Phototherapeutic Keratectomy for Map-Dot-Fingerprint Corneal Dystrophy

Abstract

In this study, excimer laser photoablation was shown to be an effective, safe, and stable choice of treatment for map-dot-fingerprint dystrophy. A refractive change, as hyperopic shift, can be an adverse side effect in some individual cases.

Clinical Outcome and Recurrence of Epithelial Basement Membrane Dystrophy after Phototherapeutic Keratectomy

“…It is therefore important to conduct a thorough examination to identify signs of EBMD based on corneal morphology in the absence of RCE. 26,27 In PTK treated eyes, epithelial removal was performed with a laser in 22 cases (42%) where the epithelium was smooth, similar to the method reported by Dinh et al 8 While there are a few reports of laser epithelial removal prior to PTK for EBMD, 5,6,8,24,28 the number of patients in these studies was small and the effect of epithelial removal method on outcome could not be examined. In this study, we found a borderline-significant trend towards a greater chance of recurrence with laser epithelial removal.…”

“…The improvement in BSCVA after PTK noted in this study has also been reported by others treating EBMD patients. [5][6][7]9,13,14,16,24 No patient required a second treatment during the entire follow-up period (the single eye excluded from this study While maintenance or improvement of BSCVA is one clinical goal of PTK treatment in EBMD, prevention of recurrent erosive episodes is in many cases equally important. In 5 of 52 (9.6%) of PTK treated eyes, at least one erosive event was noted postoperatively, but erosions were mild or infrequent and did not warrant re-operation.…”

“…The original indication for operation in this study was RCE in only 50% of the cases, whereas in a number of earlier reports, the majority of EBMD patients had RCE symptoms. [7][8][9][10][12][13][14][15][16][17] In one report, however, 67% of 30 EBMD eyes treated by PTK did not have RCE, 6 and in another series of 74 EBMD eyes, 82% were without RCE. 25 It is important to recognize that EBMD is a condition that can lead to visual disturbances, RCE, or both.…”

“…It is plausible that the epithelium may be thickened in a large proportion of EBMD patients, as suggested by others. 6 Moreover, the localized nature of basement membrane abnormalities in EBMD may result in focal areas of thinned or thickened epithelium, despite the appearance of a smooth epithelial surface. In such cases, patches of BL may have remained present following PTK, potentially leading to recurrence.…”

“…In recent years, excimer laser phototherapeutic keratectomy (PTK) has become an increasingly popular surgical option for the treatment of EBMD, due to successful resolution of symptoms documented in a number of studies. [4][5][6][7][8][9][10][11][12][13][14] While the majority of PTK treatments are successful, postoperative recurrence of symptoms has been reported, [6][7][8][9][10][15][16][17] and the reasons for recurrence remain unclear. In a recent study examining a small number of EBMD patients longitudinally, we proposed that dystrophic recurrence may be related to the depth of laser ablation by PTK and the postoperative presence of Bowman's layer (BL).…”