Phototherapeutic Keratectomy In Schnyder Corneal Dystrophy: Visual Rehabilitation And Recurrence Considerations In A 44-Year-Old Patient

Schnyder corneal dystrophy (SCD) is a rare corneal dystrophy characterized by abnormally increased deposition of cholesterol and phospholipids, early-age arcus lipoides in the cornea leading to progressive vision loss.

I present a case of a 44-year-old female patient diagnosed with Schnyder corneal dystrophy and to describe visual and structural outcomes before and after excimer laser phototherapeutic keratectomy . PTK has been reported to be effective in the treatment of SCD. PTK is indicated for anterior basement membrane dystrophies and stromal dystrophies for both symptomatic relief and visual improvement.

The aim is to highlight the therapeutic benefits and   visual rehabilitation following superficial corneal opacities removal.

. The patient was evaluated and treated at private  ophtalmology hospital in Belgrade. 

Comprehensive ocular examination, including clinical examination, anterior segment optical coherence tomography was performed to examine  corneal structure. PTK was carried out under topical anesthesia by an experienced corneal suregeon, with postoperative care and follow-up conduced in same center. Postoperative follow up for the next seven years was performed at her ophtalmologist once a year.

A 37-year-old woman presented with progressively decreased vision and central corneal opacities in both eyes. . Personal anamnesis shows high holesterol levels and mild anemia.

Slit-lamp examination revealed polygonal central crystalline deposits with surrounding stromal haze,early-age arcus lipoides consistent with Schnyder corneal dystrophy.

Best corrected visual acuity (BCVA) was 0.4 in the right eye and 0.5 in the left. Corneal topography showed irregular astigmatism, while anterior segment OCT confirmed superficial stromal involvement with the deeper stroma and endothelium unaffected.

Considering the superficial nature of lesions and patients visual complaints  PTK using eximer laser was planned.

PTK was performed on the right eye under topical anesthesia,  using excimer laser.  The postoperative course was uneventful.

Postoperative menagement inculded topical antibiotics , corticosteroids drops and preservative free artifitials tears.

After three monts , the cornea was clear with significant reduction of subepithelial deposits. BCVA improved to 0.8.

The left eye was l treated  6 months later with similar parameters and achieved comparable results, BCVA  improved to 0,9 .

No recurrence or complications were observed at seven-years follow-up. Patient has BCVA on  both eyes, stable for seven years  using corrective glasses OD -0,75/-1,25/125  OS =1,25/-1,0/15  and she is extremely satisfied with the results, considering the nature of her occupation. 

This case demonstrates that PTK can be an effective and safe  minimally invasive  therapeutic option in Schnyder corneal dystrophy, leading to improved corneal transparency and visual function.  Phototherapeutic keratectomy led to significant improvement in corneal clarity and best corrected visual acuity with stable corneal  thickness and  no complitations during the seven years of folow up.

Early detections and treatment of  superficial  lesions may delay the need form more invasive procedures such as penetrating keratoplasty.  Careful patient selection and documentation of pre and postoperative findings are essential for optimal outcomes contributing valuable evidence for the menagement of rare corneal disorders