Rx of Granular Corneal Dystrophy in the USA in 2015
Q by Doctor Randy:
I have not seen the patient yet, but was called by a colleague who wanted to refer a 55 year old patient with the above to me for “corneal laser treatment”. I asked of the patient had any ocular surface disease/recurrent erosions, and was told that the only problem was decreased acuity form the opacities themselves. No irregular astigmatism, no cataracts.
How would those of you advise those of us who only have access to “USA technology” to proceed to treat such a patient?
I have performed PTK on a handful of Granular Dystrophy patients who were experiencing reduced vision The problem in Granular Dystrophy is that the opacities are breaking through the anterior stromal surface. Removing the epithelium reveals a highly irregular surface
The goal with PTK is to just smooth out the surface, not eliminate opacities.
After smoothing out the stromal surface with PTK – patients will note improved vision – both on Snellen testing as well as report improved quality of vision
Following the PTK – There will be plenty of opacities remaining.
Overall – the PTK procedure should be a very superficial treatment. I have had one patient require a repeat PTK 6-7 years after the first treatment – and I expect that the PTK lasts for 5-10 years, depending on the patient. So focusing as much on corneal smoothing while preserving as much corneal tissue is key, in my opinion.
I hope this helps