Bilateral Lipid Keratopathy Treated with Staged Penetrating Keratoplasty: Restoration of Corneal Transparency and Visual Function.

Lipid keratopathy is an uncommon corneal disorder characterized by stromal lipid deposition that may cause progressive corneal opacity and visual impairment. We report a case of advanced bilateral lipid keratopathy with severe visual-axis involvement. At presentation, best-corrected visual acuity (BCVA) was counting fingers in the right eye and 0.1 Snellen (1.0 logMAR) in the left eye. Slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) demonstrated dense stromal lipid deposits involving the visual axis in both eyes. The patient underwent staged bilateral penetrating keratoplasty, with procedures performed three months apart. Postoperatively, corneal transparency improved in both eyes. At 6 months, BCVA was 0.5 Snellen (0.3 logMAR) in the right eye and 0.7 Snellen (0.15 logMAR) in the left eye. Residual visual limitation was attributed mainly to coexisting cataract, and sequential cataract surgery was planned. Together, the clinical photographs and AS-OCT scans illustrate an uncommon presentation of visually disabling bilateral lipid keratopathy, characterized by dense central stromal lipid deposition involving both visual axes and profound preoperative visual loss. The case is clinically noteworthy because it combines severe bilateral disease, close clinical-tomographic correlation, and sequential penetrating keratoplasty performed as a staged visual rehabilitation strategy, resulting in restoration of graft clarity and meaningful visual improvement during postoperative follow-up.