Avellino corneal dystrophy worsening after laser in situ keratomileusis: further clinicopathologic observations and proposed pathogenesis.
OBJECTIVE
To study the nature of the deposits in Avellino corneal dystrophy (ACD) worsening after laser in situ keratomileusis (LASIK), and suggest a mechanism for histopathogenesis.


METHODS
Interventional case report.


METHODS
A 28-year-old woman previously diagnosed with bilateral ACD underwent bilateral LASIK. The corneal dystrophy progressively worsened bilaterally, one year later. A penetrating keratoplasty was subsequently performed on the right eye at 31 years of age, and in the left eye a year later. The clinical and histopathologic findings of the corneal graft of the right eye were reported in the literature, with positivity to the Masson trichrome stain, negative staining with Congo red, and heterozygosity for the Arg124His mutation by serum DNA studies. Histopathologic studies of the corneal graft of the left eye were conducted at the University of Texas Southwestern Medical Center.


RESULTS
Histopathologic examination of the excised cornea showed the Masson trichrome positive deposits present from underneath the Bowman layer to the LASIK interface, with absence of deposits posterior to the latter. In contrast to the prior report describing findings in the corneal graft of the left eye, the deposits stained lightly with Congo red, but failed to show birefringence under polarized light, or fluorescence with thioflavin T.


CONCLUSIONS
Accelerated deposits developing after LASIK in ACD eyes seem to harbor pre-amyloid features. The epithelium is likely to be the culprit, in a pathway independent of with human transforming growth hormone beta (TGF-beta), with deposits developing in the anterior stroma and the stromal interface.
Awwad
Shady T
ST
Cornea, External Diseases, and Refractive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
Di Pascuale
Mario A
MA
Hogan
Robert N
RN
Forstot
Stephan L
SL
McCulley
James P
JP
Cavanagh
Harrison D
HD
D000328:Adult; D003315:Cornea / Q000473:pathology; D003317:Corneal Dystrophies, Hereditary / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D015948:Keratoplasty, Penetrating; D018613:Microscopy, Confocal; D012008:Recurrence; D014792:Visual Acuity