Abstract
A patient presents to clinic complaining of decreased vision in left eye for the past 5 years with no associated pain or tearing. On examination, BCVA was found to be 20/20 OD and 20/100 OS. Slit-lamp examination demonstrated a gray, whorled opacity with densely crowded clear intraepithelial microcysts with no associated epithelial defect. The opacity appeared to be continuous from a small patch of limbal cells. Anterior segment optical computerized tomography demonstrated epithelial hyperreflectivity with trapezoidal edges. A diagnosis of Lisch Epithelial Corneal Dystrophy (LECD) was made. LECD has a characteristic band-shaped, feathery opacity that can be visually significant if affecting visual axis. On histopathology, there is evidence of enlarged corneal epithelial cells with foam-filled cytoplasm. The treatment usually consists of superficial keratectomy, however, there is high recurrence rate. Adjuvant therapies including Mitomycin C, cryotherapy and cautery, as well as limbal excision have been used in conjunction to superficial keratectomy to avoid recurrence. We explored the possibility of medical treatment using 5-fluouracil (5-FU) to treat this condition. With only two cycles of 5-FU (1 week on, 3 weeks off), the opacity had dramatically decreased in size and vision had improved to 20/30. This demonstrates 5-FU should be considered as a potential noninvasive treatment approach in LECD.
Presentation Date: 03/12/2026
Issue Date: 03/27/2026
