Cover

Corneal Dystrophies

Editor(s): Lisch W. (Hanau) 
Seitz B. (Homburg/Saar) 
Table of Contents
Vol. 48, 2011
Section title: Paper
Lisch W, Seitz B (eds): Corneal Dystrophies. Dev Ophthalmol. Basel, Karger, 2011, vol 48, pp 116–153
(DOI:10.1159/000324081)

Stage-Related Therapy of Corneal Dystrophies

Seitz B. · Lisch W.
aDepartment of Ophthalmology, University of Saarland, Homburg/Saar, and bDepartment of Ophthalmology, City Hospital of Hanau, Hanau, Germany

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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 4/26/2011
Cover Date: 2011

Number of Print Pages: 38
Number of Figures: 12
Number of Tables: 5

ISBN: 978-3-8055-9720-3 (Print)
eISBN: 978-3-8055-9721-0 (Online)

Abstract

Corneal dystrophies typically result in a gradual bilateral loss of vision in a primary ‘white eye’ – often in conjunction with epithelial defects in later stages. Treatment of corneal dystrophies needs to be stage-related. To ensure a stage-related therapeutic approach, an adequate classification based on clinical, histopathological and genetic knowledge is indispensable. In principle, topical medications, contact lenses and various microsurgical approaches are applicable. In case of predominantly superficial dystrophies of the epithelium, basal membrane and/or Bowman’s layer (map-dot-fingerprint, Meesmann, Lisch, Reis-Bücklers, Thiel-Behnke), recurrent epithelial defects may complicate the clinical picture. If conservative therapy with gels/ointments, application of therapeutic contact lenses and/or conventional corneal abrasion are not successful, phototherapeutic keratectomy (PTK) using a 193-nm excimer laser is the method of choice today. PTK can be repeated several times, thus post poning corneal transplantation (lamellar or even penetrating) for a long time. Three major goals may be achieved by PTK depending on the diagnosis: (1) to remove superficial opacities; (2) to regularize the surface and treat irregular astigmatism, and (3) to improve the adherence of the epithelium. In dystrophies with depositions predominantly in the stroma (e.g. granular, lattice, macular, recurrence on the graft), PTK may be a reasonable alternative to anterior lamellar or penetrating keratoplasty (PKP) depending on the exact localization of the lesions. Besides exact determination of the depth of depositions using a slit lamp, a preoperative topography analysis is indispensable. The therapy of endothelial dystrophies depends on diagnosis and age: Fuchs endothelial corneal dystrophy will need corneal transplantation (e.g. when visual acuity drops below 0.4). In contrast, transplantation will only be very rarely necessary in posterior polymorphous corneal dystrophy, but the intraocular pressure has to be checked frequently. Especially in elderly patients with reduced compliance, posterior lamellar keratoplasty – preferably in the form of Descemet stripping automated endothelial keratoplasty – may be performed instead of PKP. In case of congenital hereditary endothelial dystrophy, the best time point of PKP has to be determined with regard to amblyopia (surgery too late) and inadequate follow-up (surgery too early) together with parents and pediatric ophthalmologists on an individual basis. In conclusion, for stage-related therapy of corneal dystrophies, besides contact lenses, PTK and PKP, various techniques of lamellar keratoplasties represent an indispensable enrichment of our corneal microsurgical spectrum today.


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 4/26/2011
Cover Date: 2011

Number of Print Pages: 38
Number of Figures: 12
Number of Tables: 5

ISBN: 978-3-8055-9720-3 (Print)
eISBN: 978-3-8055-9721-0 (Online)


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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