Laser in Situ Keratomileusis Flap Complication Treated by Flap Amputation, Phototherapeutic Keratectomy, and Toric IOL Implantation

Saturday, April 18, 2015: 2:05 PM
Room 5A (San Diego Convention Center)
Jonathan M. Davidorf, MD

To evaluate the feasibility of utilizing intraoperative aberrometry and toric intraocular lens implantation during cataract surgery in an eye with a history of multiple keratorefractive procedures, including LASIK flap amputation.

A 64 year old female presented with poor vision quality and eye pain (left).  She had hyperopic LASIK eight years prior with an enhancement reportedly complicated by a central epithelial defect.  A second enhancement (PRK) resulted in a subepithelial scar.  She was fit with a rigid gas permeable contact lens.  On presentation, corrected distance vision was 20/20 (+1.25+0.50x180) with poor vision quality.  A corneal nodule (10% depth) was noted.  PTK was performed, but the nodule persisted.  Ultimately, flap amputation was performed, the quality of vision improved, and the nodule never recurred.  5 years later, a significant cataract developed.  Utilizing intraoperative aberrometry, cataract surgery was done and a toric IOL implanted.

One month after cataract surgery the patient had 20/20 vision without spectacles in the left eye. (refraction +0.25 sphere).

Intraoperative aberrometry and toric IOL implantation may have a role in certain eyes with difficult LASIK flap complications.