Distinct management of peripheral hypertrophic subepithelial corneal degeneration

We report an atypical case of peripheral hypertrophic subepithelial corneal degeneration (PHSCD) managed with superficial keratectomy after 8 years of conservative treatment failure. A 34-year-old female presented with chronic bilateral foreign-body sensation, photophobia, and peripheral corneal opacities. The lesion was not extending to the visual axis or affecting visual acuity, unlike all the described cases in the literature. Initial management included lubricating drops and topical anti-inflammatory therapy, which failed to alleviate symptoms or stabilize the lesions. Slit-lamp and optical coherence tomography imaging revealed bilateral inferior peripheral subepithelial fibrosis without neovascularization. Superficial keratectomy was performed on the right eye to address her concerns about appearance and symptom persistence. Histopathology confirmed the diagnosis of PHSCD. Postoperative examination showed significant improvement in corneal appearance, peripheral thickness, and symptom relief with no recurrence at 2 months. The patient was scheduled for similar surgical management for the other eye. PHSCD is a rare, underreported corneal degeneration that may present with persistent symptoms unresponsive to medical management. Superficial keratectomy is an effective surgical option to restore corneal clarity and alleviate symptoms in advanced case. Further studies are needed to explore the disease's etiology, risk factors, and long-term surgical outcomes.