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