Abstract

SA.20.03

Overlay amniotic membrane transplantation and phototherapeutic keratectomy in inherited gelatinous drop-like dystrophy

Julia Promesberger, Constantin Uhlig, Holger Busse
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Münster, Münster

Objective
Gelatinous drop-like corneal dystrophy (GDLD) is clinically presenting with progredient, drop-like subepithelial corneal opacities, mostly starting centrally and caused by amyloid masses, as well as with the sensation of  the presence of a foreign body, photophobia, epiphora and blepharospasm. The hypothesis is that the aetiology of this dystrophy originates in limbal stem cell dysfunction. No longterm appropriate therapy is known.
A 17-year old patient was presenting with GDLD. The therapeutic aim was symptomatic relief.
Methods
Mechanical abrasion and phototherapeutic keratectomy (PTK) to smoothen the corneal surface was performed first (ESIRIS excimer laser system, Schwind company Kleinostheim/Germany, 10 µm ablanation depth, 8,0 mm optical zone, 18 s duration of treatment). Additonally two kryocoserved amniotic membranes were applied to the ocular surface and secured with sutures to the episclera in Overlay technique (Nylon 10.0, non interrupted) to cover the entire corneal surface and limbal region. Postoperatively the patient was routinely treated with topical eyedrops (Ofloxacin 4x/d, Diclofenac-Natrium 5x/d). Main outcome messures were visual acuity (VA), symptomatic relief and eyelid position before and after treatment.
Results
VA before treatment was 1/20. There was a significant amount of subjective photophobia and blepharospasm as well as a distinct sense of the presence of a foreign body. First reliefe of symptoms was reached after 3 days post therapy. Absence of symptoms and regular eyelid position was seen 4 weeks after therapy and sustained over a period of 21 months. The corneal area treated with the excimer laser was progressively opacifying after 6 weeks. 3 month after therapy VA was 0,3 and decreased to 1/20 6 months after therapy. A penetrating keratoplasty was performed 43 months later.
Conclusions
Lamellar or penetrating keratoplasty in GDLD was only temporarily helpful regarding function and subjective sympotms. This being the first treatment choice is especially in young patients critically discussed. In this case there were significant drop like corneal prominencies already at the beginning of therapy, which justified the indication for PTK. Because the temporary sympotmatic reflief was similar to case reports after keratoplasties, we assume that the amniotic membrane transplantation in combination with PTK can be very helpful and gain time before an elective when indicated HLA matched keratoplasty.

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