Distrofia corneal de Meesmann en paciente con queratotomía hexagonal / Meesmann corneal dystrophy in a patient with hexagonal keratotomy

RESUMEN Las distrofias corneales constituyen un grupo de enfermedades hereditarias que suelen ser bilaterales y simétricas, las cuales progresan lentamente y sin relación con factores ambientales o sistémicos. Se presenta una paciente de raza blanca, de 45 años de edad, remitida al Servicio de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", quien refirió sensación de cuerpo extraño, sensibilidad a la luz y mala visión de ambos ojos, así como antecedente de queratotomía hexagonal hacía aproximadamente 20 años. En lámpara de hendidura se observaron en el epitelio numerosas lesiones puntiformes en forma de vesículas claras, semejantes a ampollas, distribuidas paracentralmente, que respetaban ligeramente el centro, con espacios de córnea transparente entre ellas y mejor visibilidad de las lesiones en retroiluminación. En la microscopia confocal se observaron en el ojo derecho estructuras redondas u ovales, de forma quística, hiporreflectivas. En el ojo izquierdo se encontraron imágenes difusas hiperreflectivas en el epitelio corneal basal. Se detectó la presencia de nervios corneales tortuosos, de aspecto fragmentado en ambos ojos. Se consideró como diagnóstico la distrofia de Meesmann y se realizó queratectomía superficial, con lo cual se logró alivio de la sintomatología de la paciente(AU)

ABSTRACT Corneal dystrophies are a group of hereditary diseases often bilateral and symmetrical which progress slowly and without any relationship to environmental or systemic factors. A case is presented of a white 45-year-old female patient referred to the Cornea Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology, who reported a foreign body sensation, light sensitivity and poor vision in both eyes, as well as a history of hexagonal keratotomy from approximately 20 years before. Slit lamp examination revealed numerous punctiform lesions in the form of clear blister-like vesicles distributed paracentrally and slightly sparing the center, with transparent cornea spaces between them and better visibility of the lesions under retroillumination. Confocal microscopy showed round or oval cystic and hyporeflective structures in the right eye, whereas the left eye exhibited diffuse hyperreflective images in the basal corneal epithelium. Tortuous corneal nerves of a fragmented appearance were detected in both eyes. A Meesmann dystrophy diagnosis was considered and superficial keratectomy was performed, with which the patient's symptoms were relieved(AU)

Deep anterior lamellar keratoplasty for the management of iatrogenic keratectasia occurring after hexagonal keratotomy.

Iatrogenic keratectasia has been reported subsequent to refractive surgery or trauma. Hexagonal keratotomy (HK) is a surgical incisional technique to correct hyperopia. A number of complications have been reported following this procedure, including irregular astigmatism, wound healing abnormalities and corneal ectasia. When visual acuity is poor because of ectasia or irregular astigmatism and contact lens fitting is not possible, penetrating or lamellar keratoplasty can be performed. Since incisions in refractive keratotomy are set at 90–95% depth of cornea, intraoperative microperforations are known to occur and lamellar keratoplasty may become difficult. We describe deep anterior lamellar keratoplasty (DALK) used to successfully manage keratectasia after HK. Pre DALK vision was 20/400 and post DALK vision was 20/30 two months after surgery. This report aims to show improved visual outcome in corneal ectasia secondary to HK. DALK can be a procedure of choice with proper case selection.