Laser refractive surgery in corneal dystrophies

Area of Science:

• Ophthalmology
• Corneal Surgery
• Refractive Surgery

Background:

• Corneal dystrophies are a group of inherited eye disorders affecting the cornea.
• Laser refractive surgery is a common procedure for vision correction.
• The safety and efficacy of laser refractive surgery in patients with corneal dystrophies are not well-established.

Purpose of the Study:

• To systematically review the existing literature on laser refractive surgery in patients with various corneal dystrophies.
• To evaluate the outcomes and identify appropriate surgical techniques for different types of corneal dystrophies.

Main Methods:

• Systematic review of case reports and case series published between 2000 and 2019.
• Inclusion criteria: studies on laser refractive surgery in patients with corneal dystrophies.
• Data extraction included patient demographics, dystrophy type, surgical procedure, and outcomes.

Main Results:

• Included 28 studies involving 173 eyes from 94 patients.
• Best outcomes observed in posterior corneal polymorphous and Cogan dystrophy.
• Unfavorable results reported for Avellino dystrophy and Fuchs endothelial corneal dystrophy (FECD).
• Photorefractive keratectomy contraindicated in Meesmann and Avellino dystrophy.
• Laser in situ keratomileusis indicated for posterior polymorphous corneal dystrophy, but not FECD, Avellino, or Cogan dystrophy.
• Insufficient evidence for small-incision lenticule extraction and other dystrophies (lattice, fleck, Lisch, François).

Conclusions:

• Laser refractive surgery outcomes are highly dependent on the specific type of corneal dystrophy.
• Certain procedures like photorefractive keratectomy and laser in situ keratomileusis have specific indications and contraindications in corneal dystrophy patients.
• Further research is needed for other dystrophies and newer surgical techniques like small-incision lenticule extraction.