Phototherapeutic keratectomy for map-dot-fingerprint corneal dystrophy

To evaluate the excimer laser as a surgical instrument to treat map-dot-fingerprint (MDF) dystrophies.

Thirty eyes (24 patients) with MDF dystrophy were treated with phototherapeutic keratectomy (PTK). The treatment goal was either to improve vision (24 eyes) or to heal recurrent corneal erosions or both (10 eyes). Besides long-standing reduction in visual acuity (17 eyes), associated symptoms were fluctuating visual acuity and clinical refraction (12 eyes) and monocular diplopia (eight eyes). In 14 eyes, two or three symptoms were present, whereas 16 eyes only had one symptom. The mean age was 54 years (range, 36-79 years), and there were 14 male and 10 female subjects. Mean follow-up was 30 months (range, 12-70 months).

In 14 of 17 eyes with long-standing reduction in visual acuity, best spectacle-corrected Snellen visual acuity (BSCVA) improved by two lines or more. All eyes with fluctuating visual acuity/clinical refraction stabilized 1-3 months after PTK. Monocular diplopia or "ghost images" disappeared in all eyes after treatment. In one of 10 eyes with recurrent corneal erosions, there was one recurrence during the follow-up period. All eyes healed shortly after treatment. No recurrence of corneal dystrophic changes was seen in the ablation zone at the final follow-up (mean, 30 months). Dystrophic changes could, however, still be seen outside the treatment zone in 50% of the eyes, but were asymptomatic in all eyes. The mean refractive change was 0.34 +/- 1.05 (mean +/- SD) diopters.

In this study, excimer laser photoablation was shown to be an effective, safe, and stable choice of treatment for map-dot-fingerprint dystrophy. A refractive change, as hyperopic shift, can be an adverse side effect in some individual cases.