Definitive Treatment of Lisch Epithelial Corneal Dystrophy via Staged Keratectomy and Targeted Minor Limbal Excision With Cautery.

PURPOSE: We demonstrate a novel approach for the definitive treatment of Lisch epithelial corneal dystrophy via an unintentionally staged alcohol keratectomy and intentionally targeted minor limbal excision with cautery.

METHODS

A 46-year-old woman presented with visually significant corneal changes, suspected to be Lisch epithelial corneal dystrophy after clinical examination, anterior segment optical coherence tomography, and confocal microscopy. Alcohol keratectomy was performed with complete resolution, but there was visually significant recurrence at 2 years. As the abnormal epithelial recurrence originated in a linear tapered pattern from a focal superior limbal region, minor limbal excision with cautery and alcohol keratectomy was performed.

RESULTS

Histopathological analysis demonstrated cytoplasmic vacuolation and glycogen granules. The limbal tissue demonstrated normal histological features. The patient's vision returned to baseline on reepithelialization with a clear cornea, with no recurrence in over 5-year follow-up.

CONCLUSIONS

Our targeted two-staged approach provides definitive treatment for Lisch epithelial corneal dystrophy and highlights the focal limbal origin of abnormal cells.