The Role Of The Corneal Epithelium In Irregular Astigmatism: A Case Report

To demonstrate the impact of epithelial changes on corneal refractive power and propose a simple, effective approach to managing irregular astigmatism to optimize surgical outcomes. 

This case was discovered incidentally during a preparatory cataract study conducted by the Anterior Segment and Cornea Section of the Ophthalmology Department at the University Hospital of León.

A 73-year-old male with no relevant medical history presented for preoperative evaluation prior to cataract surgery. Corrected visual acuity in the right eye was 0.3, with intraocular pressure within normal limits. Biometry and autorefraction revealed 4 diopters of with-the-rule astigmatism. Slit-lamp examination identified a superior hemicorneal subepithelial lesion with a map-like pattern, suggestive of epithelial overgrowth. Anterior segment optical coherence tomography (AS-OCT) confirmed localized epithelial thickening corresponding to the lesion, as well as irregular astigmatism characterized by asymmetry between the superior and inferior hemimeridians.

A decision was made to perform epithelial debridement to normalize the corneal surface, and cataract surgery was postponed. At one-month follow-up, complete epithelial healing was observed, with resolution of the lesion. Repeat biometry and tomography demonstrated a reduction in corneal astigmatism to less than 1 diopter and regularization of the epithelial profile. The patient achieved a posterior better visual acuity despite the cataract still being present.

This case highlights the significant role of the corneal epithelium in refractive outcomes and underscores the need to consider epithelial contributions when assessing irregular astigmatism. Furthermore, epithelial debridement represents a straightforward and effective intervention to improve corneal regularity, thereby enhancing the predictability of refractive outcomes in cataract surgery.