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Purpose To describe the clinical features, clinical course, and response to therapy of an atypical peripheral corneal opacification. Methods Retrospective case series review. Results Six patients are described with similar findings of bilateral, fairly symmetric, peripheral, hypertrophic, subepithelial corneal opacification. All patients were female and had no concurrent systemic conditions. All six patients complained of ocular irritation. Three patients complained of blurred vision, and one patient had monocular diplopia. In three patients followed up for more than 30 months, the corneal opacification remained stable in one patient and enlarged in the other two patients. The other three patients were examined once or twice, so the evaluation of disease progression was precluded. Two patients were treated surgically with superficial keratectomy followed by 2-minute intraoperative application of 0.02% mitomycin-C. Pathologic examination of bilateral keratectomy specimens from one patient showed subepithelial fibrosis without inflammation. Conclusions The clinical findings are reminiscent but atypical of Salzmann nodular degeneration.

Objective To demonstrate the possible beneficial effects of methotrexate (MTX) therapy for patients with sarcoid-associated optic neuropathy (SAON). Design Retrospective, noncomparative, interventional case series. Participants Three patients diagnosed with SAON who received MTX. Two patients had tissue biopsies consistent with sarcoidosis, and 1 patient had clinically diagnosed sarcoidosis based on laboratory and radiographic studies. All 3 patients developed side effects with corticosteroid treatment of their optic neuropathy. Intervention Patients were treated with weekly doses of oral MTX and monitored with neuro-ophthalmic, medical, and laboratory examinations. Main outcome measures Visual acuity, automated perimetry, and reduction of oral prednisone therapy. Results After initiation of MTX, all 3 patients showed an improvement or stabilization of visual acuity. All patients had a decrease in their corticosteroid requirements, and all had improved or stabilized visual field deficits. One of the 3 patients developed leukopenia that necessitated a reduction of the methotrexate dose. Conclusion Methotrexate may be effective for SAON as an adjunct to corticosteroid therapy or as an alternative for corticosteroid-intolerant patients. Oral MTX reduced the corticosteroid requirements of 3 patients with SAON, and all 3 demonstrated stable or improved visual function.