447, Korea
- Correspondence:
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Sauvageot P, Julio G, Bolaños JV, Carrera M, de Toledo JÁ, Barraquer RI. Recurrence and Visual Outcomes of Phototherapeutic Keratectomy in Lattice Corneal Dystrophy: A Cohort Study. J Refract Surg 2022; 38:43-49. [PMID: 35020539 DOI: 10.3928/1081597x-20211104-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate recurrence and visual outcomes of phototherapeutic keratectomy (PTK) in lattice corneal dystrophy. METHODS Kaplan-Meier survival analyses were retrospectively performed. Recurrence was defined as central biomicroscopic findings of recurrence with decreased visual acuity: loss of at least two lines or visual acuity ≤ 20/40) at any time during the follow-up. RESULTS Twenty-two virgin eyes and 10 with previous keratoplasty (20 patients; 13 women and 7 men) were studied during a mean of 4.7 ± 3.5 years (range: 11 months to 18 years). One and 5 years after the first PTK (PTK1), 1 of 32 and 12 of 32 eyes, respectively, recurred. The cumulative probabilities of recurrence were 3%, 48%, and 89% in the whole sample at 1, 5, and 10 years, respectively. All cases in the virgin group and 8 eyes in the previous keratoplasty group improved their visual acuity. There were no significant differences in recurrence probability between groups (log-rank test; P = .86). A second PTK (PTK2) was performed in 15 of 32 eyes, with 6 postoperative recurrences recorded. The cumulative probabilities of recurrence in the whole sample were 18%, 30%, and 44% at 1, 3, and 5 years, respectively. Visual acuity improved in 11 of 13 eyes in the virgin group and 2 of 2 eyes in the previous keratoplasty group. Recurrence probability after PTK1 and PTK2 was similar in the whole sample (log-rank test; P = .637). Persistent graft edema after PTK1 in one eye was the only complication found. CONCLUSIONS PTK can be an effective, safe, and repeatable treatment to delay keratoplasty in symptomatic lattice corneal dystrophy. [J Refract Surg. 2022;38(1):43-49.].
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Li D, Tian L, Wang X, Chen M. Macular corneal dystrophy related to novel mutations of CHST6 in a Chinese family and clinical observation after penetrating keratoplasty. BMC Med Genomics 2021; 14:247. [PMID: 34645431 PMCID: PMC8513235 DOI: 10.1186/s12920-021-01095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Macular corneal dystrophy (MCD) is a rare corneal stromal dystrophy with bilateral progressive vision loss. The pathogenic gene of MCD is carbohydrate sulfotransferase 6 (CHST6). Herein, we report a novel missense mutation and a rare exon deletion mutation in the CHST6 gene in a Chinese family with MCD. METHODS Genomic DNA was extracted from the peripheral blood, and next generation sequencing was used to analyse the gene sequence. The pathogenic mutations were identified in all affected family members. The proband successively received binocular penetrating keratoplasty (PKP), and the corneas were examined by histopathology and colloidal iron staining to prove the diagnosis. A long-term follow-up was made to observe the changes after PKP. RESULTS Genetic analysis demonstrated hemizygous mutations in the proband, including a novel c.520A>C (p.K174Q) missense mutation and a rarely reported exon 3 deletion mutation, which were co-segregated with the MCD phenotypes in the pedigree. The positive colloidal iron staining confirmed the diagnosis of MCD in the proband. However, the clinical phenotype and pathological manifestation of both eyes were different from each other because of complicated keratitis in the left eye. During the nine years of follow-up, visual acuity was improved significantly, and the cornea was transparent without rejection and postoperative recurrence in both eyes. CONCLUSIONS The novel hemizygous mutations were thought to contribute to the loss of CHST6 function, which induced typical clinical and pathological features of MCD. PKP was an effective treatment for MCD.
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Affiliation(s)
- Dewei Li
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China
| | - Le Tian
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China
| | - Xiaochuan Wang
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China
| | - Min Chen
- Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China.
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 5 Yan'erdao Road, Qingdao, 266071, China.
