Partial incision blunt scissors lamellar keratectomy under topical anesthesia for the treatment of presumed calcific corneal degeneration in dogs.

OBJECTIVE: The aim of the study was to investigate clinical features of lamellar keratectomy for presumed calcific corneal degeneration in a population of geriatric dogs using blunt scissors dissection under topical anesthesia. ANIMALS STUDIED AND PROCEDURES: Retrospective analysis of dogs with clinically diagnosed calcific degeneration treated by keratectomy under topical anesthesia between 2015 and 2021 at two veterinary ophthalmology practices was performed. Descriptive data regarding signalment, concurrent systemic and ocular disease, complications, healing time, and recurrence were collected. Kaplan-Meier survival analysis was performed to calculate 1-year recurrence probability. RESULTS: Sixty-five eyes in 57 dogs met inclusion criteria. All 54 eyes with follow-up healed within a median of 14 days (7-74), including 17 with complicating factors of infection or deep stromal ulceration. Globe rupture occurred intraoperatively in three eyes (4.6%), for which subsequent conjunctival graft was performed. Calculated 1-year recurrence probability from 47 eyes followed long term was 25%. Multivariate Cox proportional hazard modeling showed a significant association between documented systemic disease and time to recurrence (p = .035), irrespective of topical EDTA use (p = .432). Median follow-up time available for all cases was 249 days. CONCLUSIONS: Blunt lamellar dissection with corneal scissors can be performed in dogs under topical anesthesia, yielding healing times and recurrence comparable to previously reported treatments for calcific corneal degeneration. Globe rupture is an inherent risk of both the disease and procedure and occurred in 4.6% of treated eyes. This approach expands non-anesthetic treatment options for affected patients but should only be performed with advanced microsurgical training and client counseling on individual risk and benefit.

Superficial keratectomy for the treatment of spontaneous chronic corneal epithelial defects in dogs.

OBJECTIVE: To report the outcome of superficial keratectomy with bandage contact lens placement for the treatment of spontaneous chronic corneal epithelial defects (SCCEDs) in dogs. METHODS: Patients that underwent a superficial keratectomy with bandage lens placement for the treatment of one or more SCCEDs were retrospectively included in the study. Signalment, eye(s) affected, prior medical therapy and any procedures performed, post-operative medical therapy, healing rate, and any post-operative complications were recorded. Superficial keratectomy was performed to approximately one-fifth of corneal depth under operating microscope guidance and a bandage lens was placed immediately post-operatively. Corneas were considered healed when the fluorescein stain was negative. RESULTS: One hundred and seven dogs met the inclusion criteria with 121 SCCEDs. The mean age of patients was 8.34 ± 2.89 years (1-15). Ninety-nine percent (120/121) of SCCEDS healed with no additional treatment within 21 days of surgery. One eye had a diamond burr debridement performed on Day 14 post-operatively and healed 2 weeks following the additional procedure. No post-operative complications were noted. CONCLUSIONS: This study found superficial keratectomy with bandage lens placement to be an effective treatment for SCCEDs.

Diffuse lamellar keratitis as a rare complication of diamond burr superficial keratectomy for recurrent corneal erosion: a case report.

BACKGROUND: To present a case with a history of laser in situ keratomileusis (LASIK) developing diffuse lamellar keratitis (DLK) after diamond burr superficial keratectomy (DBSK) for recurrent corneal erosion (RCE). CASE PRESENTATION: A 25-year-old man presented with multiple episodes of RCE one year after femtosecond-assisted LASIK for myopia correction. Because conservative treatments failed to halt the repetitive attack of RCE, he underwent epithelial debridement and DBSK. However, severe foreign body sensation and blurred vision developed on postoperative day one. The next day, slit lamp biomicroscopy revealed DLK manifested as diffuse granular infiltrates at the flap interface. After topical corticosteroid treatment, the inflammation resolved gradually, and his vision recovered to 20/20. CONCLUSIONS: Diffuse lamellar keratitis is a rare post-LASIK complication that can be triggered by DBSK, which causes impairment of the corneal epithelial integrity and subsequent inflammation at the flap interface. For post-LASIK patients with RCE, alternative treatments, such as anterior stromal puncture, may be considered to avoid extensive disruption of corneal epithelium and DLK development depending on the size and the location of the lesions.

Superficial keratectomy as a treatment for non-healing corneal ulceration associated with primary corneal endothelial degeneration.

