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Treatment of Lisch Corneal Dystrophy With Photorefractive Keratectomy and Mitomycin C

Wessel, Matthew M MD; Sarkar, Jayati S MD; Jakobiec, Frederick A MD, DSc; Dang, Natasha MD; Bhat, Pooja MD; Michaud, Norman BS; Starr, Christopher E MD, FACS

doi: 10.1097/ICO.0b013e3181ec8e26
Case Report

Purpose: 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.

From the *Department of Ophthalmology, New York-Presbyterian Hospital, Weill Cornell Medical College of Cornell University, New York, NY; †David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary of Harvard Medical School, Boston, MA; and ‡Department of Ophthalmology, University of Ottawa Eye Institute of the Ottawa Hospital, Ottawa, ON.

Received for publication March 25, 2010; revision received May 31, 2010; accepted June 2, 2010.

The authors state that they do not have any proprietary interest in this study.

Reprints: Christopher E. Starr, Department of Ophthalmology, New York-Presbyterian Hospital, Weill Cornell Medical College of Cornell University, 1305 York Avenue, 11th Floor, New York, NY 10021 (e-mail:

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