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Shields M, Craig JE, Souzeau E, Gupta A. Bilateral phototherapeutic keratectomy for corneal macular dystrophy in an adolescent: case report and review of the literature. Ophthalmic Genet 2020; 41:368-372. [PMID: 32543930 DOI: 10.1080/13816810.2020.1776335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Phototherapeutic keratectomy (PTK) with 193-nm excimer laser is a safe and effective procedure for the treatment of superficial corneal pathology. We aimed to review the use of PTK for the treatment of corneal macular dystrophy (MCD). METHODS Case report and literature review. RESULTS A 16-year-old boy presented to an ophthalmologist with a 4-year history of reduced vision, glare and photophobia in his left eye. He was diagnosed with corneal macular dystrophy and underwent sequencing of the CHST6 gene. Left excimer PTK with mitomycin C was performed. He remained relapse free until 18 months post procedure when his visual acuity declined and the stroma appeared more "milky". He underwent a penetrating keratoplasty in his left eye 24 month following the initial PTK. CONCLUSION Phototherapeutic keratectomy is an effective means of visual restoration in patients with macular corneal dystrophy and may delay penetrating keratoplasty. Patients should be counselled regarding the high risk of recurrence. This is the first reported case of a CHST6 gene positive patient with MCD that was treated with phototherapeutic keratoplasty.
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Affiliation(s)
- Melissa Shields
- Ophthalmology, Flinders Medical Centre , Adelaide, Australia
| | - Jamie E Craig
- Ophthalmology, Flinders University, Flinders Medical Centre , Adelaide, Australia
| | - Emmanuelle Souzeau
- Ophthalmology, Flinders University, Flinders Medical Centre , Adelaide, Australia
| | - Aanchal Gupta
- Ophthalmology, The Royal Adelaide Hospital , Adelaide, Australia
- Ophthalmology, The Queen Elizabeth Hospital , Adelaide, Australia
- South Australian Institute of Ophthalmology , Adelaide, Australia
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Kemer Atik B, Yildirim Y, Sonmez O, Gumus G, Kepez Yildiz B, Agca A. Phototherapeutic Keratectomy in Macular and Granular Dystrophy: Two-year Results. Semin Ophthalmol 2020; 35:182-186. [PMID: 32529934 DOI: 10.1080/08820538.2020.1778743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate two-year outcomes of phototherapeutic keratectomy in granular and macular dystrophy and to investigate the effects of dystrophy type on results. METHODS Sixty-three patients who underwent phototherapeutic keratectomy (PTK) for granular and macular dystrophy in the cornea funit of the University of Health Sciences Beyoglu Eye Research and Training Hospital were evaluated retrospectively. Patients under 18 years of age, patients with a follow-up period of less than 24 months, and patients who had previously undergone corneal surgery or excimer laser treatment were excluded from the study. Treatment values (ablation depth, optical zone, mitomycin-C (MMC) application time) and complications during and after treatment were recorded. Patients who had a decrease of two or more lines in their BCVA and those with recurrent or increased corneal opacities were considered to have severe recurrences. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded preoperatively and postoperatively at the 12th and 24th months. The values obtained before and after the PTK were compared with statistical methods. RESULTS A total of 41 eyes (27 with granular dystrophy and 14 with macular dystrophy) were included in this study. There were no statistically significant differences between patients with granular dystrophy and macular dystrophy in terms of preoperative UCVA and BCVA, MMC application time, and follow-up period (p > .05). The mean age of patients with macular dystrophy was statistically smaller than that of patients with granular dystrophy (p = .04). The amount of ablation applied to macular dystrophy was statistically higher than for granular dystrophy (p = .03). The mean UCVA and BCVA showed statistically significant improvements at the 24th postoperative month (p < .5). There was no statistically significant difference between the UCVA and BCVA values of the patients with granular and macular dystrophy at the 12th and 24th months after the procedure. No recurrence was observed in any patient after 24 months. However, when the follow-up continued, severe recurrence was encountered in 2 patients with macular dystrophy at 26th and 40th months. Re-treatment procedures were needed in these two patients who had severe recurrence. CONCLUSIONS Phototherapeutic keratectomy is an effective and safe option for treatment in both granular and macular corneal dystrophy. Recurrence is a more common problem in patients with macular dystrophy, and recurrent therapies or keratoplasty methods are needed more frequently.