OBJECTIVE: To analyze a study population of dogs with primary corneal endothelial degeneration (PCED) for information on the patterns of disease and to report the efficacy of superficial keratectomy (SK) for resolution of non-healing corneal ulcers associated with PCED. ANIMALS STUDIED: Primary corneal endothelial degeneration was diagnosed in 238 dogs between 1998 and 2017. Corneal ulceration associated with PCED was present in 89 dogs (109 eyes), of which 47 eyes were treated with SK. PROCEDURES: A retrospective assessment of medical records was performed to determine the signalment patterns of PCED, and the success rate of the SK procedure for resolving PCED-associated corneal ulceration. Descriptive statistics were reported on the signalment of PCED cases, with odd ratios and confidence intervals calculated to detect breed predispositions. RESULTS: Primary corneal endothelial degeneration was diagnosed in 238 dogs, 40.8% were female and 59.2% were male, with a mean age at diagnosis of 11.4 years. Dachshunds, Dalmatians, English Springer Spaniels, Welsh Springer Spaniels, Chihuahuas, Cocker Spaniels, and Golden Retrievers were significantly over-represented. All PCED-affected Dalmatians developed associated corneal ulceration. Follow-up information was available for 41/47 eyes treated with SK. At the first reassessment, 87.8% were healed which increased to 97.6% with subsequent monitoring. Four eyes (9.8%) had late corneal ulcer occurrence following SK, at a median time following SK of 182 weeks post-surgery. CONCLUSIONS: Superficial keratectomy was an effective option for resolving painful non-healing corneal ulcers associated with PCED. Dalmatians may be at increased risk of developing PCED-associated corneal ulceration.

Corneal collagen cross-linking following superficial keratectomy as treatment for corneal endothelial cell dystrophy in dogs: Preliminary clinical study.

OBJECTIVE: To describe the outcome of corneal collagen cross-linking (CXL) combined with superficial keratectomy (SK) as treatment for corneal edema due to corneal endothelial dystrophy (CED) in dogs. ANIMALS STUDIED: Four eyes of four dogs (3 Shih Tzus and 1 English Cocker Spaniel) with corneal edema due to CED were treated with SK and CXL. Two were males, and two were females. PROCEDURE: Depending on corneal thickness, 500-700 µm of edematous cornea was removed by SK. Next, CXL was performed by irradiating the cornea with UVA (365 nm) at 3 mW/cm² irradiance for 30 min after soaking with 0.1% riboflavin in 20% dextran every three minutes for 30 minutes. One drop of riboflavin was instilled every three minutes during irradiation. Slit lamp biomicroscopy and optical coherence tomography were used to examine the cornea during the follow-up period. RESULTS: The corneas had focal to diffuse edema, and the average corneal thickness was 1553 (1282-1900) µm. All corneas showed a significantly reduced corneal thickness and regained marked transparency immediately after treatment; however, the opacity increased as the corneal thickness increased during the follow-up period. Corneal vascularization (n = 4) disappeared within a month. Corneal pigmentation (n = 1) and bullae (n = 1) were observed. All cases showed marked reduction in corneal thickness; however, transparency was improved in only one case. CONCLUSION: Collagen cross-linking with SK has the potential to reduce the corneal thickness in CED cases; however, a lasting clinically significant improvement of corneal transparency seems unlikely. As the added benefit of CXL to the SK procedure is unclear based on the results of this study, combined treatment of CXL and SK for the treatment of corneal edema caused by CED is currently not recommended in dogs.

Corneal edema in four horses treated with a superficial keratectomy and Gundersen inlay flap.

OBJECTIVE: To describe the clinical presentation, treatment, and outcome of four horses with severe corneal edema caused by suspected endothelial disease treated with a superficial keratectomy and Gundersen inlay flap and to determine whether this procedure (i) reduces corneal edema, (ii) reduces ocular pain, (iii) eliminates recurrent corneal ulceration, and (iv) improves vision in these horses. ANIMALS STUDIED: Four horses met inclusion criterion of (i) diagnosis with endothelial disease by a board-certified veterinary ophthalmologist and (ii) surgical treatment with a superficial keratectomy and Gundersen inlay flap. PROCEDURE: Retrospective medical record review of included horses was used to determine breed, age and sex of included horses, as well as details of medical and surgical therapy, and visual outcome. RESULTS: Four horses were presented with a complaint of focal corneal edema that progressed to diffuse corneal edema. Epithelial bullae and ulceration were present in all cases. The disease process was unresponsive to standard medical treatment with a hyperosmotic agent and topical and systemic anti-inflammatories. However, treatment with a superficial keratectomy and Gundersen inlay flap performed under general anesthesia was associated with (i) a significant decrease in corneal edema, (ii) increased comfort, (iii) elimination of corneal ulceration, and (iv) retention of vision postoperatively with little to no need for medical therapy. Follow-up time was 15, 12, 6, and 3 months. CONCLUSIONS: The superficial keratectomy and Gundersen inlay flap may provide a surgical alternative to chronic medical treatment of severe corneal edema in horses.

