Macular Corneal Dystrophy Treatment & Management

Updated: May 02, 2018
  • Author: Anna M Edmiston, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

When recurrent corneal erosions occur with macular corneal dystrophy (MCD), they are treated like any other form of recurrent corneal erosion. Under the care of an ophthalmologist, frequent application of an antibiotic ointment can be used. Alternatively, bandage contact lens along with topical antibiotics can be prescribed.

Once the acute episode of recurrent corneal erosions has resolved, preventive treatment may include sodium chloride 5% drops (eg, Muro 128) or artificial tear lubricating drops during the day and sodium chloride 5% ointment (eg, Muro 128) or lubricating ointment at bedtime.

Sunglasses are often helpful for severe glare symptoms.

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Surgical Care

If recurrent corneal erosions occur despite medical therapy, excimer laser phototherapeutic keratectomy (PTK) may be considered in early cases of macular corneal dystrophy. [5] The excimer laser removes superficial corneal opacities, smooths the corneal surface, and allows the epithelium to re-adhere more tightly. However, macular corneal dystrophy tends to recur quickly and at a high rate after PTK, [6] making it less suitable for PTK than lattice or granular corneal dystrophy.

If visual acuity worsens and the opacities are deep, lamellar or full-thickness corneal transplantation can be performed. Although the success rate for corneal transplantation is high, macular corneal dystrophy deposits can recur with time and tend to recur at a higher rate in grafts of patients with macular corneal dystrophy than in grafts of patients with lattice or granular corneal dystrophies. [5]

Both deep anterior lamellar keratoplasty (DALK) and full-thickness penetrating keratoplasty (PKP) are viable options for the treatment of macular corneal dystrophy. DALK is associated with a higher risk of recurrence, while PKP is associated with a larger decrease in endothelial cell count and higher rate of graft failure due to endothelial rejection. [7, 8]

The use of fibrin glue in lamellar therapeutic keratectomy for the treatment of anterior corneal opacities has been assessed as safe and effective for attachment. However, the technique needs to be refined for ease and safety. [9]

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Long-Term Monitoring

Patients with epithelial defects from recurrent corneal erosions need to be observed every few days to ensure that defects are healing.

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Inpatient & Outpatient Medications

Patients with epithelial defects from recurrent corneal erosions are treated with topical antibiotics to prevent corneal infection.

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