Spontaneous epithelial hyperplasia presenting with myopic shift

Introduction: Epithelial hyperplasia has been documented to cause postoperative myopic shift in patients with a history of refractive surgery but has not been reported in patients without history of corneal disease or surgery. Patient and Clinical Findings: A 33-year-old man with previously stable myopia (−6.75 +0.25 × 010 in the right eye) presented with blurred vision in the right eye. He refracted to −10.50 +2.25 × 31 in the right eye with corrected distance visual acuity (CDVA) 20/50. Initially, the only finding after complete clinical examination that provided a potential explanation for the significant myopic shift was increased central steepening without signs of ectasia on corneal tomography. Diagnosis, Intervention, and Outcomes: Follow-up slitlamp examination showed a 0.1 × 0.3 mm nest of epithelial cells with the corresponding paracentral steepening on corneal tomography. Corneal optical coherence tomography was performed, which showed the central epithelial hyperplasia responsible for the myopic shift. Superficial keratectomy was performed and resulted in complete resolution of myopic shift and restoration of 20/20 CDVA with a residual refraction of −7.00 +0.75 × 006. Conclusions: The corneal epithelium has a unique, regenerative nature, and there is emerging use of epithelial mapping for detection of corneal abnormalities causing spontaneous refractive shifts in healthy eyes.