Epithelial Hyperplasia As A Cause Of Irregular Astigmatism: Successful Treatment By Mechanical Removal Of The Epithelium Only

To present a case of irregular astigmatism induced by a focal epithelial hyperplasia which was successfully treated by mechanical removal of the epithelium only.

Victoria de Rojas Instituto Oftalmológico

A 29-year-old woman underwent ICL implantation to correct myopia in both eyes. Three months after surgery UCDVA was 20/20 in the RE and 20/25 in the LE (CDVA 20/20 (-0.75x160)). Topography showed a symmetric bow tie pattern. Sixteen months later, she complained of decreased visual acuity in the left eye. UCDVA was 20/32 in the left eye and CDVA 20/25 (+1.00 -2.25x170). Scheimpflug corneal tomography was normal in the right eye but revealed a nasal steepening in the left eye. AS-OCT epithelial mapping showed a localized thickening in the left eye that matched with the area of steepest curvature. Slit lamp showed a clear cornea with no signs of abnormality. The patient denied any history of ocular trauma, contact lens wearing, systemic disease or medications. She referred rubbing her eyes very rarely. The patient was instructed to completely avoid eye rubbing and artificial tears were prescribed but irregular astigmatism epithelial hyperplasia persisted after two months. Mechanical removal of the corneal epithelium after application of diluted alcohol was performed. Bowman layer´s topography was analyzed immediately after epithelial delamination and showed a symmetriyc bow tie pattern, which confirmed that the focal epithelial hyperplasia was the cause of the irregular astigmatism. Topography of the epithelized cornea showed a regular bow tie pattern and UCDVA improved to 20/20. No recurrence of the irregular astigmatism or hyperplasia was detected after six months.

Focal epithelial hyperplasia may induce irregular astigmatism. Epithelial mapping is very useful to assess cases with irregular topography. Mechanical removal of the epithelium only may be useful to manage these cases successfully. Further investigations are required to fully understand the mechanism that may trigger the development of a focal area of epithelial hyperplasia in an otherwise normal eye.