Addition by Subtraction: Reversing Epikeratophakia and Stromal Scarring in a Patient With Myopia Magna.

PURPOSE: To describe a three-phase surgical approach for managing progressive visual decline in a patient with myopia magna and a history of epikeratophakia.

METHODS

A 55-year-old woman with previous epikeratophakia surgery in both eyes experienced progressive visual deterioration. The three-phase approach included: (1) removal of the epikeratophakia lenticule, (2) cataract extraction with intraocular lens implantation, and (3) transepithelial topography-guided photorefractive keratectomy (trans-PRK). Preoperative and postoperative refraction, corneal topography, and visual acuity were assessed.

RESULTS

After trans-PRK, the right eye exhibited regularization of the corneal surface, with a final best spectacle-corrected acuity of 0.15 logMAR. A similar two-phase approach without lenticule removal was applied to the left eye, resulting in improved visual outcomes.

CONCLUSIONS

A three-phase surgical approach combining lenticule removal, cataract surgery, and topography-guided PRK offers a potential pathway for visual improvement in patients with phakic postepikeratophakia.