Scarring of a recipient cornea following epikeratoplasty

A recipient cornea gradually developed wrinkling and opacification in Bowman's layer following an uneventful myopic epikeratoplasty. The process continued after removal of the lenticule, and the best corrected visual acuity decreased from 20/20 to 20/60. Glare, especially at night, severely compromised the vision in this eye. Six months after removal of the lenticule, a homoplastic myopic keratomileusis was performed to remove the corneal opacity and correct the residual myopia. Morphologic analysis of the patient's excised cornea demonstrated wrinkles and folds in Bowman's layer. To our knowledge, this is the first reported case of scarring of a patient's own cornea after epikeratoplasty and of treatment of a failed epikeratoplasty with homoplastic myopic keratomileusis.