Immediate effects of diamond burr debridement in patients with spontaneous chronic corneal epithelial defects, light and electron microscopic evaluation.

PURPOSE: To evaluate immediate effects of diamond burr debridement (DBD) on the cornea of canine patients diagnosed with spontaneous chronic corneal epithelial defects (SCCEDs). ANIMALS STUDIED: Eight client owned dogs with SCCEDs. METHODS: Nine eyes from eight dogs with SCCEDs underwent superficial keratectomy (SK). The ulcerated area was divided into quadrants with a 300-micron restricted depth knife. Two of four quadrants underwent DBD for 40-60 s. A SK followed immediately. One burred section and one nonburred section were fixed with formaldehyde 10% and underwent light microscopy (LM). The remaining quadrants from five eyes were fixed with glutaraldehyde 2.5% and underwent transmission electron microscopy (TEM). Masked pathologists evaluated the samples. A student's paired t-test was used to analyze the data. RESULTS: With LM all nonburred samples had a superficial stromal hyaline acellular zone (HAZ), seven of the burred samples had an intermittent HAZ and in two burred samples this zone was absent. The HAZ thickness of burred samples (1.062 ± 0.664 µm) was significantly thinner than that of the nonburred samples (4.309 ± 1.348 µm) (P < 0.0001). Transmission electron microscopy showed an absence of basement membrane and the presence of an amorphous, fine fibrillar material in the superficial stroma in nonburred samples. This material was intermittent or absent in burred samples. CONCLUSION: DBD significantly reduces the superficial stromal HAZ in SCCEDs. A reduction of its thickness may be responsible for the healing rates reported with DBD.

Corneal keloid: four case reports of clinicopathological features and surgical outcome.

BACKGROUND: Surgical outcome of corneal keloid is largely variable depending on reports, although surgical management is inevitable in visually significant cases. We here report clinical features, histopathological findings, and surgical outcome of four cases of corneal keloid. CASE PRESENTATION: Four Korean male patients without a history of corneal trauma or disease were clinically and histologically evaluated for a slowly-growing, white opacity in the cornea. On slit lamp examination, corneal lesions appeared as a solitary, pearly white, well-circumscribed nodule with a smooth and glistening surface. Because the lesions involved the visual axis deteriorating the visual acuity, the nodules were surgically removed by superficial keratectomy in all patients. Amniotic membrane transplantation was combined in three patients, and an intraoperative mitomycin C application in two patients. Hematoxylin-eosin staining of the excised nodules revealed epithelial hyperplasia, Bowman's layer disruption, thick and irregularly-arranged collagen fibers in the stroma, and accumulation of prominent fibroblasts, which are consistent with the diagnosis of corneal keloid. The corneal keloids recurred in all patients within 10 months of surgical excision and outgrew the boundary of the excised area. CONCLUSION: A diagnosis of corneal keloid should be suspected in patients presenting with an enlarging, white, glistening corneal nodule, even in the absence of a history of corneal trauma or disease. The recurrence is common after surgical excision, and the lesion can be exacerbated by surgery.

Superficial Keratectomy Alone versus in Combination with Amniotic Membrane Transplantation in Aniridia-Associated Keratopathy and a Short-Term Clinical Outcome.

