The Number of Cases, Cause and Treatment of Avellino Corneal Dystrophy Exacerbated After LASIK

Jeong Ho Yi; Byoung Jin Ha; Sang Woo Kim; Tae-im Kim; Eung Kweon Kim

doi:10.3341/jkos.2008.49.9.1415

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Yi, Ha, Kim, Kim, and Kim: The Number of Cases, Cause and Treatment of Avellino Corneal Dystrophy Exacerbated After LASIK

Original Article

J Korean Ophthalmol Soc 2008;49(9):1415-1424.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.9.1415

The Number of Cases, Cause and Treatment of Avellino Corneal Dystrophy Exacerbated After LASIK

Jeong Ho Yi, M.D.¹, Byoung Jin Ha, M.D.², Sang Woo Kim, M.D.³, Tae-im Kim, M.D.¹, Eung Kweon Kim, M.D.¹

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine^¹, Seoul, Korea

²Siloam Eye Hospital, Seoul, Korea

³Department of Ophthalmology, Ulsan University Hospital, Ulsan University School of Medicine^³, Ulsan, Korea

Address reprint requests Eung Kweon Kim, M.D. Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine #134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3770, Fax: 82-2-312-0541, E-mail: eungkkim@yuhs.ac

Received 11 June 2008 Accepted 21 January 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To describe the number of cases and cause of Avellino corneal dystrophy (ACD) exacerbated after LASIK (laser in situ keratomileusis), to study the possible mechanism of exacerbation, and to suggest possible preventive measures and the most suitable treatment modality.

Methods

Twenty-eight (56 eyes) ACD patients who underwent LASIK were enrolled, and 24 parameters including pre-and post-operative best corrected visual acuity, contrast sensitivity, and corneal opacity were analyzed. To evaluate the effect of treatment modality for exacerbated cases after LASIK, the progression of corneal opacity, visual acuity, and contrast sensitivity were compared between the two surgical methods (mechanical removal from LASIK interface with removal of surgical flap and deep lamellar keratoplasty (DLKP)).

Results

All patients showed progression of corneal opacities after LASIK regardless of the type of laser instruments, microkeratomes, or the size or thickness of the LASIK flap. As for treatment of exacerbated ACD patients after LASIK, DLKP showed better results than mechanical removal from the LASIK interface after removal of the surgical flap.

Conclusions

LASIK is contraindicated in any patient with ACD. DLKP could be a good treatment modality for ACD patients with exacerbated conditions after LASIK.

Keywords: Avellino corneal dystrophy, Deep lamellar keratoplasty, Laser in situ keratomileusis

References

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Figure 1.

Slit-lamp photographs showing areas of corneal deposits after LASIK.

Figure 2.

Slit-lamp photographs showing exacerbated Avellino corneal dystrophy after LASIK. Corneal images from case 1: (A) Right eye (B) Left eye

Figure 3.

Contrast sensitivity test: (A) before mechanical removal of corneal deposits from LASIK interface, (B) at 2 weeks after surgery, (C) at three and a half years after surgery (R=right eye; L=left eye; solid line=right; dotted line=left).

Figure 4.

(a) Corneal image from case 1: (A) before removal of LASIK flap (at three and a half years after mechanical removal of corneal deposits from LASIK interface). (B) 2 weeks and (C) 1 year and 1 month after LASIK flap removal (R=right eye; L=left eye).

Figure 5.

Corneal images from case 2 (A) before deep lamellar keratoplasty (DLKP). (B) after 6 months of DLKP (R) and after 4 months of DLKP (L). (R=right eye; L=left eye)

Table 1.

