J Korean Ophthalmol Soc.  2015 Aug;56(8):1170-1180. 10.3341/jkos.2015.56.8.1170.

Clinical Outcomes of Combined Photorefractive Keratectomy and Cataract Surgery in Patients with Granular Corneal Dystrophy

• Yoo YJ
• Kim MK
• Wee WR

• KMID: 2215067
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1170

Abstract

PURPOSE
To evaluate the efficacy of combined photorefractive keratectomy (PRK) and cataract surgery in granular corneal dystrophy (GCD) patients with corneal stromal haziness compromising vision and cataract and clinically significant lens opacity.
METHODS
Medical records of 12 eyes that underwent PRK and cataract surgery between August 2009 and November 2013 in patients with GCD and cataracts were retrospectively evaluated. All PRKs were performed with the VISX S4 IR (VISX, Santa Clara, CA, USA). The double K SRK-T formula or double K Hoffer Q formula and postoperative corrected K were utilized to determine the intraocular lens power in patients with prior PRK. Postoperative best corrected visual acuity (BCVA), spherical equivalent, presence of the central island using topography analysis and recurrence of corneal opacity after combined PRK and cataract surgery were evaluated.
RESULTS
In all eyes, the PRK was successful and 3 eyes showed recurrence of corneal opacities without visual impairment during a mean follow-up of 36.6 months. The mean BCVA improved with an average increase of 4.63 lines (minimum 1 line, maximum 9 lines) and no patient showed any BCVA loss. Final spherical equivalent was -0.56 diopter (D) and the corneal central island was reported in only 1 eye. The Maloney method using the double-K formula with the SRK/T formula showed the lowest absolute error of 0.33 +/- 0.25 D.
CONCLUSIONS
Combined PRK and cataract surgery are effective methods for improving BCVA if patients with GCD have both visually significant diffuse corneal haze and clinically significant lens opacity.

Keyword

Avellino corneal dystrophy; Cataract; Granular corneal dystrophy; Photorefractive keratectomy

MeSH Terms

Cataract*
Corneal Opacity
Follow-Up Studies
Humans
Lenses, Intraocular
Medical Records
Photorefractive Keratectomy*
Recurrence
Retrospective Studies
Vision Disorders
Visual Acuity

Figure

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  Figure 1. Anterior segment photos of delayed wound healing after photorefractive keratectomy (PRK) in a granular corneal dystrophy patient. Slit lamp examination revealed diffuse corneal punctate epithelial erosion (A, D) 10 days after PRK. After applying bandage contact lens, the punctate epithelial erosion much decreased but irregular corneal surface remained (B, E) 1 month after PRK. Using topical fluorometholone 0.1%, antibiotics and artificial tears, corneal surface smoothing (C, F) occurred after 4 months.

• 

  Figure 2. (A, B, C) The preoperative anterior segment photography. (D, E, F) The postoperative anterior segment photography at day 3. (G, H, I) The postoperative 36-month anterior segment photography. (I) The anterior segment photography showing corneal opacity recurrence (white arrows) after laser surgery. This recurred cornea opacity did not affect the patients’ visual acuity.

• 

  Figure 3. Representative (A) pre- and (B) post-operative photorefractive keratectomy photographs of the eye which showed central island postoperatively. Axial curvature maps after photorefractive keratectomy surgery (C) shows the central island 1 month after surgery. The topography (D) shows decrease of the central island postoperative 35 months. K = keratometry.

Reference

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