Background/Objectives: Aniridia-associated keratopathy (AAK) is a potentially vision-threatening pathology in congenital aniridia, for which both the underlying etiopathogenesis and effective treatment remain unclear. Methods:This prospective study was conducted to assess and compare the short-term outcome after superficial keratectomy (SK) alone or in a combination with an amniotic membrane transplantation (AMT). Here, 76 eyes were enrolled in 76 patients with grade 4 AAK. In all eyes, in order to assess preoperatively the efficiency of the limbal epithelial stem cells (LESC), the presence of corneal epithelial cells in confocal microscopy was established. The analyses included: best corrected visual acuity (BCVA), the stage of AAK and the number of corneal quadrants involved in corneal neovascularization (CNV). Results: Six months after surgery, the mean BCVA was 0.05 and ranged from 0.002 up to 0.1 in both groups. Improvement in BCVA occurred in 94.29% patients when *SK alone* was performed, and in 92.68% when in combination with AMT. There were no statistically significant differences in the effect of therapy depending on the type of surgery, regarding BCVA, stage of AAK and the number of quadrants with CNV. Conclusions: SK alone is an effective procedure in short outcomes limited to six months for advanced AAK in association with LESC partial efficiency.

Successful treatment of corneal hypertrophic scar in Hurler syndrome.

In Hurler syndrome, corneal opacification is a common finding but rarely manifests as hypertrophic scars. A 6-year-old boy with Hurler syndrome had a hypertrophic scar on his left eye, which was successfully treated with superficial keratectomy.

Anterior segment optical coherence tomography for superficial keratectomy.

PURPOSE: To report the use of anterior segment optical coherence tomography (AS-OCT) for superficial keratectomy (SK) in anterior corneal opacity. METHODS: The characteristics of 43 eyes (39 patients) with various lesions responsible for anterior corneal opacity were included in this retrospective non-comparative study. AS-OCT was performed on all eyes before surgery. The thickness of corneal opacity and the underlying healthy stroma were measured. SK was performed on each individual. RESULTS: Four types of anterior corneal opacity were evaluated, including corneal degeneration (26/43), Reis-Bücklers corneal dystrophy (8/43), alkali burn (1/43) and corneal tumors (8/43). Based on AS-OCT images, all eyes showed abnormal hyper-reflective signals in the superficial cornea to less than one-third of the normal corneal thickness in the deepest corneal opacity. All 43 eyes underwent an SK procedure. In addition, 1 eye with alkali burns and 7 eyes with corneal tumors were combined with amniotic membrane transplantation. All eyes restored transparency without significant complications. CONCLUSION: AS-OCT is a valuable method for objective preoperative and noninvasive assessments of anterior corneal opacities and is useful for guiding SK.

Systemic treatment and surgical intervention in inflammatory Terrien disease.

This case report presents a unique instance of a 55-year-old male patient exhibiting features of both Terrien marginal degeneration (TMD) and Fuchs' superficial marginal keratitis. Characterized by peripheral corneal thinning vascularization, and a pseudopterygium, the patient experienced recurrent photophobia, redness, and tearing over 15 years. This case challenges the traditional distinction between TMD and Fuchs' superficial marginal keratitis, suggesting a potential common underlying disorder. Mycophenolate mofetil provided a partial response, while pseudopterygium removal led to sustained remission, emphasizing its therapeutic significance. This case highlights the first documented use of mycophenolate in TMD and supports the notion of shared vasculitic origins between TMD and Fuchs' keratitis, raising intriguing questions about targeted therapeutic interventions.

Superficial Keratectomy: A Review of Literature.

Superficial keratectomy (SK) is the manual dissection of the superficial corneal layers (epithelium, Bowman's layer, and sometimes superficial stroma). SK is done using a surgical blade or diamond burr. Some surgeons use intraoperative mitomycin C 0.02% or amniotic membrane transplantation to improve surgical outcomes. This literature review shows that SK remains an effective method for different indications, including tissue diagnosis, excision of corneal degenerations, dystrophies, scarring, recurrent corneal erosions, and retained corneal foreign body.

Superficial keratectomy followed by intense pulsed light for Salzmann's nodular degeneration and coexisting meibomian gland dysfunction.

PURPOSE: To describe the clinical course of a case of bilateral Salzmann nodular degeneration (SND) treated with superficial keratectomy (SK) followed by intense pulsed light (IPL) for the treatment of coexisting meibomian gland dysfunction (MGD). CASE DESCRIPTION: A 54-year-old man who presented to us complaining of progressive blurred vision associated with foreign body sensation in both eyes because of SND and coexisting MGD. In view of symptoms and visual acuity (VA) deterioration, bilateral SK was performed. Two months after SK, IPL treatment to the face and meibomian gland expression (MGX) using the E-eye device (E-SWIN, Paris) on days 0, 15, and 45, were performed in both eyes with the aim to avoid recurrence and/or progression of MGD. One year after SK, the patient was asymptomatic and VA was 20/20 in both eyes; however because of worsening of non-invasive tear film break-up time measured on Sirius® Scheimpflug tomograph, IPL and MGX were promptly repeated and scheduled every 6 months. CONCLUSION: In our case, IPL was a safe and effective option to control MGD in a patient with SND requiring SK with no observed recurrence of SND 2 years after surgery.

