Reduction of hyperopia associated with manual excision of Salzmann's nodular degeneration

PURPOSE: Removing central corneal pathology often leads to a hyperopic shif t secondary to corneal flattening. A myopic shift, or reduction in hyperopi a, would be expected after removal of peripheral corneal pathology with cen tral corneal steepening. This case illustrates the refractive changes induc ed by Salzmann's nodular degeneration and the myopic shift associated with their excision, METHODS: A 53-year-oId female presented with a slowly progressive increase in hyperopia. Vision in the right eye was 20/40 with a refraction of +10.00 -4.00 x 90 degrees. Vision in the left eye was 20/30 with a refraction of +5.75 -2.00 x 105 degrees. Both corneas exhibited nodular subepithelial opa cities in the mid-periphery. A superficial keratectomy was performed on eac h eye, 1 year apart. RESULTS: Twelve days postoperatively, uncorrected visual acuity in the righ t eye was 20/25, and 20/20 with a refraction of -0.75 -0.50 x 31 degrees, 6 months later, Six days postoperatively, uncorrected visual acuity in the l eft eye was 20/40, and 20/30 with a refraction of -1.25 D, 1 month later. CONCLUSION: Superficial keratectomy provides a means of restoring the origi nal corneal contour, especially when the pathology is easily dissected from Bowman's layer, The surgeon should investigate the refractive status prior to the development of the nodules and be aware of the possible refractive change upon removal of the pathology.