BACKGROUND: Macular corneal dystrophy is a rare inherited disease of the cornea leading to deposits mainly in the stroma. Affected patients suffer from progressive loss of visual acuity which should be treated with penetrating keratoplasty. This is the first case report describing the clinical and histopathological findings of corneal tissue after failed phototherapeutic keratectomy (PTK) in a patient with macular corneal dystrophy.
METHODS: A 32-year-old man presented with visual impairment, blurred vision and increasing glare sensitivity in both eyes in 2014. All symptoms had existed for several years and had recently increased sharply. A corneal dystrophy was diagnosed and penetrating keratoplasty was recommended but the patient was hesitant to undergo surgery. In 2018, in contrast to current guidelines, a PTK was performed in both eyes in Turkey for unknown reasons. In May 2019, he presented again in our clinic. Best corrected visual acuity was markedly reduced in both eyes. Slit-lamp examination revealed multiple dense, poorly circumscribed grey-white patchy changes in the stroma accompanied by corneal opacity in both eyes. In February 2020, the patient decided to have penetrating keratoplasty performed at the University Eye Hospital in Tübingen. The explanted cornea was stained for acid mucopolysaccharides (AMP) and periodic acid-Schiff staining (PAS). The histopathological examination revealed destruction of Bowman\'s layer and a subepithelial fibrosis band due to the PTK previously performed. The AMP staining demonstrated blue deposits typical of macular corneal dystrophy, mainly in the stroma but also in the endothelium. Interestingly, the acidic mucopolysaccharides were found increased in the PTK-induced subepithelial fibrosis band. The postoperative course after keratoplasty was favourable with a significant increase in visual acuity and a clear graft.
CONCLUSIONS: This report presents the first case of a histologically evident exacerbation of macular corneal dystrophy after PTK and emphasizes the relevance of thorough pre-interventional diagnosis and patient selection to consider other therapeutic approaches, such as penetrating keratoplasty.

OBJECTIVE: To describe a new technique for management of recalcitrant deep stromal keratitis using posterior lamellar keratectomy.
METHODS: A 66-year-old pseudophakic male presented with deep stromal corneal infiltrates, extending from 2 to 4 o\'clock in the vicinity of the limbus of the left eye, 3 months after phacoemulsification. The infiltrates failed to respond to empirical topical medications, anterior chamber wash and intrastromal injection. Posterior lamellar keratectomy was done to debulk the infectious load. In this technique the diseased posterior lamella was excised through a sclerocorneal lamellar pocket without a donor graft.
RESULTS: The infection subsided within 2 weeks after posterior lamellar keratectomy. Patient achieved best corrected visual acuity (BCVA) of 20/60 with complete resolution of symptoms at 2 weeks follow up. Till the last follow-up at 6 months, the patient maintained BCVA of 20/60 with no sign of recurrence or corneal decompensation at the keratectomy site.
CONCLUSIONS: Posterior lamellar keratectomy is a simple, effective and inexpensive technique for management of small, peripheral, deep-seated recalcitrant keratitis. It leads to radical treatment of the disease like therapeutic penetrating keratoplasty but in a less invasive manner and without a donor graft.

A 7-month-old intact female Persian cat was diagnosed with symblepharon accompanied by epiphora, brownish ocular discharge, and ocular discomfort in the left eye. Superficial keratectomy (SK) was performed to remove adhesions between the conjunctiva and cornea. To prevent re-adhesion after SK, the detached conjunctival tissue was sutured to the corneal limbus, and a soft contact lens (SCL) was inserted and a partial temporary tarsorrhaphy was performed. The SCL and tarsorrhaphy sutures were maintained for 22 days, and symblepharon did not recur 347 days postoperatively. SK combined with SCL is a relatively easy and cost-effective surgical option for feline symblepharon.

This is the first report of a primary corneal fibrosarcoma in a canine. A 4-year-old male dog, Blue Heeler, owas examined because of a reddish nodular mass in the right eye. A complete ophthalmic exam was conducted, including slit-lamp biomicroscopy, applanation tonometry, fundoscopy, ocular and abdominal ultrasound, hemogram, serum biochemistry profile, and a thoracic X-ray. After the ophthalmic evaluation of the right eye, conjunctival hyperemia and the presence of a .5 cm diameter mass was found in the cornea. The diagnosis of fibrosarcoma was confirmed by histopathological analysis. The keratectomy showed satisfactory results in the removal of the corneal fibrosarcoma. The patient was followed up on for 18 months after the surgical procedure, and there were not any signs of local recurrence or metastasis.

BACKGROUND: Corneal ectasia after small-incision lenticule extraction (SMILE) is uncommon. To our knowledge, this is the first report of 3-year results of combined phototherapeutic keratectomy (PTK) and corneal collagen cross-linking (CXL) for corneal ectasia after SMILE.
METHODS: Herein, we describe a case of prominent corneal ectasia after SMILE treated with PTK combined with CXL 3 years ago. After surgery, maximum corneal keratometry, mean corneal keratometry, spherical equivalent and uncorrected distance visual acuity were significantly improved at follow-up intervals.
CONCLUSIONS: Transepithelial PTK combined with CXL for corneal ectasia after SMILE may be an effective and safe treatment in the long term.

To compare the postoperative clinical outcomes of single-step transepithelial photorefractive keratectomy (PRK) and femtosecond-assisted laser in situ keratomileusis (LASIK).
Bergman Clinics, Utrecht, the Netherlands.
Retrospective case series.
The eyes of consecutive patients who had transepithelial PRK were retrospectively compared with the same number of case-matched eyes (based on the preoperative refractive components) treated with femtosecond-assisted LASIK. The clinical outcomes evaluated were predictability, refractive outcomes, and visual acuity. The Student t test and chi-square test were used for statistical analysis.
The study compared 98 patients (196 eyes) who had transepithelial PRK with the outcomes in 196 case-matched eyes that had femtosecond-assisted LASIK. All patients completed the 1-year follow-up. At 1 year, 130 eyes (66%) in the transepithelial PRK group and 91 eyes (46%) in the femtosecond-assisted LASIK group achieved an uncorrected distance visual acuity of -0.1 logMAR or better (P < .005), 4 eyes (2%) in the transepithelial PRK and 2 eyes (1%) in the femtosecond-assisted LASIK group lost 2 lines of corrected distance visual acuity (P = .04), and 163 eyes (83%) in the transepithelial PRK and 167 eyes (85%) in the femtosecond-assisted LASIK group were within ±0.50 diopter (D) of emmetropia. The postoperative mean spherical equivalent was +0.11 D ± 0.56 (SD) for transepithelial PRK and -0.09 ± 0.46 D for femtosecond-assisted LASIK (P < .0001).
Transepithelial PRK outcomes 1 year postoperatively were equivalent to those of femtosecond-assisted LASIK. Transepithelial PRK was efficacious and safe; however, the procedure had a longer recovery time than the femtosecond-assisted LASIK.
Mr. Ewering and Dr. Arba-Mosquera are employees of Schwind eye-tech-solutions GmbH and Co. KG. Dr. Luger has no financial or proprietary interest in any material or method mentioned.