Recurrent gelatinous Salzmann-like nodular lesion with prior history of astigmatic keratotomy: September consultation #1.

A 67-year-old woman was referred to our facility with declining vision in the right eye that has been present since her cataract surgery in 2016. The patient has a history of an 8-cut radial keratotomy (RK) with 2-cut astigmatic keratotomy (AK) along the vertical meridian in both eyes since 1993. She underwent superficial keratectomy of the right eye 3 times in 3 consecutive years after her cataract extraction with toric intraocular lens (IOL) implantation. She is hoping to improve her vision in the right eye with a corrected distance visual acuity (CDVA) of 20/50 with a manifest refraction of +2.00 -5.50 × 65. Keratometry readings are 39.4 @ 87/43.3 @ 177. Slitlamp examination shows a persistent raised white gelatinous tissue overlying the inferior AK at the 6 o'clock position (, , and ). The patient had attempted several failed trials of scleral lens and rigid gas-permeable (RGP) lens-fitting after each corneal scraping with intolerance and lack of improvement in her vision. Her left eye is an asymptomatic pseudophakic eye with uncorrected distance visual acuity (UDVA) and CDVA of 20/25.(Figure is included in full-text article.)(Figure is included in full-text article.)(Figure is included in full-text article.)What would be your next step? Would you request additional diagnostic workup? What medical and surgical interventions would you recommend?