Medical Care
When recurrent erosions occur with granular corneal dystrophy (GCD), they are treated like any other form of recurrent erosions. Under care of an ophthalmologist, bandage contact lens along with antibiotic drops 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 erosions has resolved, preventive treatment may include sodium chloride 5% drops (eg, Muro 128) or artificial tear lubricating drops during the day and lubricating ointment at bedtime. If recurrent corneal erosions occur despite medical therapy, corneal punctures or excimer laser phototherapeutic keratectomy (PTK) may be considered.
Surgical Care
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. When deep opacities are causing significant visual symptoms, corneal transplantation may be required.
If visual acuity worsens 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. A study showed that multiple PTK procedures can be safely performed in grafts without compromising graft survival and with improved visual acuity. [17]
For cases in which all of these therapies fail, sutureless femtosecond laser-assisted anterior lamellar keratoplasty (FALK) is recommended as a safe and effective technique for the management of recurrent granular corneal dystrophy in post–penetrating keratoplasty and post-PTK eyes. [18]
Two long-term case reports have suggested that the simultaneous transplantation of healthy donor limbus when performing penetrating keratoplasty (ie, limbo-keratoplasty) may prolong recurrence in granular corneal dystrophy. [19]
Long-Term Monitoring
Patients with corneal epithelial defects due to recurrent erosions need to be observed every few days to make certain the defect is healing.
Inpatient & Outpatient Medications
Patients with corneal epithelial defects from recurrent erosions require treatment with topical antibiotics to prevent infection.
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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.
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The slit lamp parallelipid demonstrates the deposition of opacities throughout the central stroma.
