Dr. Perl presented a case study at a conference about a patient who developed a rare eye condition, Avellino Corneal Dystrophy, after LASIK surgery. The patient's vision worsened significantly in one eye. After ruling out other potential causes, Dr. Perl determined it was ACD based on the patient's history and test results. He performed surgery to remove the affected corneal tissue. Genetic testing confirmed ACD. The patient's vision improved substantially. The case highlights the importance of considering genetic factors and rare conditions when evaluating complications after refractive eye surgery.

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AECOS
IN ASPEN COLORADO
Presented by Theodore Perl, M.D.
CornealAssociates.com 3
A CASE STUDY
A 34 year-old patient with bilateral BCVA of 20/20 underwent LASIK
to correct their myopia of -3.25 + 0.50 x 085 and OS: -3.75 +
0.75 x 097.
One day post-op data conveyed no reported complications. As time
went on, the patient returned to the surgeon and had complaints
about their left eye being very blurry. The LASIK surgeon lifted the
flap, irrigated the cornea, prescribed topical steroids, antibiotics
and artificial tears for 1 week, then tapered. However the patients
vision worsened and the surgeon referred the patient out for a sec-
ond opinion. After seeing several cornea specialists throughout Long
Island, treatment options ranged from PTK, relift/irrigate to cornea
transplant. The patient’s BCVA was 20/400 OS.
After a lot of unknowns, the patient was referred to Corneal Associates
of New Jersey to see Dr. Perl. After examining the patient records,
Dr. Perl began to suspect Avellino Corneal Dystrophy (ACD), a rare
complication that can arise in people with certain genetic predispo-
sitions. ACD can cause blurry vision due to the build up of protein
in the cornea while in the healing process. In patients with Avellino
corneal dystrophy, a particular protein that is a normal part of the
healing process behaves differently than in patients who don’t have
this condition. In patients who don’t have this genetic condition, the
particular protein appears on the cornea early in the healing process
and then disappears completely after it has performed its natural
function. However, in patients with ACD, the protein continuously
accumulates, and the resulting opacity on the cornea can cause a
decrease in the quality a vision. In severe cases, a significant loss of vision may occur. This condition usually
develops slowly but can vary by person, according to a patient’s age, lifestyle and environmental exposures.
Avellino Lab USA has developed the first and only commercially available testing system, the Avellino DNA
Dual Test for LASIK Safety, for granular corneal dystrophy type 1 (GCD1) and granular corneal dystrophy
type 2 (GCD2), also known as Avellino corneal dystrophy (ACD). The company’s proprietary genetic di-
agnostics system provides fast, safe and affordable evaluations of an individual’s genetic predisposition to
having the GCD1 and / or GCD2 gene mutation. With the Avellino DNA Dual Test, Avellino Lab USA is
able to positively identify, with high accuracy, a patient’s GCD status. Based on the test’s results, patients
and their physician can make an informed decision when considering vision correction surgery.
BEST COURSE OF ACTION
Dr. Perl decided the best course of action would be stromal flap amputation. This surgery was conducted using the
iFS Laser, with 190u of tissue being removed. The dissected tissue was sent to Avellino Lab USA. After testing, the
patient tested positive for Avellino Corneal Dystrophy. After treatment the patient has BCVA of 20/40, a major
improvement over 20/400 BCVA when the patient first arrived at Corneal Associates. More importantly, the patient
knows exactly why they weren’t seeing well and is 20/happy.
Our own Dr. Perl of Corneal Associates,
presented at the AECOS conference
in Aspen Colorado in March. The
purpose of his presentation was to
educate other doctors on post LASIK
complications, using a first hand
example to demonstrate his point.
A few weeks before the meeting, a
patient with an extremely rare eye
condition came to Corneal Associates
of New Jersey to see Dr. Perl.
American-European Congress of Ophthalmic Surgery®

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