Knutsson KA, et al. - In this single-institution study, researchers reported the results of a two-step surgical strategy consisting in conducting a large diameter tectonic lamellar keratoplasty (TLK) to restore appropriate corneal thickness and an avascular recipient bed, followed by central optical PK within the lamellar graft at a later date. Participants in the study were 7 patients (7 eyes) who received PK after large diameter TLK. TLK was conducted in all cases with 10/10.1-mm diameters. Treatment of deep corneal opacity associated with extensive vascularization and peripheral thinning with optical PK under a previous TLK is a safe and effective technique. An extended follow-up period is required to assess endothelial cell loss and the procedure's long-term efficacy.