Simple scraping maneuvers can treat opacities in corneal dystrophies, avoiding transplantation

Issue: April 2016

BASSANO DEL GRAPPA, Italy — Corneal opacities generated by various forms of corneal dystrophy can be effectively removed manually or with the touch of a laser, thus avoiding corneal transplantation, according to one surgeon.

“Too often we perform keratoplasty procedures on corneas that could simply be treated with a few scraping maneuvers using a spatula,” Paolo Vinciguerra, MD, said here at the Bassano Ophthalmology Meeting.

Paolo Vinciguerra

In many types of corneal dystrophy, including Groenouw, lattice, Cogan, Schnyder and several others, the opacified layer can be removed, uncovering a perfectly clear and smooth cornea just under the cleavage plane. In some cases, phototherapeutic keratectomy might be necessary to smoothen up the surface.

“The cleavage plane is easy to find, and once the opaque layer is removed from the entire surface, up to the limbus, the cornea can stay clear for up to 10 years or more. Visual results are perfect, and all the consequences of a corneal graft, including astigmatism, are avoided,” Vinciguerra said.

Corneal transplantation is not only unnecessary, but it does not solve the problem. In most cases, the proliferation restarts from the limbus and covers the graft.

“We have treated many cases where keratoplasty had been performed. Recurrent opacifications on a corneal graft are much thicker and more difficult to scrape off. So, we have a hard time treating recurrences that could have been avoided with a much easier, minimally traumatic procedure that can be performed in the office, leads to fast recovery within 3 or 4 days and can be easily repeated if necessary,” he said. – by Michela Cimberle

Reference: Vinciguerra P. Corneal dystrophies: Interactive video. Presented at: Bassano Ophthalmology Meeting; April 9; Bassano del Grappa, Italy.

Disclosure: Vinciguerra reports he is a consultant to Schwind and Oculus.