Abstract
Abstract: :
Purpose: To document for the first time induction of significant hyperopic refractive shift secondary to peripheral superficial corneal scarring from phlyctenular keratoconjunctivitis. Methods: Observational case report Results: A 70 year old caucasian female presented with 360 degrees of extensive peripheral superficial corneal scarring OU secondary to quiescent phlyctenular keratoconjunctivitis. A refraction of +7.50–1.75 x 080 OD and +10.75–3.25 x 096 OS yielded a BCVA of 20/40 OD and 20/60 OS. Corneal topography (Zeiss Humphrey Systems Atlas A11.1) revealed unobtainable keratometric readings OD, 37.50 at 38/31.75 at 48 OS, and corneal irregularity measurements (CIM) of 17.54 OD and 9.97 OS. One month following lamellar excision of the peripheral pannus OU (peeled in virtually one piece using jeweler forceps), the refraction was +3.25–1.75 x 115 OD and +2.75–0.75 x 105 OS. Repeat topography revealed final keratometric readings of 41.62 at 14/40.75 at 104 OD and 40.75 at 32/39.75 at 122 OS, with dramatically improved CIMs of 2.18 OD and 2.41 OS. Final BCVA was 20/25 OU. Conclusions: Phlyctenular keratoconjunctivitis related peripheral corneal scarring is capable of inducing a significant hyperopic refractive shift, which averaged 4.375 spherical equivalent diopters in this case. Such a potential shift should be taken into account when assessing visual complaints in patients with phlyctenular–related peripheral corneal scarring, and particularly when contemplating cataract or refractive surgery in such patients. Based on the observed topographic changes, the mechanism of shift observed in this case would appear to be compressive central corneal flattening from the constricting peripheral scar tissue.
Keywords: cornea: clinical science • refractive error development • keratitis