Avellino Corneal Dystrophy Worsening after Laser In Situ Keratomileusis: Further Clinicopathologic Observations and Proposed Pathogenesis

Abstract

PURPOSE-To study the nature of the deposits in Avellino corneal dystrophy (ACD) worsening after laser in situ keratomileusis (LASIK), and suggest a mechanism for histopathogenesis. DESIGN-Interventional case report.METHODS-A 28-year-old woman previously diagnosed with bilateral ACD underwent bilateral LASIK. The corneal dystrophy progressively worsened bilaterally, one year later. A penetrating keratoplasty was subsequently performed on the right eye at 31 years of age, and in the left eye a year later. The clinical and histopathologic findings of the corneal graft of the right eye were reported in the literature, with positivity to the Masson trichrome stain, negative staining with Congo red, and heterozygosity for the Arg124His mutation by serum DNA studies. Histopathologic studies of the corneal graft of the left eye were conducted at

Heterozygous Avellino Corneal Dystrophy 9 Years After Photorefractive Keratectomy: Natural or Laser-Induced Accelerated Course?

“…It has been reported that the mean time of exacerbation after excimer laser ablation procedure is 26 months and not exceeding 5 years. [4][5][6][7][8][9] In our patient, the cornea was clear before surgery and the clarity was maintained for 9 years after surgery. The most interesting part is how this heterozygous patient with ACD maintained the clarity of cornea for 9 years after PRK.…”

“…ACD has been a closely watched issue since 2002 because of the exacerbation after laser in situ keratomileusis (LASIK). [4][5][6][7][8][9] Worsening or recurrence of ACD has also been reported after phototherapeutic keratectomy (PTK) and laser-assisted subepithelial keratomileusis. [10][11][12][13] Increased production of cytokines, including transforming growth factor-beta (TGF-b) after tissue removal with excimer laser, is thought to be a factor to worsen ACD.…”

“…[10][11][12][13] Increased production of cytokines, including transforming growth factor-beta (TGF-b) after tissue removal with excimer laser, is thought to be a factor to worsen ACD. 9,14 The purpose of this study was to report a patient who developed stromal opacities of a typical granular pattern 9 years after photorefractive keratectomy (PRK) and was confirmed as having heterozygous ACD by DNA analysis. We will discuss whether refractive surgery with excimer laser affects the natural course of this patient with heterozygous ACD.…”

Visual Outcomes Following Deep Anterior Lamellar Keratoplasty in Granular Corneal Dystrophy Types 1 and 2

“…The phenotypic appearance of granular corneal dystrophy (GCD) type 1 and GCD type 2 (also known as Avellino corneal dystrophy) changes with age, but is believed to also be influenced by trauma or intervening surgical procedures [123]. This report presents two cases of GCD, with varied manifestations before and after surgical intervention.…”

“…Recurrence in the graft-host interface following DALK and lamellar keratoplasty is noted in the literature, and often granules will progress over time from the epithelium to the stroma [4]. Disease recurrence is well recognized in the graft-host interface area, and may be related to both GCD types, as well as surgical factors such as recurrence along suture tracks and incision lines [12345]. The exact reasons why recurrence is seen in some cases and not in others has yet to be elucidated.…”