Atypical Presentation of Salzmann Nodular Corneal Degeneration as a Subepithelial Corneal Dystrophy: A Case Report.

Salzmann nodular corneal degeneration (SNCD) is a rare, non-inflammatory, slowly progressive degenerative disease of the cornea. It is characterized by bluish-white nodules raised above the surface of the cornea. SNCD does not seem to consist of one clinical entity, which poses challenges to differentiate it from corneal dystrophies. A 20-year-old Chinese female with a history of eczema and dry eyes presented with a complaint of itchiness in both eyes, watery eyes, and gradual blurring of vision in the right eye for two years. Upon examination, right eye vision was counting fingers, whereas the left eye's best-corrected vision was 6/9. The anterior segment examination of the right eye showed generalized cornea haziness with superficial vascularization, while the left eye showed mild corneal haziness with no vascularization. Otherwise, both eyes had no signs of corneal infection, corneal scar, subepithelial nodular appearance, or allergic reactions, with no evidence of fluorescein staining. Anterior segment optical coherence tomography (AS-OCT) did not indicate subepithelial opacity. Subsequently, the patient underwent right eye superficial keratectomy under local anesthesia. Although clinically the patient was thought to have a form of subepithelial dystrophy, the histopathological report confirmed it to be SNCD. The best-corrected vision of the right eye improved to 6/12 post-keratectomy. We report an unusual presentation of Salzmann's corneal degeneration as subepithelial corneal haziness, which was treated successfully with superficial keratectomy.

Burr-Assisted Peripheral Superficial Keratectomy for the Treatment of Persistent Symptomatic Peripheral Corneal Edema.

PURPOSE: To describe a simple technique of diamond burr-assisted superficial keratectomy for the treatment of peripheral corneal edema. CASES PRESENTATION: Two patients with persistent symptomatic peripheral corneal edema underwent superficial keratectomy with the use of a diamond ophthalmic burr. The efficacy of the treatment was evaluated clinically as well as with anterior segment optical coherence tomography. During the postoperative follow-up period, no adverse events were observed and corneal edema reduced significantly. The patients were asymptomatic, no epithelial cysts could be identified clinically, and visual acuity remained unchanged. CONCLUSION: Peripheral superficial keratectomy could be an effective alternative for the treatment of peripheral, symptomatic corneal edema.

Effects of Superficial Keratectomy in Peripheral Hypertrophic Subepithelial Corneal Opacification on Front and Back Corneal Astigmatism.

PURPOSE: To evaluate changes of anterior and posterior corneal astigmatism after superficial keratectomy in peripheral hypertrophic subepithelial corneal opacification (PHSCO). METHODS: Patients with PHSCO, who had received superficial keratectomy with mitomycin C 0.02%, were included in this retrospective study. Scheimpflug imaging of the cornea (Pentacam®, Oculus, Wetzlar, Germany), best-corrected visual acuity (BCVA) and objective refraction were determined preoperatively and 3 months after superficial keratectomy. RESULTS: Fifteen eyes of 15 patients (age: 55 ± 16 years; range: 36-82 years) were included. The mean preoperative BCVA was logMAR 0.4 ± 0.2 and improved to logMAR 0.21 ± 0.3 (p < .01) postoperatively. The median preoperative astigmatism of the anterior corneal surface was 4.67 ± 2.4 D (range: 0.9-13.2 D) and decreased to 1.4 ± 0.4 D (range: 0.8-2.3 D) 3 months after surgery. The median astigmatism of the posterior corneal surface was 0.6 ± 0.5 D (range: 0.1-2.2 D) before surgery and decreased to 0.3 ± 0.2 D (range: 0-0.7 D) 3 months after surgery. CONCLUSION: Superficial keratectomy reduces anterior corneal astigmatism more than posterior corneal astigmatism in patients with PHSCO. Furthermore, a myopic shift and corneal steepening in the peripheral and mid-peripheral cornea was observed after removal of the subepithelial corneal opacification spots.

A rare case of corneal keloid occurred 30 years after pterygium surgery and 3 years after cataract surgery.

