Persistence of granular corneal dystrophy type-1 deposits in the predescemetic layer after big-bubble deep anterior lamellar keratoplasty

Abstract

We report intraoperative finding of Granular Corneal Dystrophy Type-1 (GCD1) deposits after stromal pneumodissection in deep anterior lamellar keratoplasty (DALK) in a 61-year-old female. Pneumodissection was performed from the center to the periphery of the cornea, characterizing a big bubble type 1 technique which dissects the deep stroma from the predescemetic layer. After stromal removal, persistence of whitish deposits inside the predescemetic layer was noted. During post-operative evaluation, anterior biomicroscopy and anterior segment optical coherence tomography showed granular opacities between the patient's Descemet's membrane and the donor cornea, suggesting possible involvement of the predescemetic layer in GCD1. This may require the surgeon's attention to choose between DALK keratoplasty or penetrating keratoplasty.

Granular corneal dystrophy recurrence at the posterior graft-host interface after type 1 big bubble deep anterior lamellar keratoplasty

“…Similar to our case #2, Muller et al found that residual GCD deposits could be seen in the PDL after type 1 BB formation. 13 However, the fact that these deposits increased in number in our second case illustrates that there are likely residual keratocytes that continue to produce keratoepithelin in the remaining host tissue posterior to the type 1 BB cleavage plane.…”

OCT in Lamellar Corneal Transplantation

“…Muller et al published a case report with granular corneal dystrophy type-1 and reported that although they achieved pneumatic dissection to predescemetic layer during DALK, AS-OCT showed granular opacities between DM and graft [61]. It is thought that granular deposition occurs at predescemetic layer in granular corneal dystrophy type-1 and PK could be a better alternative than DALK.…”