Customized keratectomy shows long-term efficacy in treatment of granular corneal dystrophy
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Key takeaways:
- A customized PTK technique showed long-term efficacy in the treatment of granular corneal dystrophy type 1.
- It is a safe, effective, minimally invasive alternative to corneal transplantation.
Sequential custom therapeutic keratectomy proved effective in the treatment of granular corneal dystrophy type 1, leading to long-term vision improvement and reduction of astigmatism and higher-order aberrations, according to a study.
“SCTK is a minimally invasive, safe and effective technique that can avoid or delay corneal grafting, while improving vision as well as corneal aberrations,” study author Paolo Vinciguerra, MD, told Healio. “The recurrence of dystrophy is well known with corneal transplantation, so postponing or avoiding it is a better choice.”
Granular corneal dystrophy type 1 (GCD1) is a progressive genetic condition that develops from an early age and leads to corneal erosion, pain and decreased vision. Corneal transplantation was the traditional treatment, but more recently, phototherapeutic keratectomy (PTK) has been used.
“We have further developed PTK with a transepithelial, customized, multistep approach, and defined this technique as sequential customized therapeutic keratectomy (SCTK),” the authors wrote.
Thirty-seven eyes of 21 patients with GCD1 were treated between February 2002 and July 2017. In six eyes of five patients, the treatment was performed on a corneal graft for disease recurrence.
Mean corrected distance visual acuity improved from 0.60 logMAR to 0.25 logMAR (P < .001). The difference was still significant in the 14 eyes that had a follow-up of 5 years (P = .048). A gain of two or more lines was achieved in 71.4% of the eyes, while 5.7% lost two or more lines. A significant decrease in astigmatism and corneal higher-order aberrations and a significant increase in spherical aberration were reported. Disease recurrence was observed in only one eye 8 years after SCTK. No eye required corneal transplantation.
GCD1 tends to recur repeatedly, including after corneal transplantation. Therefore, a minimally invasive treatment such as SCTK, which can be safely repeated without causing ectasia, is advantageous, the authors said.
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