PHOTOTHERAPEUTIC KERATECTOMY OF RECURRENT GRANULAR CORNEAL-DYSTROPHY AFTER KERATOPLASTY

Background Recurrences of granular corneal dystrophy (Groenouw type I dystrophy) after penetrating keratoplasty have been offen reported in the literature. Up to now the therapy of these recurrences consists in performing a lamellar or penetrating re-keratoplasty. As those recurr ent opacities at first are located in the area of Bowman's membrane an d the superficial corneal stroma, a phototherapeutic keratectomy (PTK) with an excimer laser offers a therapeutic alternative to re-keratopl asty. Patients and methods We describe three eyes of two patients with recurrent opacities on the transplant after successful keratoplasty b ecause of granular corneal dystrophy. In ah eyes we performed an excim er-laser PTK (Keratom((R)) of Schwind Company, Kleinostheim/Germany, w ave length 193 nm) after abrasio of the epithelium with a hockey-knife . The depth of ablation depended on the location of the opacities and was between 7 mum and 35 mum. During the excimer-laser treatment sever al biomicroscopical slit-lamp controls were performed to make sure whe ther a sufficient depth of ablation was obtained. Results The opacitie s could be totally removed in all eyes by excimer-laser PTK. Postopera tively the visual acuity increased and the patient's photophobia decre ased. At the same time a slight progression of hyperopia developed dep ending on the depth of ablation. During the follow-up period of 5 to 1 2 months no recurrent opacities could be found until now. Conclusions Phototherapeutic keratectomy with the excimer laser seems to be a good alternative to re-keratoplasty in superficially located recurrences o f granular corneal dystrophy in a graft after keratoplasty. A slight p rogression of hyperopia depending on the depth of ablation has to be a ccepted. The future will show whether there will develops recurrent op acities of the dystrophy after an excimer laser treatment.