eMedicine Specialties > Ophthalmology > Cornea

Dystrophy, Map-dot-fingerprint: Treatment & Medication

Author: David Verdier, MD, Clinical Professor, Department of Surgery, Division of Ophthalmology, Michigan State University College of Human Medicine
Contributor Information and Disclosures

Updated: May 26, 2009

Treatment

Medical Care

Numerous treatment options are available, and like map-dot-fingerprint dystrophy itself, results are variable and differ from patient to patient.

  • Hypertonic drops or ointment often are the first line of treatment. They may help both irregular astigmatism and recurrent corneal erosion problems. Sodium chloride (5%) drops at breakfast, lunch, and dinner, and ointment at bedtime are recommended.
  • Nonhypertonic lubricating drops or ointment may be used; however, the only prospective study to date detected no difference in the results of bland versus hypertonic lubricating treatment.
  • Consider patching for acute episodes of associated corneal erosions.
  • Bandage extended-wear soft contact lenses may be useful, but the risk of infectious keratitis makes this a secondary choice.
  • Hard or gas-permeable contact lenses may improve vision by masking corneal irregular astigmatism, but they are often poorly tolerated because of increased corneal fragility/erosion problems.

Surgical Care

  • Debridement/superficial keratectomy is preferred by this author, for both significant visual loss from associated irregular astigmatism and recurrent corneal erosions, if treatment with hypertonic drops and ointment fails. Combined debridement and superficial keratectomy can be completed easily in the office setting, at the slit lamp, using topical proparacaine or a similar anesthetic drop. Place a lid speculum, then debride (with a rather blunt Kimura spatula) the entire extent of any loosely adherent epithelium or basement membrane level opacities. With sweeping and pushing motions, using the trailing or leading edges of the instrument, keeping nearly parallel to the corneal plane, redundant basement membrane level material can be massaged away, while maintaining the integrity of the Bowman layer.
  • Diamond burr superficial keratectomy is very useful for recurrent erosions associated with map-dot-fingerprint dystrophy that does not respond to keratectomy with a Kimura spatula. Following epithelial debridement, a 4- or 5-mm diameter diamond-dusted burr very gently is used to polish the basement membrane throughout the area of epithelial debridement.
  • Excimer laser phototherapeutic keratectomy is an alternative treatment for recurrent corneal erosions associated with map-dot-fingerprint dystrophy, with results similar to the above-described superficial keratectomy procedures (but much more expensive in most settings). Ablation should not extend more than 10 micrometers beyond the debrided epithelium, as an undesired hyperopic shift can occur.
  • Corneal anterior stromal needle puncture is useful for recurrent corneal erosions from trauma that recur in the same location. This procedure is not as successful for recurrent erosions associated with map-dot-fingerprint dystrophy, which is usually more diffuse and often migratory.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Hyperosmolar agents

Create osmotic gradient that draws water out of the cornea.


Sodium chloride (Muro 128, AK-NaCl)

Used for temporary relief of corneal inflammation.

Adult

Solution: 1-2 gtt into affected eye(s) tid
Ointment: 0.25-inch ribbon to inside of affected eye(s) qhs

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

May cause temporary burning and irritation upon use; if pain, change in vision, continued redness, or irritation of the eye(s) occur, or if initial condition/problem worsens or persists, reevaluate therapy; do not use product if it changes color or becomes cloudy

More on Dystrophy, Map-dot-fingerprint

Overview: Dystrophy, Map-dot-fingerprint
Differential Diagnoses & Workup: Dystrophy, Map-dot-fingerprint
Treatment & Medication: Dystrophy, Map-dot-fingerprint
Follow-up: Dystrophy, Map-dot-fingerprint
Multimedia: Dystrophy, Map-dot-fingerprint
References
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References

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  2. Boutboul S, Black GC, Moore JE, et al. A subset of patients with epithelial basement membrane corneal dystrophy have mutations in TGFBI/BIGH3. Hum Mutat. Jun 2006;27(6):553-7. [Medline].

  3. Buxton JN, Constad WH. Superficial epithelial keratectomy in the treatment of epithelial basement membrane dystrophy. Cornea. 1987;6(4):292-7. [Medline].

  4. Cogan DG, Donaldson DD, Kuwabara T, et al. Microcystic dystrophy of the corneal epithelium. Trans Am Ophthalmol Soc. 1964;62:213-25. [Medline].

  5. Cogan DG, Kuwabara T, Donaldson DD, et al. Microcystic dystrophy of the cornea. A partial explanation for its pathogenesis. Arch Ophthalmol. Dec 1974;92(6):470-4. [Medline].

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Further Reading

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Keywords

map-dot-fingerprint dystrophy, corneal map-dot-fingerprint dystrophy, Cogan’s dystrophy, Cogan's microcystic dystrophy, anterior basement membrane dystrophy, epithelial basement membrane dystrophy, corneal dystrophy, corneal dystrophies, corneal degeneration, corneal erosion

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Contributor Information and Disclosures

Author

David Verdier, MD, Clinical Professor, Department of Surgery, Division of Ophthalmology, Michigan State University College of Human Medicine
David Verdier, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Cornea Society, Eye Bank Association of America, Michigan Society of Eye Physicians & Surgeons, and Michigan State Medical Society
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: Nothing to disclose.

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

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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