eMedicine Specialties > Ophthalmology > Cornea

Dystrophy, Lattice: Treatment & Medication

Author: Natalie Afshari, MD, MA, FACS, Associate Professor of Ophthalmology, Duke University Eye Center, Duke University Medical Center
Coauthor(s): William B Trattler, MD, Ophthalmologist, The Center for Excellence in Eye Care; Volunteer Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute; William Lloyd Clark, MD, Consulting Staff, Palmetto Retina
Contributor Information and Disclosures

Updated: Jan 26, 2010

Treatment

Medical Care

When recurrent erosions occur with lattice corneal dystrophy, they are treated similar to any other form of recurrent erosion. Under the care of an ophthalmologist, a bandage contact lens along with antibiotics can be prescribed. Alternatively, patching with an antibiotic ointment can be used. Once the acute episode of recurrent erosion has resolved, preventative treatments may include Muro 128 drops, lubrication drops, and lubricating ointment at bedtime. If recurrent corneal erosions occur despite medical therapy, then excimer laser treatment (PTK) may be considered.2

Surgical Care

Excessive corneal erosions or mild visual decreases can be treated with PTK. The excimer laser removes the opacities, smooths the corneal surface, and allows the epithelium to re-adhere more tightly. If the visual acuity drops and the opacities are deep, a lamellar or full-thickness corneal transplant can be performed. Although the success rate for a corneal transplant is very high, lattice deposits can recur.

A recent study examined the histopathological and ultrastructural correlate of delayed epithelial healing in eyes with lattice corneal dystrophy;3 the study concluded that histopathological findings may correspond to reduced cell matrix interactions and may help explain the delayed healing.

Medication

Medical therapy for recurrent corneal erosions includes hypertonic saline, which is believed to increase adherence of the epithelium to underlying stroma. Lubrication may also help prevent further corneal erosions.

Hypertonic saline

This agent dehydrates epithelium, allowing epithelium to adhere better to underlying stroma.


Sodium chloride 5% (Muro 128)

For osmotic pressure control and water distribution. Dehydrates epithelium, allowing epithelium to adhere better to underlying stroma.

Adult

Solution: 1-2 gtt into affected eye q3-4h

Pediatric

Not established

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Caution in edema and sodium toxicity

Lubricating drops

These agents can moisten ocular surface and decrease the number of recurrent erosion episodes.


Artificial tears (GenTeal, Refresh, Bion tears)

Can moisten ocular surface and decrease number of recurrent erosion episodes.

Adult

1 gtt to affected eye 4-6 times/d

Pediatric

Administer as in adults

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Hyperemia, photophobia, stickiness of eyelashes, and ocular discomfort or irritation may occur

More on Dystrophy, Lattice

Overview: Dystrophy, Lattice
Differential Diagnoses & Workup: Dystrophy, Lattice
Treatment & Medication: Dystrophy, Lattice
Follow-up: Dystrophy, Lattice
Multimedia: Dystrophy, Lattice
References
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References

  1. Stone EM, Mathers WD, Rosenwasser GO, et al. Three autosomal dominant corneal dystrophies map to chromosome 5q. Nat Genet. 1994;6(1):47-51. [Medline].

  2. 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].

  3. Resch MD, Schlotzer-Schrehardt U, Hofmann-Rummelt C, Kruse FE, Seitz B. Alterations of epithelial adhesion molecules and basement membrane components in lattice corneal dystrophy (LCD). Graefes Arch Clin Exp Ophthalmol. Aug 2009;247(8):1081-8. [Medline].

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

  5. Das S, Langenbucher A, Seitz B. Delayed healing of corneal epithelium after phototherapeutic keratectomy for lattice dystrophy. Cornea. Apr 2005;24(3):283-7. [Medline].

  6. Kawashima M, Yamada M, Funayama T, et al. Six cases of late-onset lattice corneal dystrophy associated with gene mutations induced by the transforming growth factor-beta. Nippon Ganka Gakkai Zasshi. Feb 2005;109(2):93-100. [Medline].

  7. Krachmer J. Cornea (3 volume set). Vol 2. 1996.

  8. Mashima Y, Yamamoto S, Inoue Y, et al. Association of autosomal dominantly inherited corneal dystrophies with BIGH3 gene mutations in Japan. Am J Ophthalmol. Oct 2000;130(4):516-7. [Medline].

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Further Reading

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Keywords

lattice dystrophy, corneal dystrophy, stromal dystrophy, stromal dystrophies, corneal erosion, corneal transplant, phototherapeutic keratectomy, PTK, treatment, diagnosis, symptoms

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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: Nothing to disclose.

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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman 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; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma  Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching

CME Editor

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.

 
 
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