International Medical Case Reports Journal (May 2023)

Combined Topography-Guided Trans-Epithelial PRK and PTK for Recalcitrant Recurrent Corneal Erosions in Lattice Corneal Distrophy

  • Pignatelli F,
  • Passidomo F,
  • Buonamassa R,
  • Niro A,
  • Addabbo G

Journal volume & issue
Vol. Volume 16
pp. 275 – 280

Abstract

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Francesco Pignatelli,1 Fedele Passidomo,1 Rosa Buonamassa,2 Alfredo Niro,1 Giuseppe Addabbo1 1Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, Taranto, Italy; 2Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari “Aldo Moro”, Bari, ItalyCorrespondence: Fedele Passidomo, Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, Via Francesco Bruno, 1, Taranto, 74121, Italy, Tel +39 3288569125, Email [email protected]: To report morphologic and functional changes after topography-guided trans-epithelial photorefractive keratectomy (PRK) combined with phototherapeutic keratectomy (PTK) for recalcitrant recurrent corneal erosions in Lattice Corneal Dystrophy (LCD).Methods: One case report.Results: A 78-year-old man presented us with decreased visual acuity [20/100 in right eye (RE), and 20/400 in left eye (LE)], and redness with foreign body sensation in both eyes. Clinical examination revealed epithelial erosions, and linear stromal opacities involving the center of the cornea in both eyes, supporting the diagnosis of LCD. Several medical approaches including autologous serum, amniotic membrane extract, and nerve growth factor eye drops allowed a temporary improvement in symptoms. A single-step topography-guided trans-epithelial PRK combined with PTK (CIPTA® 2 software, iVis Technologies) was performed in both eyes. After surface ablation using PRK, PTK was performed using masking agents (1% hydroxy-methylcellulose) to smooth the ablated surface. Subsequently, 0.02% Mitomycin C was applied over the ablated surface. At the 3-month follow-up, a resolution of corneal erosions, and stromal opacities were observed in both eyes, with a visual improvement to 20/25 in the RE and 20/50 in the LE. Furthermore, spherical equivalent, keratometric astigmatism, and corneal morphological irregularity index improved.Conclusion: Recalcitrant corneal erosions and stromal opacities in LCD may be successfully treated using combined topography-guided trans-epithelial PRK and PTK.Keywords: corneal dystrophy, recurrent corneal erosions, phototherapeutic keratectomy, topography-guided photorefractive keratectomy

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