Heterozygous Avellino Corneal Dystrophy 9 Years After Photorefractive Keratectomy: Natural or Laser-Induced Accelerated Course?

PURPOSE: To report a photorefractive keratectomy (PRK)-treated patient who first developed stromal opacities with a typical granular pattern 9 years after surgery, which was confirmed as heterozygous Avellino dystrophy by DNA analysis. METHODS: A 37-year-old woman, who had undergone PRK 17 years ago, has been followed for glaucoma and corneal dystrophy. She had preoperative clear corneas in both eyes. RESULTS: Nine years after PRK, at the age of 29 years, 2-3 small, white, anterior stromal corneal opacities were first detected in both eyes. Seventeen years postoperatively, multiple anterior stromal corneal deposits with a dot, crumb, or snowflake appearance were noted to the same degree in both eyes. The intervening cornea was relatively clear. Her DNA was heterozygous for the R124H mutation. CONCLUSIONS: Slowly developing, mild corneal deposits occurred after PRK in this patient with heterozygote Avellino corneal dystrophy. Various clinical manifestations can occur after excimer laser refractive surgery in patients with Avellino corneal dystrophy.