Purpose: A 63-year-old female with Fuchs' endothelial corneal dystrophy, stromal edema and subepithelial scarring was inappropriately treated with phototherapeutic keratectomy, leading to a central focal circular corneal scar and decreased visual acuity that required penetrating keratoplasty.
Method: The host corneal button was bisected and fixed in 10% formaldehyde and in glutaraldehyde immediately after its removal.
Results: Light microscopy demonstrated a central area of absent Bowman's layer with a thin layer of subepithelial fibrosis, stromal corneal edema, and thickened Descemet's membrane.
Conclusion: Correct estimation of differential ablation rates of tissue and shallow, repeated ablations followed by slit-lamp microscopy and/or videokeratography help prevent over-treatment.
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