Clinical Characteristics of Avellino Corneal Dystrophy Patients Exacerbated after LASIK^∗

Characteristics			No. of eyes
	Male	Female
Sex	9 (18 eyes)	19 (38 eyes)	56
Age (years)	30.32±7.20 (22~48)		56
Time to exacerbation after surgery (months)	47.80±26.67 (7~108)		56
Schirmer test (mm/5min)	7.17±5.75 (2~24)		18
	preoperative	postoperative
UCVA^†	0.09±0.09 (HM^‡~0.4)	0.56±0.27 (HM~1.25)	30/56
BCVA^§	0.99±0.14 (0.7~1.25)	0.73±0.23 (0.4~1.25)	44/54
Refractive error (Diopter)	-5.89±3.23 (-14.50~+1.50)	-0.56±1.09 (-3.63~+1.00)	56/54
Corneal Refractive Power (Diopter)	44.13±1.38 (41.13~47.25)	40.54±2.72 (36.00~44.50)	42/18
Corneal thickness (μ m)	536.39±36.02 (460~626)	338.25±105.64 (225~474)	36/8
Amounts of correction (Diopter)	-5.45±3.14 (-10.25~+1.38)		36
	Thickness (μ m)	Diameter (mm)
LASIK flap	135±18.67 (100~160)	8.44±1.03 (5.5~10)	32/32

^∗ LASIK=laser in situ kertomileusis; acuity.

^† UCVA=uncorrected visual acuity

^‡ HM=hand movement

^§ BCVA=best corrected visual

Table 2.

Comparison of BCVA* between Pre- and Post- LASIK^†

		Eyes (%)
BCVA∗	Worsened	34 (60.7)
	No change	6 (10.7)
	Improved	0 (0)
	Unknown	16 (28.6)

^∗ BCVA=best corrected visual acuity

^† LASIK=laser in situ kertomileusis

Table 3.

Comparison of CST* between Pre- and Post-LASIK^†

		Eyes (%)
CST∗	Normal range	9 (16.0)
	Subnormal	31 (55.4)
	N/A^‡	16 (28.6)

^∗ CST=contrast sensitivity test

^† LASIK=laser in situ kertomileusis

^‡ N/A=not accessed.

Table 4.

Status of Corneal Deposits at Pre- and Post-LASIK∗

		Eyes (%)
			preoperative	postoperative
Presence		34 (60.71)	56 (100)
Absence		5 (8.93)	0 (0)
N/A		17 (30.36)	0 (0)
Amounts	1-5	3 (5.36)	0 (0)
	6-10	17 (30.36)	0 (0)
	11-19	4 (7.14)	0 (0)
	20≤	2 (3.57)	56 (100)
	N/A^†	30 (53.57)	0 (0)

^∗ LASIK=laser in situ kertomileusis

^† N/A=not accessed.

Table 5.

Presence of Diffuse Fine Deposits and Exacerbation after LASIK∗

	Eyes (%)
	Diffuse fine deposits	Exacerbation
Presence	56 (100)	56 (100)
Absence	0 (0)	0 (0)

^∗ LASIK=laser in situ kertomileusis.

Table 6.

Location of Corneal Deposits after LASIK∗

	Eyes (%)
Superior	0 (0)
Superior, center, inferior	4 (7.1)
Center	8 (14.3)
Center, inferior	43 (76.8)
Inferior	1 (1.8)

^∗ LASIK=laser in situ kertomileusis.

Table 7.

Types of LASER instruments Used

	Eyes (%)
NIDEK EC-5000	6 (10.7)
LADARVision	4 (7.1)
MEL60	4 (7.1)
MEL70	4 (7.1)
VISX strar S2	4 (7.1)
VISX star S3	4 (7.1)
VISX strar S4	4 (7.1)
CHIRON (B&C)	2 (3.6)
Kerator 217	2 (3.6)
MEL80	2 (3.6)
Schwind Keratom Multiscan	2 (3.6)
Technolas C-217	2 (3.6)
Telco	2 (3.6)
VISX 2020	2 (3.6)
VISX STAR	2 (3.6)
Unknown	10 (17.9)
Total	56 (100)

Table 8.

Types of Microkeratomes Used

	Eyes (%)
Hansatome	4 (7.1)
ACS	12 (21.4)
Nidek MK2000	6 (10.7)
Moria LSK1	6 (10.7)
Moria C&B	2 (3.6)
Moria C&B evolution 2	4 (7.1)
SCMD	8 (14.3)
Innovatome	2 (3.6)
Unkown	12 (21.4)
Total	56 (100)

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