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.