Granular Dystrophy Treatment & Management

  • Author: Natalie Afshari, MD, MA, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jan 26, 2010
 

Medical Care

  • When recurrent erosions occur with granular dystrophy, they are treated like any other form of recurrent erosion.
  • Under care of an ophthalmologist, bandage contact lens along with antibiotics can be prescribed; alternatively, patching with an antibiotic ointment can be used. Some physicians treat recurrent erosions with frequent antibiotic ointments while awake.
    • Once the acute episode of recurrent erosion has resolved, preventive treatment may include sodium chloride 5% drops or artificial tear lubricating drops during the day and lubricating ointment at bedtime.
    • If recurrent corneal erosions occur despite medical therapy, then excimer laser phototherapeutic keratectomy (PTK) may be considered.
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Surgical Care

Excimer laser PTK is quite effective at removing opacities from the superficial cornea. When deep opacities are causing significant visual symptoms, corneal transplantation may be required.

  • Excessive corneal erosions or visual decrease from superficial opacities can be treated with PTK. Excimer laser PTK removes superficial opacities, smooths the corneal surface, and allows the epithelium to re-adhere more tightly.
  • If the visual acuity drops and most of the opacities are deep, lamellar or full-thickness corneal transplantation can be performed. Although the success rate for corneal transplantation is very high, granular deposits recur with time. Fortunately, when the deposits recur, they tend to be superficial, and amenable to treatment with excimer laser PTK.
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Contributor Information and Disclosures
Author

Natalie Afshari, MD, MA, FACS  Associate Professor of Ophthalmology, Duke University Eye Center, Duke University Medical Center

Natalie Afshari, MD, MA, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

William B Trattler, MD  Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute

William B Trattler, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Allergan Consulting fee Consulting; Alcon Consulting fee Consulting; Inspire Consulting fee Consulting; Abbott Medical Optics Consulting fee Consulting

William Lloyd Clark, MD  Consulting Staff, Palmetto Retina

William Lloyd Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Fernando H Murillo-Lopez, MD  Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Grunauer-Kloevekorn C, Brautigam S, Wolter-Roessler M. Molecular genetic analysis of the BIGH3 gene in lattice type I (Biber-Haab-Dimmer) and granular type II (Avellino) corneal dystrophy: is indirect mutation analysis for hot spots recommended?. Klin Monatsbl Augenheilkd. Dec 2005;222(12):1017-23. [Medline].

  2. Mori H, Miura M, Iwasaki T, et al. Three-dimensional optical coherence tomography-guided phototherapeutic keratectomy for granular corneal dystrophy. Cornea. Sep 2009;28(8):944-7. [Medline].

  3. Dalton K, Schneider S, Sorbara L, Jones L. Confocal microscopy and optical coherence tomography imaging of hereditary granular dystrophy. Cont Lens Anterior Eye. Nov 27 2009;[Medline].

  4. Das S, Langenbucher A, Seitz B. Excimer laser phototherapeutic keratectomy for granular and lattice corneal dystrophy: a comparative study. J Refract Surg. Nov-Dec 2005;21(6):727-31. [Medline].

  5. Albert D, Jakobiec F. Principles and Practice of Ophthalmology. Vol 1. 1994:26-49.

  6. Klintworth GK. Advances in the molecular genetics of corneal dystrophies. Am J Ophthalmol. Dec 1999;128(6):747-54. [Medline].

  7. Krachmer J. Cornea. Vol 2. 1996.

  8. Yamamoto S, Okada M, Tsujikawa M, et al. The spectrum of beta ig-h3 gene mutations in Japanese patients with corneal dystrophy. Cornea. May 2000;19(3 Suppl):S21-3. [Medline].

 
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Granular dystrophy. Image courtesy of James J Reidy, MD, FACS, Associate Professor of Ophthalmology, State University of New York, School of Medicine & Biomedical Sciences, Buffalo, New York.
The slit lamp parallelipid demonstrates the deposition of opacities throughout the central stroma.
 
 
 
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