The manual technique can be a less expensive alternative to using laser
Map-dot-fingerprint dystrophy of the cornea for the most part can be
asymptomatic and may not require any treatment. Various treatment options are
available for the management of symptomatic map-dot-fingerprint dystrophy,
including diamond burr superficial keratectomy, alcohol delamination, and the
use of laser modalities such as phototherapeutic keratectomy. Most of these
techniques are largely effective, but some of them may be more expensive than
others. Additionally, a clinician may not have easy access to or may not be
currently using laser refractive technology.
In this column, I describe the surgical technique of manual superficial
keratectomy for the management of symptomatic map-dot-fingerprint corneal
A 40-year-old Caucasian man presented with blurred vision involving his
right eye. He also complained of glare, halos and monocular diplopia in the
right eye that interfered with his daily activities, depending on the lighting
conditions. Clinical examination revealed bilateral map-dot-fingerprint corneal
dystrophy that was more pronounced in his right eye (Figure 1).
|Figure 1. Slit lamp
photographs showing significant corneal map-dot-fingerprint dystrophy affecting
the visual axis. The corneal opacities overlie the pupillary region and extend
to the peripheral cornea.
Images: John T
Lidocaine jelly 2% was applied to the ocular surface (Figure 2).
Attempts at removing the surface corneal layers with a Weck-Cel spear
(Medtronic) were not very successful (Figure 3). Hence, a straight crescent
blade (Alcon) was used to remove the corneal epithelium. The blade was held
slanted to the corneal dome, such that the Bowmans layer was not
violated. The tangential motion of the blade on the corneal dome removed the
surface corneal layers (Figure 4). Care was exercised to avoid any penetration
into the Bowmans layer. Starting from the central region of the cornea,
the epithelium was removed in a circular manner (Figure 5). The surface corneal
epithelial complex was removed, leaving an intact, smooth Bowmans layer
(Figure 6). The completed view of the superficial keratectomy is shown in
Figure 7. There were no corneal opacities from the map-dot-fingerprint corneal
dystrophy (Figure 7).
|Figure 2. Lidocaine
jelly 2% is applied to the ocular surface.
|Figure 3. Attempts
at removing the superficial layers of the cornea using a Weck-Cel spear are not
|Figure 4. A straight
crescent blade is used to remove the corneal epithelium. The blade is held
slanted to the corneal dome, such that the Bowmans layer is not
|Figure 5. Starting
from the central region of the cornea, the epithelium is removed in a circular
|Figure 6. The
surface epithelial complex is removed with an intact Bowmans
|Figure 7. Completed
view of superficial keratectomy. The cornea is devoid of all opacities from the
map-dot-fingerprint corneal dystrophy.
Postoperatively, an antibiotic and a steroid drop, such as Pred Forte 1%
(prednisolone acetate, Allergan) four times a day and Besivance (besifloxacin,
Bausch + Lomb) three times a day, were used until re-epithelialization was
complete. A bandage soft contact lens added to patient comfort during the
The epithelial complex is relatively well-attached to the underlying
cornea in the absence of recurrent erosion. Hence, a Weck-Cel sponge alone will
not usually remove the surface corneal layers. Use of a straight crescent blade
will facilitate the removal of the outer corneal layers.
It is important not to damage the Bowmans layer of the cornea. An
intact, smooth Bowmans layer will facilitate re-epithelialization without
- Mencucci R, Paladini I, Brahimi B, Menchini U, Dua HS, Romagnoli P.
Alcohol delamination in the treatment of recurrent corneal erosion: an electron
microscopic study. Br J Ophthalmol. 2010;94(7):933-939.
- Pogorelov P, Langenbucher A, Kruse F, Seitz B. Long-term results of
phototherapeutic keratectomy for corneal map-dot-fingerprint dystrophy
(Cogan-Guerry). Cornea. 2006;25(7):774-777.
- Seitz B, Lisch W. Stage-related therapy of corneal dystrophies.
Dev Ophthalmol. 2011;48:116-153.
- Soong HK, Farjo Q, Meyer RF, Sugar A. Diamond burr superficial
keratectomy for recurrent corneal erosions. Br J Ophthalmol.
- Thomas John, MD, is a clinical associate professor at Loyola
University at Chicago and is in private practice in Oak Brook, Tinley Park and
Oak Lawn, Ill. He can be reached at 708-429-2223; fax: 708-429-2226; e-mail:
- Disclosure: Dr. John has no relevant financial disclosures.