Late recurrence of corneal dystrophy treated with phototherapeutic keratectomy combined with epikeratophakia using double lenticules

Phototherapeutic keratectomy (PTK) combined with epikeratophakia (EP) using double lenticules through small-incision lenticule extraction (SMILE) after late recurrence was used in a patient with Reis-Bückler corneal dystrophy (RBCD) who underwent bilateral PTK 9.5 years previously. Opacity recurred at 4 years, with PTK + EP being performed using SMILE-derived lenticules, and at 5.5 years with an uncorrected visual acuity of 20/100 and disrupted counting fingers in the right and left eyes. PTK + EP in the right eye and PTK on the original lenticule in the left eye were performed. Manifest refraction was −4.25/−2.5 × 155 with a corrected distance visual acuity (CDVA) of 20/20 and −3.50/−0.75 × 140 with a CDVA of 20/20 in the right and left eyes, respectively, 2 months postoperatively. Lenticules remained transparent and well-attached to the corneal stroma, and the corneal epithelium reshaped successfully. The feasibility of repeated PTK + EP in patients with multiple RBCD recurrences was demonstrated, delaying the need for corneal transplantation.