2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 10: Refractive Surgery in Ocular and Systemic Disease
Other Corneal Dystrophies
Basement membrane dystrophy (also called map-dot-fingerprint dystrophy) is a common corneal dystrophy that can be an incidental finding in many asymptomatic patients. In determining the safety of refractive surgery in these eyes, one must ensure that the irregularity in the epithelium is not impacting the refractive error being treated, nor is it causing visually significant irregularity in the central corneal surface. If the eye is deemed stable to proceed with laser refractive surgery, surface ablation may be the preferred approach. In addition, surface treatment may help reduce irregular astigmatism and recurrent erosions, which are frequent in these patients.
The experience and published reports of refractive surgery in patients with Fuchs endothelial dystrophy are limited. Among the small number of patients with mild guttae and family history of Fuchs dystrophy who, following LASIK, were evaluated and reported on, the majority developed progressive corneal edema, loss of endothelial cells, and loss of BCVA. The progressive nature of this disease and the fluctuations in the corneal refractive power due to the fluctuating edema make these eyes difficult to stabilize for accurate measurements and postoperative management.
Moshirfar M, Feiz V, Feilmeier MR, Kang PC. Laser in situ keratomileusis in patients with corneal guttata and family history of Fuchs’ endothelial dystrophy. J Cataract Refract Surg. 2005;31(12):2281–2286.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.