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Affiliation(s)
- Burcu Kemer Atik
- Department of Ophthalmology, University of Health Sciences, Gaziosmanpasa Training and Research Hospital , Istanbul, Turkey
| | - Yusuf Yildirim
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul, Turkey
| | - Orcun Sonmez
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul, Turkey
| | - Gulsah Gumus
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul, Turkey
| | - Burcin Kepez Yildiz
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul, Turkey
| | - Alper Agca
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital , Istanbul, Turkey
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Hieda O, Kawasaki S, Yamamura K, Nakatsukasa M, Kinoshita S, Sotozono C. Clinical outcomes and time to recurrence of phototherapeutic keratectomy in Japan. Medicine (Baltimore) 2019; 98:e16216. [PMID: 31277131 PMCID: PMC6635226 DOI: 10.1097/md.0000000000016216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess the indications, outcomes and time to recurrence of phototherapeutic keratectomy (PTK) for anterior corneal pathology.This study involved 714 eyes of 477 consecutive patients (mean age: 66.0 ± 15.2 years; range: 6-101 years) who underwent PTK as the initial surgical intervention for an anterior corneal pathology. In case of each patient, the cornea treated by PTK, followed up by slit-lamp examination and corrected distance visual acuity (CDVA) testing. Main outcome measures included Slit-lamp findings (1), CDVA (2), patients' complaints (3).The mean follow-up period was 44.0 ± 38.8 months (range: 1-156 months).We treated 376 granular corneal dystrophy (GCD) eyes, 238 band keratopathy (BK) eyes, 23 epithelium attachment disorder eyes, 16 gelatinous drop-like corneal dystrophy (GDLD) eyes, 13 lattice corneal dystrophy (LCD) eyes, and 48 eyes with other corneal diseases. The CDVA significantly improved from LogMAR 0.65 ± 0.61 pre PTK to LogMAR 0.26 ± 0.39 post PTK. A 2 or more lines increase of CDVA was observed in GCD eyes (67.8%), BK eyes (49.2%), epithelium attachment disorder eyes (57.1%), GDLD eyes (87.5%), LCD eyes (76.9%), and other corneal disease eyes (60.4%). The recurrence of BK was rare. GCD recurred slowly. Epithelium attachment disorder eyes remitted simultaneously, and recurred comparatively faster.PTK was proved to be a successful therapy for all 6 corneal disease categories. Disease recurrence after PTK differed among the diseases, and surgeons should recognize the different rates of disease recurrence after PTK surgery.
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Affiliation(s)
- Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto
| | | | | | - Mina Nakatsukasa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto
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Aggarwal S, Peck T, Golen J, Karcioglu ZA. Macular corneal dystrophy: A review. Surv Ophthalmol 2018; 63:609-617. [DOI: 10.1016/j.survophthal.2018.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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Moore CT, Christie KA, Marshall J, Nesbit MA. Personalised genome editing – The future for corneal dystrophies. Prog Retin Eye Res 2018; 65:147-165. [DOI: 10.1016/j.preteyeres.2018.01.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 12/21/2022]
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Jun I, Jung JW, Choi YJ, Kim TI, Seo KY, Kim EK. Long-term Clinical Outcomes of Phototherapeutic Keratectomy in Corneas With Granular Corneal Dystrophy Type 2 Exacerbated After LASIK. J Refract Surg 2018; 34:132-139. [PMID: 29425392 DOI: 10.3928/1081597x-20171220-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the long-term clinical outcomes and recurrence patterns of phototherapeutic keratectomy (PTK) in patients with granular corneal dystrophy type 2 (GCD2) exacerbated after LASIK. METHODS Fifty-one patients (76 eyes) with GCD2 exacerbated after LASIK who underwent PTK between January 2007 and February 2017 were included. Participants underwent ophthalmic examination, including slit-lamp microscopy, corrected distance visual acuity (CDVA), slit-lamp photography, and Fourier domain optical coherence tomography at preoperative and postoperative visits. PTK was performed using VISX S4 IR (VISX, Inc., Santa Clara, CA). Visual acuity, complications, interval, and contributing factors of recurrence were evaluated. RESULTS The follow-up period ranged from 1 to 108 months (mean: 35.22 months). The mean logMAR CDVA was 0.55 ± 0.43 (Snellen equivalent 20/80) preoperatively and 0.09 ± 0.43 (Snellen equivalent 20/25) at 3 months postoperatively. Forty-five (61.6%) eyes developed biomicroscopic recurrence at a mean of 18.6 months after PTK; 20 (27.4%) eyes developed significant recurrence at a mean of 31.3 months after PTK. The flap removal group demonstrated better CDVA at 3 years after surgery and lower recurrence and complication rates than the flap conservation group. Multivariate analysis revealed that flap removal remarkably reduced the risk of both any sign of and significant recurrence. CONCLUSIONS PTK improved corneal transparency and visual acuity in patients with GCD2 exacerbated after LASIK, although GCD2 eventually recurred. PTK with flap removal was superior to PTK with flap conservation in terms of visual acuity, recurrence, and complications. [J Refract Surg. 2018;34(2):132-139.].
