Sequential Customized Therapeutic Keratectomy for Reis-Bucklers' Cornea Dystrophy: Long-term Follow-up

PURPOSE: To report long-term outcomes of sequential customized therapeutic keratectomy for Reis-Bucklers' comeal dystrophy. METHODS: This was a retrospective review of 14 eyes of 8 patients with Reis-Bucklers' corneal dystrophy that underwent surgical peeling with a spatula of the epithelium and subepithelial membrane present in Reis-Bucklers' corneal dystrophy, with subsequent sequential customized therapeutic keratectomy featuring a multi-step approach with sequential, repeated customized excimer laser photoablations alternating with repeat intraoperative topographies to monitor and progressively reduce comeal irregularities. RESULTS: At the last follow-up of 5.09 +/- 4.67 years (range: 0.29 to 12.87 years), mean corrected distance visual acuity improved from 20/50 (range: 20/630 to 20/30) to 20/25 (range: 20/20 to 20/40) (P < .01), whereas mean refraction changed from -0.29 +/- 1.91 diopters (D) sphere and -0.75 +/- 0.81 D cylinder preoperatively to 1.25 +/- 2.10 D sphere and -1.08 +/- 0.53 D cylinder postoperatively. Mean central keratometry values changed minimally from 42.67 +/- 2.26 D preoperatively to 42.65 +/- 2.30 D postoperatively. Coma significantly decreased from 0.60 +/- 0.40 to 0.35 +/- 0.28 pm (P < .05), whereas total higher order aberrations, spherical aberration, and trefoil remained stable. No patient underwent corneal transplantation. Disease recurrence required re-treatment using the same protocol in 14.28% of eyes (n = 2) for a mean of 5.86 +/- 0.31 years (range: 5.64 to 6.08 years) after initial surgery. CONCLUSIONS: Five years after sequential customized therapeutic keratectomy, most eyes with Reis-Bucklers' corneal dystrophy showed improved visual acuity, stable refraction, and improved or stable higher order aberrations.