Visual, refractive, and tomographic outcomes after mitomycin-free manual superficial keratectomy for Salzmann nodular degeneration and peripheral hypertrophic subepithelial corneal degeneration: a retrospective cohort study.

PURPOSE: To evaluate visual, refractive, keratometric, aberrometric, and densitometric outcomes after manual superficial keratectomy (MSK) without adjuvant mitomycin C (MMC) for Salzmann nodular degeneration (SND) and peripheral hypertrophic subepithelial corneal degeneration (PHSCD).

METHODS

Retrospective cohort study of patients treated with MSK without adjuvant MMC at Ghent University Hospital. Outcomes included best-corrected visual acuity (BCVA), refraction, and Scheimpflug-based tomography, aberrometry, and densitometry (Pentacam HR). Recurrence and complications were recorded throughout follow-up.

RESULTS

Pre- and postoperative outcomes were compared in 56 eyes of 38 patients (50 SND, 6 PHSCD) over a median follow-up of 4.6 (mean 13.8) months (maximum 6.4 years). BCVA improved from 0.20 to 0.08 logMAR, spherical equivalent from + 1.51 to - 0.85 D, refractive cylinder from - 4.56 to - 1.24 D, and corneal astigmatism from 4.31 to 1.40 D (all P < 0.001). K1 increased from 38.92 to 42.26 D (P < 0.001), with a smaller increase in K2 (43.25 to 43.67 D; P = 0.009). Higher-order root-mean-square aberrations decreased from 2.79 to 1.12 µm (P < 0.001) and total root-mean-square aberrations from 7.30 to 3.27 µm (P < 0.001). Corneal densitometry did not change significantly in any prespecified zone. Nodular recurrence occurred in one eye (1.8%); secondary pterygia developed in 4 eyes (7.1%); no intraoperative complications occurred.

CONCLUSIONS

In this retrospective cohort of eyes with SND or PHSCD, MSK without adjuvant MMC was associated with significant visual, refractive, keratometric, and aberrometric improvement. We consider this approach an effective first-line surgical option in symptomatic or visually significant SND and PHSCD.