PURPOSE: We report a case of corneal keloid occurring 30 years after pterygium surgery and 3 years after cataract surgery. OBSERVATIONS: The case of a 72-year-old man was referred because of blurred vision and corneal opacity in the right eye. Pterygium surgery had been performed on the right eye 30 years earlier, and bilateral cataract surgery had been done uneventfully via a temporal corneal incision 3 years ago. Deterioration of vision occurred in the right eye from 2 years ago. At the initial visit, his best corrected visual acuity (BCVA) was 20/2000 on the right. A white nodule that was well demarcated from the underlying stroma was seen on the right cornea. The nodule was excised by superficial keratectomy, with BCVA being 180/200 at 1 week after surgery. Pathological examination of the resected specimen revealed proliferation of fibroblasts and haphazard arrangement of collagen bundles, leading to a diagnosis of corneal keloid. Keloid-like lesion was also later noted in temporal corneal incision site of cataract surgery. CONCLUSIONS AND IMPORTANCE: This rare case of corneal keloid occurred as a late complication of pterygium surgery.

Successful surgical management of post-penetrating or deep lamellar keratoplasty Acquired Corneal Sub-Epithelial Hypertrophy (ACSH): A case series.

INTRODUCTION: Acquired Corneal Sub-Epithelial Hypertrophy (ACSH) has been described in patients with peripheral superficial corneal opacities following penetrating keratoplasty and might present similar to Salzmann's nodular degeneration (SND) or peripheral hypertrophic sub-epithelial corneal degeneration (PHSCD). We describe the clinical presentation, topographic findings and the surgical outcome of three cases, which fit the appearance and characteristics of ACSH. PRESENTATION OF CASES: Three patients (3 eyes) with paracentral or peripheral corneal opacification were reviewed to describe their clinical examination (SL), morphology of the opacity (depth, diameter and density) and document their topographic changes before and after surgical intervention by peeling of the epithelium with or without superficial keratectomy under the microscope in addition to brief description of their histopathological examination. DISCUSSION: All 3 cases were secondary to corneal procedures [Penetrating keratoplasty (PKP) in 1 for pseudophakic bullous keratopathy and deep anterior lamellar keratoplasty (DLK) in 2 for advanced keratoconus]. All cases presented with reduced vision, astigmatic changes in topography or manifest refraction. The visual acuity, symptoms, and topographical findings all improved after treatment. Histopathologically, all cases fit the newly described entity of ACSH. CONCLUSION: Careful clinical judgement guided by corneal topography are needed for proper the diagnosis of acquired corneal opacification that results in reduction of vision to identify ACSH from other similar conditions (PHSCD and SND). Peeling of the thickened epithelial and sub-epithelial tissue is curative avoiding the need for corneal re-grafting.

Management of advanced ocular surface disease in patients with severe atopic keratoconjunctivitis.

AIM & OBJECTIVE: Severe ocular surface disease, including limbal stem cell deficiency (LSCD) can occur as a consequence of severe atopic keratoconjunctivitis (AKC) that has been inadequately treated. Our goal was to describe the management and outcomes of severe ocular surface disease in AKC patients. METHODS: We performed a retrospective analysis of a case series of 13 eyes of 8 patients with advanced ocular surface disease associated with severe AKC. The clinical presentation, medical and surgical management, and visual and anatomic outcomes were analyzed. RESULTS: Five eyes were treated with medical interventions alone, which included topical or systemic immunomodulatory therapy (IMT) for all eyes. These eyes had a decline in mean visual acuity from LogMAR 0.96 to 2.04 between the initial and final visits related to recurrent epithelial defects or corneal ulceration. Eight eyes were treated with surgical approaches in addition to medical treatment. Initial surgical treatments included limbal stem cell transplantation (n = 5), Boston keratoprosthesis (n = 2), and superficial keratectomy (n = 1). Both eyes that underwent primary keratoprosthesis had severe post-operative complications and became no light perception. In the remainder of the surgically treated eyes, there was an improvement visual acuity from LogMAR 1.43 to 0.6 between the pre-operative and final post-operative visit. CONCLUSION: Visual rehabilitation in eyes severe ocular surface disease due to prolonged AKC is challenging. While some patients did experience improved vision, most eyes did not improve or experienced severe complications with vision loss. Early intervention with immunomodulatory therapy may prevent progression of the disease to advanced stages.