[OCT Article] Granular dystrophy and therapeutic trans-photokeratectomy.

Patient description

A 31-year-old female patient has been referred to us for an opinion regarding corneal dystrophy and is experiencing increasingly frequent left eye pain. Her visual acuity is 9/10 in the right eye and 7/10 in the left eye.

Clinical Results

Upon clinical examination, we confirm the diagnosis of Granular Dystrophy Type 1. The pain is present in the morning upon waking and sometimes at night. She is experiencing recurrent corneal erosions. We propose therapeutic trans-photokeratectomy (T-PKT) as a treatment option.

Figure 1: Slit-lamp appearance, typical of Granular Dystrophy Type 1.

Figure 2: Optovue Solix OCT (Optical Coherence Tomography) appearance, with epithelial mapping. This clearly shows the irregular aspect of the subepithelial stroma and the compensation of the epithelium.

Figure 3: Characteristic appearance of Optovue Solix OCT, with measurement using the caliper. This will enable precise guidance for the Trans-PKT (here, a total ablation depth of 90µ will be chosen).

At the 3-month postoperative follow-up, the symptoms of the left eye have significantly improved. The patient no longer experiences pain. Visual acuity has increased to 10/10.

Figure 4: Postoperative slit-lamp image. Almost complete disappearance of corneal opacities.

Figure 5: Postoperative appearance on Optovue Solix OCT confirming the almost complete disappearance of subepithelial opacities. Deeper opacities persist, inaccessible to therapeutic photokeratectomy.

Figure 6: Epithelial mapping on Optovue Solix showing a much more regular epithelium.

Conclusion

The precision of SOLIX for anterior segment OCT makes it possible to precisely guide the ablation depth of therapeutic photokeratectomy in cases of subepithelial or anterior stromal pathology.

Dr. Dimitri Cœuru practices at the Sourdille-Atlantique Ophthalmological Institute in Saint Herblain, near Nantes. He specializes in refractive surgery, corneal surgery (particularly corneal grafts), and cataract surgery. He regularly engages with his colleagues, presenting the advantages and recommendations of new technologies in refractive surgery.

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