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Song Y, Sun M, Wang N, Zhou X, Zhao J, Wang Q, Chen S, Deng Y, Qiu L, Chen Y, Aldave AJ, Zhang F. Prevalence of transforming growth factor β-induced gene corneal dystrophies in Chinese refractive surgery candidates. J Cataract Refract Surg 2017; 43:1489-1494. [PMID: 29233738 DOI: 10.1016/j.jcrs.2017.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the prevalence of the transforming growth factor (TGF) β-induced gene corneal dystrophies in refractive surgery candidates in China. SETTING Five hospitals in China. DESIGN Prospective case series. METHOD Refractive surgical candidates from 5 preselected eye hospitals/centers in China were recruited after providing informed consent. All patients had slitlamp biomicroscopy and collection of a buccal swab as a source of DNA for screening of the TGF β-induced gene for the 5 most common mutations associated with Reis-Bückler corneal dystrophy, Thiel-Behnke corneal dystrophy, granular corneal dystrophy type 1, granular corneal dystrophy type 2, and lattice corneal dystrophy type 1. RESULTS Of the 2068 refractive surgery candidates analyzed, 4 had corneal opacities in both eyes on slitlamp examination. Screening for the TGF β-induced gene found the heterozygous p.R124H mutation associated with granular corneal dystrophy type 2 in each of the 4 individuals with corneal opacities as well as in a fifth individual who did not have any corneal opacities, for a prevalence of 0.24%. Exacerbation of dystrophic corneal deposition developed after laser refractive surgery in 2 individuals who did not have preoperative TGF β-induced gene screening. CONCLUSIONS The prevalence of the TGF β-induced gene corneal dystrophies in Chinese refractive surgery candidates was estimated to be approximately 0.24%. Genetic testing is recommended to identify and exclude from candidacy all individuals with a TGF β-induced gene dystrophy before elective keratorefractive surgery to avoid causing accelerated postoperative dystrophic deposition.
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Affiliation(s)
- Yanzheng Song
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Mingshen Sun
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Ningli Wang
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Xingtao Zhou
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Jing Zhao
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Qinmei Wang
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Shihao Chen
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Yingping Deng
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Lemei Qiu
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Yueguo Chen
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Anthony J Aldave
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA
| | - Fengju Zhang
- From the Beijing Tongren Eye Center (Song, Sun, N. Wang, Zhang), Beijing Tongren Hospital, Capital Medical University and Beijing Ophthalmology & Visual Sciences Key Laboratory, the Peking University Third Hospital (Y. Chen), Beijing, Key Laboratory of Myopia, Ministry of Health, Department of Ophthalmology (Zhou, Zhao), the Eye and ENT Hospital of Fudan University, Shanghai, the Eye Hospital of Wenzhou Medical University (Q. Wang, S. Chen), Wenzhou, the West China Hospital of Sichuan University (Deng, Qiu), Chengdu, China; the Stein Eye Institute (Aldave), University of California Los Angeles Medical Center, Los Angeles, California, USA.
