[Excimer laser-assisted penetrating keratoplasty for stromal scarring after epikeratoplasty]

Epikeratoplasty was previously used as a treatment option for correcting high myopia and keratoconus; however, structural complications, including interface scarring, surface irregularities and corneal ectasia, are not uncommon during follow-up.

A 55-year-old male patient presented with decreased visual acuity in the right eye. He had undergone an epikeratoplasty in South Korea 34 years earlier to improve visual acuity due to high myopia. As the postoperative visual acuity remained inadequate, an additional photorefractive keratectomy (PRK) was performed at a later stage. In terms of surface irregularity, anterior stromal scarring, increased central corneal thickening to 708 μm, and contact lens intolerance as well as corticonuclear cataract, a penetrating excimer laser keratoplasty with simultaneous cataract surgery (triple-PKP) was recommended; however, the patient initially opted to have the epikeratoplasty lenticule removed first at an external clinic. Upon re-examination a significant thinning of the corneal stroma was noted. Therefore, the previously recommended triple-PKP procedure was performed on the right eye. Postoperatively, a substantial improvement in visual acuity, from 0.05 to 0.4, was already evident at the 6‑month visit.

Lenticule removal can be associated with a variety of complications. In this case, a triple-PKP procedure was considered the most appropriate treatment option to restore anatomical stability and achieve visual rehabilitation without delay.