Background: To analyze visual and refractive modifications and corneal topography changes in a patient treated for bilateral advanced Salzmann's nodular degeneration (SND).
Methods: A forty-three-year-old man with bilateral advanced SND underwent manual, alcohol-assisted removal of the altered layer. Visual acuity, refraction, corneal topography and corneal aberrations were examined before and after the treatment after 7 days and 1, 6 and 12 months.
Results: The uncorrected visual acuity changed from 0.1 to 1.0 in both eyes. Refraction changed from sphere +3.00 and cylinder +4.50 x 180 degrees in the right eye and sphere +6 and cylinder +4.0 x 170 degrees in the left eye to bilateral emetropia. Corneal topography recovered from an extremely flat profile to a normal shape and it was unvaried during the follow-up period. Main topographic indices, highly altered before the treatment, normalized and were normal at control examinations. The quality of vision improved significantly with reduction of high-order aberrations from RMS of 5,07 microm to 0,66 microm in the right eye and RMS of 4,89 microm to 0,57 microm in the left eye respectively.
Conclusions: Salzmann nodules produce an impressive central corneal flattening with high hyperopic refractive error and significant increment of corneal aberrations. After manual removal of the altered layer, the visual and refractive recovery, corneal topography and aberrometry normalization were immediate and stable during the observational period.