Avellino corneal dystrophy after LASIK

Objective: To report cases of Avellino corneal dystrophy (ACD) exacerbated by LASIK for myopia. Design: Retrospective, noncomparative, interventional case series and review of the literature. Participants: Seven patients. Intervention: Six patients with exacerbation of granular corneal deposits after LASIK were examined for TGFBI mutations by polymerase chain reaction sequencing of DNA. One previously reported patient who was heterozygous for the ACID gene was followed up for 16 months after mechanical removal of granular deposits from the interface after LASIK. Main Outcome Measures: Slit-lamp examination, visual acuity, manifest refraction, and DNA sequencing analysis. Results: All patients were heterozygous for the Avellino dystrophy gene. Corneal opacities appeared 12 months or more after LASIK. Best spectacle-corrected visual acuity decreased as the number and density of the opacities increased. One patient underwent mechanical removal of granules from the interface and had a severe recurrence within 16 months. Another patient had removal of the granules from the interface with PTK, followed by treatment with topical mitomycin C. In this patient, the cornea has remained relatively clear for 6 months. Conclusions: Laser in situ keratomileusis increases the deposition of visually significant corneal opacities and is contraindicated in patients with ACD. Mechanical removal of the material from the interface does not prevent further visually significant deposits. Mitomycin C treatment, in conjunction with surgical removal of opacities may be an effective treatment. (C) 2004 by the American Academy of Ophthalmology.