Treatment of lisch corneal dystrophy with photorefractive keratectomy and mitomycin C.
OBJECTIVE
To describe a case of Lisch dystrophy; review the clinical, histopathologic, and electron microscopic features of this entity; and discuss a novel treatment approach using photorefractive keratectomy (PRK) and mitomycin C (MMC).


METHODS
A 45-year-old man with a feathery, comet-shaped, right-sided, corneal lesion was treated with excimer laser PRK and 20 seconds of MMC. The uninvolved fellow eye underwent traditional PRK without the use of MMC. Epithelial scrapings were sent for histopathologic analysis.


RESULTS
Histopathologic analysis showed vacuolated cells in the epithelial layer. Electron microscopy revealed empty intracytoplasmic vacuoles, electron-dense whorled inclusions, and reduced tonofilaments. Surface ablation and MMC was successful in treating the initial lesion, with only minimal recurrence noted in the affected eye. Surprisingly, a new asymptomatic lesion was noted in the unaffected eye but dissipated over time.


CONCLUSIONS
Although the whorled inclusions represent a novel finding, the overall clinical and microscopic analysis was consistent with Lisch dystrophy. Surface ablation with MMC should be considered as a treatment option for this disease.
Department of Ophthalmology, New York-Presbyterian Hospital, Weill Cornell Medical College of Cornell University, New York, NY, USA.
Matthew M
MM
Wessel
Jayati S
JS
Sarkar
Frederick A
FA
Jakobiec
Natasha
N
Dang
Pooja
P
Bhat
Norman
N
Michaud
Christopher E
CE
Starr
D000477:Alkylating Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003317:Corneal Dystrophies, Hereditary / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use*; D018903:Photorefractive Keratectomy; D014792:Visual Acuity
D000477:Alkylating Agents; D016685:Mitomycin