Keratorefractive Surgery in Presbyopic 40-Year-Old Female—PresbyLASIK With Incomplete Disc
Narrative Responses:
Purpose
To report a case of refractive surgery for myopia and presbyopia in a 40 year-old female with surgery complications
Methods
40 years old female patient, healthy, looking for refractive surgery. Never used contact lenses. The preoperative uncorrected visual acuity was counting fingers and J5 in both eyes. With correction had visual acuity of 20/20 in the right eye (RE) and 20/25 in the left eye (LE). The dynamic refractive presented -3.00E()-1.25Cx170º RE /-5.25E()-0.50Cx30º C LE and J1. The ultrasonic pachymetry showed central thickness of 551μm RE and 546μm LE. Keratometry indicated 2.4 / 43.5 D OD and 42.4 / 43.7 in OE. Tonometry shows in both eyes 12mmHg . We propose LASIK surgery on both eyes with planned monovision.
Results
During the procedure there was a complication and the disc was incomplete in the right eye. We aborted this eye and perform Lasik with the total correction in the left eye. The first postoperative shows uncorrected visual acuity 20/100 and 20/25 with biomicroscopy revealing the flap unchanged in both eyes with mild punctate keratitis. Returned after 48 days with complaining headache while attending classes on university. Binocular visual acuity was 20/25 and J1, presenting uncorrected vision of 20/100 RE and 20/25 LE. The dynamic refraction presented -2.25E()-0.75Cx 165º(20/20) RE and -0.50E()-0.50Cx170º(20/25+2) LE. Was prescribed glasses and lubricant eye drops.
Conclusion
Even within intraoperative complication the patient had good visual acuity for near and distance using presbiLasik. Wasn’t required reintervention because there was monovision adaptation in the eye appeared dominant. The visual neuroadaptation of refractive surgery in presbyopia is a controversial issue and should be individualized for each patient