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Management of epithelial hyperplasia after photorefractive keratectomy on a cornea with intrastromal corneal ring segments
  1. Jose L Güell1,2,
  2. Merce Morral1,3,
  3. Oscar Gris1,
  4. Felicidad Manero1
  1. 1Instituto de Microcirugia Ocular (IMO), Barcelona, Spain
  2. 2Universitat Autonoma de Barcelona, Barcelona, Spain
  3. 3Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic i Provincial de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Jose Luis Güell, Instituto de Microcirugia Ocular (IMO), c/Josep María Lladó no 3, 08022 Barcelona, Spain; guell{at}imo.es

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Intracorneal ring segments (ICRS) have been implanted to treat mild to moderate keratoconus (KC) to correct myopia, and improve topographic abnormalities by recentring of the corneal optical zone.1 Residual refractive errors may subsequently be corrected with contact lenses (CLs) or by implanting a phakic intraocular lens (PIOL).2 Some authors have proposed photorefractive keratectomy (PRK) with mitomycin C (MMC).3 However, the risk of unpredictable refractive results caused by the intense stromal–epithelial interaction that has been observed after surface ablations following lamellar surgery raises concern over this approach (personal communication; Intacs and Intracorneal Lenses. Refractive Surgery Subspeciality Day, AAO 2002).

We present a case of reactive epithelial hyperplasia after PRK in a patient with KC who had previously been implanted with ICRS. The epithelial hyperplasia had induced high hyperopic astigmatism and was successfully managed with mechanical epithelial debridement, MMC and amniotic membrane (AM).

A 27-year-old woman with KC and CL intolerance underwent two 450 μm ICRS (Intacs, KeraVision, Fremont, California) implantation in the right eye. Preoperative best-spectacle corrected visual acuity (BSCVA) was 20/25 with −3.00 −2.75 × 110°, and topography revealed grade II KC, according to the Krumeich classification.4 …

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