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Recurrence of Granular Corneal Dystrophy Type 1 After Phototherapeutic Keratectomy, Lamellar Keratoplasty, and Penetrating Keratoplasty in a Single Population. Cornea 2017; 36:1227-1232. [DOI: 10.1097/ico.0000000000001303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee J, Kim JH, Lee D, Chang JW, Shin JY, Seo JW, Seo MH, Moon NJ. Long-term clinical outcome of femtosecond laser-assisted lamellar keratectomy with phototherapeutic keratectomy in anterior corneal stromal dystrophy. Br J Ophthalmol 2017; 102:31-36. [DOI: 10.1136/bjophthalmol-2017-310189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/03/2017] [Accepted: 04/30/2017] [Indexed: 11/04/2022]
Abstract
PurposeTo evaluate long-term outcome of femtosecond laser-assisted lamellar keratectomy (FLK) with phototherapeutic keratectomy (PTK) in patients with anterior corneal stromal dystrophies.MethodsA total of 10 eyes from seven patients who underwent FLK were included. The patients had suffered from recurrent corneal erosion or visual disturbance in anterior corneal dystrophies (five Avellino dystrophies and two lattice dystrophies). Planar-shaped lamellar keratectomy was performed using femtosecond laser. The amount of corneal excision was determined by the depth of corneal opacity. Additional PTK with mitomycin C application was performed for smoothening of corneal cut surface. The patients were evaluated with following parameters: uncorrected visual acuity, best-corrected visual acuity (BCVA), mean anterior keratometric value, corneal irregularity, corneal high-order aberrations (HOA) and the recurrence of corneal erosion.ResultsMean duration of follow-up was 64 months (2.5–9.5 years). The BCVA improved more than two lines of Snellen chart at last visit. The changes of keratometric values were within ±1 D in eight out of 10 eyes. Corneal irregularities in central 5 mm cornea and the values of total corneal HOA in central 6 mm cornea decreased by 0.3–3.1 D and 0.01–2.2 µm, respectively. Corneal erosion did not recur in any of those patients during follow-up and corneal dystrophy did not recur in eight out of 10 eyes.ConclusionIn anterior corneal stromal dystrophies, FLK with PTK can be an effective surgical option to improve VA through decreasing corneal irregularities and HOA, while minimising corneal curvature changes.
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Rathi VM, Taneja M, Murthy SI, Bagga B, Vaddavalli PK, Sangwan VS. Phototherapeutic keratectomy for recurrent granular dystrophy in postpenetrating keratoplasty eyes. Indian J Ophthalmol 2016; 64:140-4. [PMID: 27050350 PMCID: PMC4850810 DOI: 10.4103/0301-4738.179715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for recurrence. Methods: PTK was performed for visually significant recurrence: A reduction in best-corrected visual acuity (BCVA) by >2 lines over BCVA before recurrence was considered as visually significant recurrence. Three eyes had amniotic membrane patch performed with PTK. The main outcome measures were a recurrence of GCD, clinical course, and visual outcome. Intervals between repeat PTK procedures were noted. Results: Six patients (n = 10 eyes; males: 4, mean age 39 ± 13.97 years) underwent PTK. The mean pachymetry before first PTK was 527.1 ± 34 microns. The mean duration between PKP and first PTK was 85.1 months (range: 37–108 months). Two and three PTK procedures were done for seven and five eyes, respectively. Mean duration between first and second and second and third PTK was 62.12 ± 34.41 and 42.8 ± 13.54 months respectively. The average cut depth was 43.66 ± 19.57, 75 ± 43.30 and 39 ± 19.79 microns after the first, second and third PTK procedures, respectively. All eyes had a corneal haze. Prefirst PTK mean BCVA was 20/200 and improved significantly after the first two PTK procedures to 20/40 and after the third PTK procedure to 20/32 (P < 0.001). Five eyes had hyperopia. One acute graft rejection was managed successfully at 5 months with medical therapy. Conclusion: Multiple PTK procedures can be performed safely with improved visual acuity in grafts without compromising graft survival.
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Affiliation(s)
- Varsha M Rathi
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Reply: To PMID 25811730. Cornea 2015; 34:e15. [PMID: 25782405 DOI: 10.1097/ico.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Comparative study of corneal endothelial cell damage after femtosecond laser assisted deep stromal dissection. BIOMED RESEARCH INTERNATIONAL 2014; 2014:731565. [PMID: 25114918 PMCID: PMC4119749 DOI: 10.1155/2014/731565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
Purpose. To find a relatively safe designed stromal bed thickness to avoid endothelial damage for lamellar keratoplasty with an Allegretto Wavelight FS200 femtosecond laser. Methods. Twelve rabbits were randomly divided into 50 μm and 150 μm groups according to the anticipated residue stromal bed thickness preparation with a femtosecond laser. Six rabbits without laser cutting were used as a control group. Central endothelial images were analyzed with in vivo confocal microscopy and scanning electron microscopy. The apoptosis of endothelium was evaluated with Hoechst 33342 staining and a TUNEL assay. Results. The endothelium of the 50 μm group had extensive injuries upon in vivo confocal and scanning electron microscopic observation, and minor injuries were observed in the 150 μm group. Moreover, more apoptotic cells were observed in the 50 μm group. Conclusions. When using a FS200 femtosecond laser assisted anterior lamellar keratoplasty, there was minor endothelium damage with a 150 μm stromal bed, and a more than 150 μm thickness stromal bed design may prevent the damage of corneal endothelium.
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