OBJECTIVE To evaluate the safety and efficacy of microkeratome-assisted lamellar keratoplasty (MLK) for the treatment of recurrent granular corneal dystrophy (GCD) after phototherapeutic keratectomy (PTK). METHODS We performed a prospective study of nine eyes (seven patients) with recurrent granular dystrophy after PTK. A microkeratome was used to cut partial-thickness sections through the anterior surface of the donor and host corneas. The donor disc was placed on the recipient bed with four or eight interrupted sutures. The stitches were removed between 4 and 6 weeks after surgery. Visual acuity (VA), corneal clarity, corneal thickness, and corneal topography were assessed before and at different time points after surgery. RESULTS During a mean follow-up period of (18.9 +/- 4.1) months, all grafts were transparent without visible opacity at the interface, and no serious complications occurred. The VA was improved in all cases. seven eyes had best corrected visual acuity with spectacles of 20/40 or better, two eyes reached 20/25. At the last follow-up visit more than 12 months postoperatively, the mean corneal refractive power increased significantly by (2.34 +/- 0.93) D (P < 0.01), and the corneal astigmatism significantly decreased by (0.91 +/- 0.98) D (P < 0.05). The mean corneal thickness was (477.4 +/- 26.9) microm preoperatively and (507.8 +/- 23.4) microm at the last follow-up visit (P < 0.01). CONCLUSIONS Our findings suggest that MLK for the treatment of recurrent GCD is a safe and easy-to-perform method for restoring VA.