Map-dot-fingerprint Dystrophy Treatment & Management
- Author: David Verdier, MD; Chief Editor: Hampton Roy, Sr, MD more...
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; 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.
Indications for surgical treatment of corneal map-dot-fingerprint dystrophy include decreased vision or discomfort, including recurrent corneal erosion syndrome, that does not respond to medical treatment as outlined above. Another common indication for surgical treatment is the need for a smooth and stable corneal surface prior to undergoing cataract surgery to maximize intraocular lens calculation accuracy.
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.[17, 18]
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.[19, 20]
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.[21, 22, 23, 24]
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.
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