Management of myopic shift and central corneal steepening resulting from superficial corneal opacity in a patient with previous radial keratotomy: a case report

PurposeThe purpose of this study was to report a patient who developed myopic shift and anterior corneal steepening many years following radial keratotomy (RK). The etiology of this myopic shift resulted from central corneal opacity and was successfully managed with supra-stromal keratectomy.Case presentationA 59-year-old woman with a history of radial keratotomy and cataract surgery presented with blurred vision and ocular irritation in both eyes for years. Poor visual acuity and myopic change to -7.0 D were noted upon initial evaluation. Further ophthalmic examination revealed central corneal opacity occupying the optical axis with steepening of the anterior corneal surface. Anterior segment optical coherence tomography (ASOCT) revealed superficial corneal opacity with minimal stromal scarring. The opacity was successfully removed via supra-stromal keratectomy. After surgery, the patient's visual acuity improved, and refraction returned to nearly plano. Postoperative corneal topography revealed flattening of the central cornea in both eyes.ConclusionLate-onset central corneal steepening with myopic shift following RK may be a sign of corneal ectasia disorders such as keratoconus. It is important to recognize corneal opacity as a distinct etiology of central corneal steepening, which may mimic corneal ectasia. A comprehensive evaluation of patients with corneal topography and ASOCT may reveal the etiology of central corneal steepening and further guide treatment decisions.